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Vascular

A branch of medicine that deals primarily in medical treatment of vascular diseases. Vascular disease includes any condition that affects the circulatory system in the body. The two major vessels that define the circulatory system are arteries and veins. Common conditions patients may suffer from, but not limited to, are peripheral arterial disease (PAD), abdominal aortic aneurysms, carotid artery disease, varicose veins and chronic venous insufficiency (CVI).

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Peripheral Arterial Disease (PAD)

Peripheral Arterial Disease (PAD) affects the circulation of blood to your legs. A buildup of fatty, waxy plaque deposits called atherosclerosis, narrows or blocks the major arteries. Often patients will suffer from cramping or aching in their buttocks, thighs, or calves after a short walk. When PAD progresses, patients will notice non-healing ulcers around their ankles or development of gangrene. Many of these patients are then at risk of losing their limbs.

The patients usually at risk for the development of PAD are: Diabetic, Smokers, Hypertensive and High Cholesterol

All the symptoms are related to a lack of blood flow in the affected areas.

  • Intermittent Claudication- this is pain or discomfort in the affected muscles that gets worse when exercising or even walking, and is relieved by rest, due to lack of blood flow. When exercising your muscles need extra oxygen to function. When the arteries are blocked the muscles don’t get the needed oxygen. This causes difficulty walking or climbing stairs, and cramping in the affected legs, buttocks, thighs, calves, and feet.
  • Weak or absent pulses in the ankles, legs or feet
  • Sores on the toes, feet or legs that heal slowly or not at all
  • Cooler skin temperature on the affected areas
  • Poor nail growth on toes and lost hair on legs
  • Erectile dysfunction

Abdominal Aortic Aneurysms

The largest artery in your body is the aorta. It runs from the heart down through your chest and into your abdominal region. This region is responsible for delivering blood to your legs, GI tract, and kidneys. When the walls of the aorta progressively weaken and begin to expand, an aneurysm occurs. If left untreated, it will rupture, create internal bleeding and possibly death. The majority of patients are asymptomatic and in some case, they will feel unexplained pain in their abdomen or back.

Patients that are prone to suffer from Abdominal Aortic Aneurysm (AAAs) are males with a history of aneurysms in the family, patients diagnosed with Peripheral Arterial Disease, Smokers, the Elderly, those with chronic lung disease and, Hypertensive Individuals.

Venous ulcers and arterial ulcers have different characteristics and risk factors.

  1. Venous ulcers
  • Superficial
  • Irregular in shape
  • Painful due to edema, phlebitis or infection
  • Usually appear on the lower leg and ankle, and
  • Often contact dermatitis develops
  1. Arterial Ulcers
  • Thick, bright red granulation tissue
  • With a punched out appearance and smooth edges
  • Painful at night
  • Found most often on the lateral foot, but
  • Can be found anywhere on the lower leg and foot
  • Lower legs feel cool to the touch
  • Skin is shiny, taut and thin
  • Loss of hair growth on lower limbs
  • May be due to peripheral arterial disease
  • Often results after a trivial trauma

Carotid artery disease

There are four arteries that supply blood flow to the brain: two vertebral arteries passing along the back of the neck, and two carotid arteries passing in front of the neck. Narrowing of the carotid arteries in front of the neck is the most common condition for these vessels. The narrowing is due to a fatty, waxy plaque buildup. This buildup occurs over time, putting a patient at risk for a stroke.

Most often patients with carotid artery disease are asymptomatic and are identified by their personal physician as having a “whooshing” sound in the neck, also known as bruit (pronounced “brewee”). A minority of patients do experience sudden symptoms of transient ischemic attacks (mini-strokes) that are due to temporary reduction of blood circulation to one part of the brain. If the symptoms last longer than 24 hours, the patient is then considered to have had a stroke. Stroke means that a portion of the brain has ceased to function because of a severe reduction in blood flow.

