Disease Specific FAQs

1. What is a stroke?
2. Why screen for carotid artery disease?
3. What are the warning signs of stroke?
4. Will carotid artery disease screening exams prevent all strokes?
5. Who supports carotid artery disease screening?
6. What is an abdominal aortic aneurysm (AAA)?
7. Why screen for abdominal aortic aneurysm disease?
8. Who supports abdominal aortic aneurysm screening?
9. Why do more men have AAA than women?
10. What is peripheral arterial disease (PAD)?
11. Why screen for peripheral arterial disease?
12. Who supports peripheral arterial disease screening?
13. What does a Non-Diagnostic ABI mean?

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1. What is a stroke?

   Stroke is a sudden loss of muscle function, vision, and/or speech, caused by obstruction of blood flow to the brain.
   Please visit our Stroke page for more information.

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2. Why screen for carotid artery disease?

   Stroke is the No. 3 cause of death in the U.S., behind heart disease and cancer(1). Stroke affects about 795,000 people annually in the United States⁽¹⁾ Approximately 600,000 of these are first attacks, meaning about 75% of strokes occur without any symptoms or warning signs⁽¹⁾. Stroke is the leading cause of disability among adults in the U.S. with an estimated direct & indirect cost is $73.7 billion for 2010⁽²⁾.

   A basic tenet of our healthcare system is a requirement that medical necessity be established prior to receiving care. In other words, you must have a stroke or stroke-like symptoms before you can be tested for possible causes of stroke. The presence of carotid artery blockage, also known as stenosis, is the leading cause of strokes⁽³⁾. Futura Health Screening is able to detect the presence of carotid artery stenosis with ultrasound scanning which is painless, affordable and quick.

   Futura Health Screening, along with other organizations such as the American Stroke Association and the National Stroke Association, believes that most strokes can be prevented. The most effective way of preventing stroke is to identify individuals at risk before they ever have symptoms, which at worst, can be a devastating stroke. Our mission is to identify individuals at increase risk of stroke who might otherwise be left unaccounted for by the conventional health care system.

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3. What are the warning signs of stroke?

   • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.
   • Sudden confusion, trouble speaking or understanding.
   • Sudden trouble seeing in one or both eyes.
   • Sudden trouble walking, dizziness, loss of balance or coordination.
   • Sudden, severe headache with no known cause.

   Another way to recognize the signs and symptoms of stroke is to “Act F.A.S.T”.

   • Face
     • Ask the person to smile. Does the face look uneven?
   • Arms
     • Ask the person to raise both arms. Does one arm drift downward?
   • Speech
     • Ask the person to repeat a simple sentence. Does their speech sound strange? Can he/she repeat the sentence correctly?
   • Time
     • If you observe any of these signs, then it’s time to call 9-1-1 or get to the hospital FAST.

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4. Will carotid artery disease screening exams prevent all strokes?

   No, but early detection of carotid disease will greatly reduce your risk of stroke. Screening the carotid arteries will identify the major risk factor for ischemic stroke (blockage of a blood vessel supplying the brain), which is the presence of carotid artery disease. It should also be recognized that a “normal” screening procedure does not mean you will never have a stroke, as there are other causes of stroke that are not related to carotid disease such as cerebral hemorrhage or heart disease. If carotid artery disease is present, your doctor can suggest treatments to remove or reduce your carotid disease either surgically or medically. Regardless of the finding of the screening procedure, should you at anytime experience symptoms or warning signs of stroke, you should seek medical attention immediately. Take action to reduce your stroke risk by stopping smoking and by controlling your blood pressure, blood cholesterol, and weight. If you are found to be at risk for stroke, control your risk factors, know the stroke warning signs, and see your doctor!

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5. Who supports carotid artery disease screening?

   The Society for Vascular Surgery recommends screening for carotid artery disease by ultrasonography for individuals age 55 years or older with cardiovascular risk factors, such as a history of hypertension, diabetes mellitus, smoking, hypercholesterolemia (high cholesterol), or known cardiovascular disease⁽⁹⁾.

   The American Society of Neuroimaging recommends against screening in unselected populations, but advises that screening of adults age 65 years or older with 3 or more cardiovascular risk factors should be considered⁽¹⁰⁾.