Carotid artery disease can present with many symptoms, most commonly a stroke or transient ischemic attack (TIA), or the symptoms associated with stroke/TIA. These symptoms include, but are not limited to:

  • Weakness or loss of feeling in on side of the body
  • Visual disturbance
  • Dizziness
  • Speech impairment
  • Previous stroke or TIA

Varicose Veins

Veins return blood back to the heart. In order to prevent blood from flowing backward, there are several small leaflet valves located in veins. When these leaflet valves stop working properly or become damaged; blood begins to pool in the veins and enlarged, twisted cords, raise above the skin. These twisted cords are called varicose veins, and often they appear to be blue, red or flesh color. More often than not, they are a cosmetic problem, where life-threatening complications are uncommon.

Chronic Venous Insufficiency (CVI)

Chronic Venous Insufficiency (CVI) is a condition that occurs over time. Individuals that are susceptible to CVI usually have occupations that sit or stand for long periods of time. These two actions cause blood to pool, which in return weakens the vein walls and damages vein valves. Patients may experience swelling, tired, restless, legs; or CVI may occur because varicose veins have gone left untreated. CVI is usually not considered a serious health risk, and once you consult your physician they will be able to determine the best treatment option.

Patients may experience:

  • Swelling
  • Tired
  • Restless legs

Peripheral Arterial Disease (PAD)

  • Increasing physical activity
  • Quitting smoking
  • Lowering blood pressure
  • Lowering high cholesterol
  • Lowering blood sugar levels

Abdominal Aortic Aneurysms

Venous ulcers and arterial ulcers have different characteristics and risk factors:

Venous ulcers

The first goal is to identify the cause and address it. To treat the ulcer, conservative compression therapy is the standard of care. Venous ulcers heal faster. Leg elevation of the affected limb minimize edema, improves circulation and aids healing. Debridement or removal of dead, damaged and infected skin enhances healing. Venous leg ulcers often become infected and will be treated with antibiotics.

Arterial Ulcers

For all patients with PAD, reducing cardiovascular morbidity and mortality are a primary concern. The objective is to increase blood flow to the legs, and restore function. There are several time tested treatments that are most effective to promote healing. Recommendations to improve blood flow also include controlling diabetes, stopping smoking, controlling hypertension and hyperlipidemia. Most patients with claudication can remain stable with medical therapy.

Treatment must be individualized. Surgical revascularization is indicated in patients with acceptable surgical risk, including consideration of the patient’s comorbidities. Antiplatelet therapy with stenting improves outcomes. Indications for lower extremity revascularization are acute limb ischemia, critical limb ischemia (indicated by rest pain, non-healing leg ulcers, and claudication).

Carotid artery disease

An ultrasound screening of the carotid arteries is often performed to determine the presence of disease. If carotid artery disease is found, ultrasound is also used to monitor the disease development over time, to help determine when or if treatment should be performed. Ultrasound is used after surgery to determine the success of the procedure or possible reoccurrence of disease.

Chronic Venous Insufficiency (CVI)

CVI is usually not considered a serious health risk, and once you consult your physician they will be able to determine the best treatment option.

A vascular surgeon treats many conditions that affect the blood vessels in every part of your body except for your heart and brain. This can include:

  • Aneurysm, a bulge or weak spot in an artery
  • Atherosclerosis, or hardening of the arteries, where plaque builds up on your artery walls
  • Carotid artery disease or peripheral artery disease (PAD), where the arteries that bring blood to your neck or limbs become narrow or blocked
  • Compression disorders like nutcracker syndrome and thoracic outlet syndrome
  • Dialysis access, or the placement of a graft or fistula that allows you to receive dialysis treatment for kidney disease
  • Deep vein thrombosis (DVT), a blood clot in a vein deep below your skin
  • Spider veins, or small webs of veins just below the surface of the skin
  • Trauma to arteries and veins caused by accidents or injuries
  • Varicose veins, or large, swollen, twisted veins that can cause pain or aching in your legs
  • Venous ulcers and arterial and diabetic (neuropathic) wounds, which are nonhealing wounds that result from poor blood flow, especially in the legs