   The U.S. Preventive Services Task Force (USPSTF) has concluded that evidence was insufficient to recommend for or against screening of asymptomatic persons for carotid artery stenosis by using carotid ultrasonography⁽¹⁰⁾. The rationale for this decision was that carotid artery duplex ultrasonography has moderate sensitivity and specificity and yields many false-positive results (e.g. showing the presence of disease when there is no disease). The USPSTF state that false-positive results may harm the participant due to unnecessary further testing. Futura Health Screening, however, is reliable and of high quality with high sensitivity and specificity, yielding few, if any, false positive results. This is due to the fact that all sonographers are highly trained (all are Registered Vascular Technologists); state-of-the-art equipment is being used in the screening studies; appropriate protocols and reporting are implemented; there are ongoing quality assurance accuracy studies; and the appropriate selection of high risk participants are being screened.

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6. What is an abdominal aortic aneurysm (AAA)?

   The aorta is the largest artery in your body which passes from the heart to the rest of the body. The portion located in the abdomen can enlarge or balloon to an abnormal size due to arterial wall weakness, forming an what is called an "abdominal aortic aneurysm".
   Please visit our AAA page for more information.

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7. Why screen for abdominal aortic aneurysm disease?

   An abdominal aortic aneurysm (AAA) is an abnormal enlargement in a weakened area within the largest artery in the abdomen. If the AAA remains undetected, the aortic wall continues to weaken and the aneurysm continues to grow. Eventually, it can grow to the point where there is danger of rupture, which is usually fatal. There are nearly 200,000 people in the United States who are diagnosed with AAA annually. Of those 200,000, nearly 15,000 may have AAA threatening enough to cause death from rupture if not treated⁽⁴⁾. Although AAAs may not show symptoms for years, as many as 1 in 3 eventually rupture if left untreated⁽⁵⁾.

   Abdominal aortic aneurysms (AAA) are the 10th leading cause of death in men over the age of 50 in the United States⁽⁶⁾. More than 15,000 people die each year in the U.S. from aortic aneurysm rupture with 9,000 deaths being attributed to abdominal aortic anerysmsm⁽⁵⁾. A ruptured abdominal aortic aneurysm (AAA) can cause severe internal bleeding, which can lead to shock or death.

   Futura Health Screening uses ultrasound scanning which is a painless, noninvasive examination that accurately diagnoses the presence of AAA. Many deaths related to AAA rupture can be prevented by early identifying those individuals without any symptoms who are at risk for AAA.

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8. Who supports abdominal aortic aneurysm screening?

   The U.S. Preventive Services Task Force (USPSTF) recommends one-time screening for AAA by ultrasonography in men aged 65-75 who have ever smoked⁽¹¹⁾.

   The Society for Vascular Surgery (SVS) recommends a one-time AAA screening for all men 65 years of age or older. However, if there is a family history of AAA, SVS recommends AAA screening as early as 55 years. AAA screening for women is recommended at age 65 years or older only if there is a if there is a family history of AAA or if they have ever smoked⁽¹⁴⁾.

   Medicare covers this one-time screening ultrasound if you get a referral for it as a result of your "Welcome to Medicare" physical exam. You must receive the physical exam and the screening ultrasound referral (not the ultrasound exam itself) within the first twelve months you have Medicare Part B. People who meet the following criteria are eligible:

   • He or she must get a referral for the AAA ultrasound screening from a physician or other qualified non-physician practitioner as a result of the “Welcome to Medicare” physical exam.
   • He or she has never had an AAA ultrasound screening paid for by Medicare.
   • The person with Medicare has at least one of the following risk factors:
     • a family history of abdominal aortic aneurysm
     • is a man age 65 to 75 who has smoked at least 100 cigarettes in his lifetime.

   If you are an AAA Medicare beneficiary, please contact Pacific Vascular at (425) 486-8868 to schedule a complete AAA diagnostic evaluation.

   See Medicare Website for information about AAA coverage from Medicare.

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9. Why do more men have AAA than women?