Healthcare Providers

Symptoms

Peripheral Arterial Disease (PAD)

Peripheral Arterial Disease (PAD) affects the circulation of blood to your legs. A buildup of fatty, waxy plaque deposits called atherosclerosis, narrows or blocks the major arteries. Often patients will suffer from cramping or aching in their buttocks, thighs, or calves after a short walk. When PAD progresses, patients will notice non-healing ulcers around their ankles or development of gangrene. Many of these patients are then at risk of losing their limbs.

The patients usually at risk for the development of PAD are: Diabetic, Smokers, Hypertensive and High Cholesterol

All the symptoms are related to a lack of blood flow in the affected areas.

  • Intermittent Claudication- this is pain or discomfort in the affected muscles that gets worse when exercising or even walking, and is relieved by rest, due to lack of blood flow. When exercising your muscles need extra oxygen to function. When the arteries are blocked the muscles don’t get the needed oxygen. This causes difficulty walking or climbing stairs, and cramping in the affected legs, buttocks, thighs, calves, and feet.
  • Weak or absent pulses in the ankles, legs or feet
  • Sores on the toes, feet or legs that heal slowly or not at all
  • Cooler skin temperature on the affected areas
  • Poor nail growth on toes and lost hair on legs
  • Erectile dysfunction

Abdominal Aortic Aneurysms

The largest artery in your body is the aorta. It runs from the heart down through your chest and into your abdominal region. This region is responsible for delivering blood to your legs, GI tract, and kidneys. When the walls of the aorta progressively weaken and begin to expand, an aneurysm occurs. If left untreated, it will rupture, create internal bleeding and possibly death. The majority of patients are asymptomatic and in some case, they will feel unexplained pain in their abdomen or back.

Patients that are prone to suffer from Abdominal Aortic Aneurysm (AAAs) are males with a history of aneurysms in the family, patients diagnosed with Peripheral Arterial Disease, Smokers, the Elderly, those with chronic lung disease and, Hypertensive Individuals.

Venous ulcers and arterial ulcers have different characteristics and risk factors.

  1. Venous ulcers
  • Superficial
  • Irregular in shape
  • Painful due to edema, phlebitis or infection
  • Usually appear on the lower leg and ankle, and
  • Often contact dermatitis develops
  1. Arterial Ulcers
  • Thick, bright red granulation tissue
  • With a punched out appearance and smooth edges
  • Painful at night
  • Found most often on the lateral foot, but
  • Can be found anywhere on the lower leg and foot
  • Lower legs feel cool to the touch
  • Skin is shiny, taut and thin
  • Loss of hair growth on lower limbs
  • May be due to peripheral arterial disease
  • Often results after a trivial trauma

Carotid artery disease

There are four arteries that supply blood flow to the brain: two vertebral arteries passing along the back of the neck, and two carotid arteries passing in front of the neck. Narrowing of the carotid arteries in front of the neck is the most common condition for these vessels. The narrowing is due to a fatty, waxy plaque buildup. This buildup occurs over time, putting a patient at risk for a stroke.

Most often patients with carotid artery disease are asymptomatic and are identified by their personal physician as having a “whooshing” sound in the neck, also known as bruit (pronounced “brewee”). A minority of patients do experience sudden symptoms of transient ischemic attacks (mini-strokes) that are due to temporary reduction of blood circulation to one part of the brain. If the symptoms last longer than 24 hours, the patient is then considered to have had a stroke. Stroke means that a portion of the brain has ceased to function because of a severe reduction in blood flow.

Carotid artery disease can present with many symptoms, most commonly a stroke or transient ischemic attack (TIA), or the symptoms associated with stroke/TIA. These symptoms include, but are not limited to:

  • Weakness or loss of feeling in on side of the body
  • Visual disturbance
  • Dizziness
  • Speech impairment
  • Previous stroke or TIA

Varicose Veins

Veins return blood back to the heart. In order to prevent blood from flowing backward, there are several small leaflet valves located in veins. When these leaflet valves stop working properly or become damaged; blood begins to pool in the veins and enlarged, twisted cords, raise above the skin. These twisted cords are called varicose veins, and often they appear to be blue, red or flesh color. More often than not, they are a cosmetic problem, where life-threatening complications are uncommon.

Chronic Venous Insufficiency (CVI)

Chronic Venous Insufficiency (CVI) is a condition that occurs over time. Individuals that are susceptible to CVI usually have occupations that sit or stand for long periods of time. These two actions cause blood to pool, which in return weakens the vein walls and damages vein valves. Patients may experience swelling, tired, restless, legs; or CVI may occur because varicose veins have gone left untreated. CVI is usually not considered a serious health risk, and once you consult your physician they will be able to determine the best treatment option.

Patients may experience:

  • Swelling
  • Tired
  • Restless legs

Treatments

Peripheral Arterial Disease (PAD)

  • Increasing physical activity
  • Quitting smoking
  • Lowering blood pressure
  • Lowering high cholesterol
  • Lowering blood sugar levels

Abdominal Aortic Aneurysms

Venous ulcers and arterial ulcers have different characteristics and risk factors:

Venous ulcers

The first goal is to identify the cause and address it. To treat the ulcer, conservative compression therapy is the standard of care. Venous ulcers heal faster. Leg elevation of the affected limb minimize edema, improves circulation and aids healing. Debridement or removal of dead, damaged and infected skin enhances healing. Venous leg ulcers often become infected and will be treated with antibiotics.

Arterial Ulcers

For all patients with PAD, reducing cardiovascular morbidity and mortality are a primary concern. The objective is to increase blood flow to the legs, and restore function. There are several time tested treatments that are most effective to promote healing. Recommendations to improve blood flow also include controlling diabetes, stopping smoking, controlling hypertension and hyperlipidemia. Most patients with claudication can remain stable with medical therapy.

Treatment must be individualized. Surgical revascularization is indicated in patients with acceptable surgical risk, including consideration of the patient’s comorbidities. Antiplatelet therapy with stenting improves outcomes. Indications for lower extremity revascularization are acute limb ischemia, critical limb ischemia (indicated by rest pain, non-healing leg ulcers, and claudication).

Carotid artery disease

An ultrasound screening of the carotid arteries is often performed to determine the presence of disease. If carotid artery disease is found, ultrasound is also used to monitor the disease development over time, to help determine when or if treatment should be performed. Ultrasound is used after surgery to determine the success of the procedure or possible reoccurrence of disease.

Chronic Venous Insufficiency (CVI)

CVI is usually not considered a serious health risk, and once you consult your physician they will be able to determine the best treatment option.

Services

A vascular surgeon treats many conditions that affect the blood vessels in every part of your body except for your heart and brain. This can include:

  • Aneurysm, a bulge or weak spot in an artery
  • Atherosclerosis, or hardening of the arteries, where plaque builds up on your artery walls
  • Carotid artery disease or peripheral artery disease (PAD), where the arteries that bring blood to your neck or limbs become narrow or blocked
  • Compression disorders like nutcracker syndrome and thoracic outlet syndrome
  • Dialysis access, or the placement of a graft or fistula that allows you to receive dialysis treatment for kidney disease
  • Deep vein thrombosis (DVT), a blood clot in a vein deep below your skin
  • Spider veins, or small webs of veins just below the surface of the skin
  • Trauma to arteries and veins caused by accidents or injuries
  • Varicose veins, or large, swollen, twisted veins that can cause pain or aching in your legs
  • Venous ulcers and arterial and diabetic (neuropathic) wounds, which are nonhealing wounds that result from poor blood flow, especially in the legs

Doctors

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