   Men have a higher genetic predisposition for AAA than in women. Males are 5-10 times more likely to than females to develop AAA. Also, women have a relative hormonal protection against atherosclerosis, the major cause of AAA. However, some studies show that the risk of rupture and the likeihood of a poor outcome are greater in women than in men.

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10. What is peripheral arterial disease (PAD)?

    PAD is a build-up of fatty substances or cholesterol in the peripheral arteries that can decrease the flow of blood to arms and/or legs; resulting in persistent pain, inability to heal wounds or tissue death (gangrene).
    Please visit our PAD page for more information.

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11. Why screen for peripheral arterial disease?

    Peripheral arteries are the blood vessels that provide oxygenated blood to the upper and lower extremities (e.g., the arms and legs). Peripheral arterial disease (PAD) results in damage and dysfunction of the arteries that can result in reduced blood flow. The most common cause of PAD is atherosclerosis, where cholesterol and fatty substances build up in the walls of the arteries forming what is referred to as "plaque". Eventually, plaque can result in loss of flexibility and narrowing of the artery, reducing or completely obstructing the flow of blood.

    PAD affects about 8 million American men and women. The prevalence of PAD increases dramatically with age and disproportionatly affects blacks⁽¹⁾. One in every 20 Americans over the age of 50 has PAD⁽⁷⁾ and one in 3 people age 70 or older has PAD⁽⁸⁾. PAD affects 12-20% of Americans age 65 or older⁽¹⁾. Smoking or having diabetes increases one’s chances of developing the disease sooner.

    There may be no symptoms in the very early stages of PAD, however, if left untreated, the disease may advance to a point where it can become lifestyle limiting and limb threatening (e.g., amputation). About 40% of persons do not complain of leg pain or other symptoms of PAD⁽¹⁾. The ABI test is a painless screening exam that can detect PAD in its early stages, where treatment and lifestyle modification can prevent the advancement of the disease.

    PAD in the legs is a sign for atherosclerotic disease (plaque buildup) throughout the body which when involving the coronary arteries can lead to a heart attack or when involving the arteries supplying the brain, can lead to stroke. Individuals with PAD suffer a five-fold increased relative risk of a stroke and the total death rate is two-three times greater than those without PAD⁽⁹⁾. The risk factors for PAD are similar to those for coronary heart disease and stroke, although diabetes and cigarette smoking are particularly strong risk factors for PAD. If you have PAD in your legs, you are at greater risk of heart attack, stroke, and death.

    PAD screening evaluates your risk for PAD through a risk factor assessment and measurement of resting ankle/brachial indices (ABI's). A resting ABI test is painless and is used to detect the presence of PAD that is producing a measurable change in the blood flow to the lower extremities at rest. The test involves placement of blood pressure cuffs over both upper arms and around both ankles. Part of measuring the arm and ankle blood pressures involves the use of an ultrasound probe or transducer that allows the technologist to "listen" to blood flow (as opposed to using a stethoscope). Once measured, the pressures are compared by dividing the ankle pressure by the arm pressure. Normally the ankle pressure is equal to or greater than the arm pressure (an ABI of 0.90 is considered normal). However, in the presence of significant PAD, the ankle pressure is lower than the arm pressure resulting in an ABI of 0.90 or less, in which case further diagnostic testing should be considered.

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12. Who supports peripheral arterial disease screening?

    The Society for Vascular Surgery recommends the ankle/brachial (ABI) exam to identify PAD and risk of heart disease in individuals 55 years of age or older with cardiovascular risk factors, such as a history of hypertension, diabetes mellitus, smoking, hypercholesterolemia (high cholesterol), or known cardiovascular disease⁽⁹⁾.

    The Society of Interventional Radiology recommends greater cardiovascular screening efforts by the medical community through the use of the ankle brachial index (ABI) test. Individuals over 50 with any cardiovascular risk factors should be tested⁽¹²⁾.

    The American Diabetes Association recommends performing an ABI in all individuals with people with diabetes who are over 50 should get screened for PAD once every five years. Those under 50 should be have and ABI exam if they have PAD symptoms or additional risk factors including smoking, overweight, lack of exercise, high blood pressure, blood lipid imbalances (such as high LDL cholesterol and triglycerides), cardiovascular disease, and family history of heart attacks or strokes⁽¹³⁾.

    The American Heart Association & the American College of Cardiology recommends resting ABI exams for the diagnosis of PAD all individuals age 65 and older along with all individuals age 50 years and older with a history of smoking or diabetes.

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13. What does a Non-Diagnostic ABI mean?

    A non-diagnostic ankle brachial index (ABI) can occur when the arteries where the blood pressure cuffs were placed in your calf are stiff, causing incompressible arteries or falsely elevated pressures. This is possibly due to calcium in the walls of the arteries or possibly due to tight tissues and swelling. These findings of incompressible tibial arteries are very typical in patients with diabetes, patients on chronic kidney dialysis, and patients with significant swelling and firm tissues in their calf areas. It is also very common for individuals over the age of 80 to have stiffening of their arteries that make it difficult to interpret blood pressure at the ankle.

    Along with performing an ABI test for PAD screening, Futura can also see the blood flow characteristics, or waveforms, at the ankles. If the waveforms are normal, this indicates that there is no significant arterial narrowing to your arteries from your heart to your ankles at rest. If the waveforms are abnormal, this indicates that there is significant arterial narrowing to your arteries from your heart to your ankles at rest.

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References

¹ “Heart Disease & Stroke Statistics – 2010 Update.” American Heart Association. American Heart Association, 2010. Web. 21 Jul 2010.

² “Stroke 101 Fact Sheet.” National Stroke Association. National Stroke Association, 2010. Web. 21Jul 2010.

³ “Brain Basics: Preventing Strokes.” National Institute of Neurological Disorders and Stroke. National Institute of Neurological Disorders and Stroke, 07/29/2009. Web. 21Jul 2010.

⁴ “Abdominal Aortic Aneurysm.” Society for Vascular Surgery. Society for Vascular Surgery, 01/19/2010. Web. 21 Jul 2010.

⁵ “Screening for Abdominal Aortic Aneurysm: A Best-Evidence Systematic Review.” Agency for Healthcare Research and Quality. U.S. Department of Health & Human Services. Agency for Healthcare Research and Quality. U.S. Department of Health & Human Services, 2005. Web. 21 Jul 2010.

⁶ “Abdominal Aortic Aneurysm Screening.” Centers for Medicare & Medicaid Services. Department of Health & Human Services. Centers for Medicare & Medicaid Services. Department of Health & Human Services, 05/04/2010. Web. 21Jul 2010.

⁷ “Peripheral Arterial Disease (P.A.D.), Facts About, NHLBI.” National Heart Lung and Blood Institute. National Institutes of Health. National Heart Lung and Blood Institute. National Institutes of Health, 08/2006. Web. 21 Jul 2010.

⁸ “Peripheral Artery Disease (PAD).” Society for Vascular Surgery. Society for Vascular Surgery, 01/26/2010. Web. 21 Jul 2010.

⁹ “SVS Position on Vascular Screening.” Society for Vascular Surgery. Society for Vascular Surgery, 01/2010. Web. 21 Jul 2010.

¹⁰ “Screening for Carotid Artery Stenosis: U.S. Preventive Services Task Force Recommendation Statement.” Agency for Healthcare Research and Quality. U.S. Department of Health & Human Service. Agency for Healthcare Research and Quality. U.S. Department of Health & Human Services, 12/2007. Web. 21 Jul 2010.

¹¹ “Screening for Abdominal Aortic Aneurysm: Recommendation Statement.” Agency for Healthcare Research and Quality. U.S. Department of Health & Human Services. Agency for Healthcare Research and Quality. U.S. Department of Health & Human Services, 02/2005. Web. 21 Jul 2010.

¹² “Peripheral Arterial Disease Overview and Treatments – SIR.” Society of Interventional Radiology. Society of Interventional Radiology, 2010. Web. 21 Jul 2010.

¹³ “Peripheral Arterial Disease in People With Diabetes – Clinic Diabetes.” American Diabetes Association. American Diabetes Association, 10/2004. Web. 21 Jul 2010.

¹⁴ “SVS Position on Vascular Screening.” Society for Vascular Surgery. Society for Vascular Surgery, 01/2010. Web. 14 Jul 2010.