Your primary care physician may have referred you to our practice for evaluation of one of the following vascular problems:
Abdominal Aortic Aneurysm
- The aorta is the main blood vessel carrying arterial blood from your heart to all parts of your body. In some individuals it may become dilated. This enlarged diameter of a blood vessel is called an aneurysm. As the aneurysm enlarges, the walls thin and weaken. With time, the vessel may rupture resulting in potentially fatal bleeding. The risk of rupture increases significantly when the aneurysm exceeds 5 – 5.5 cm (about 2 inches) in diameter. It is for this reason that abdominal aortic aneurysms are closely monitored by ultrasound and repair is recommended when the aneurysm is 5 – 5.5 cm.
- Traditional repair involves a major abdominal operative procedure that involves replacing the enlarged segment of aorta with a synthetic tube of Dacron or Gor-Tex®. This is often associated with a 5 – 7 day hospital stay and several weeks convalescence at home.
- Technology now allows some patients to have repair by a much less invasive procedure in which the aneurysm is “excluded” by placing a stent graft. Rather than a major abdominal incision, this requires only a small incision (or needle puncture) in each groin. This is done with fluoroscopy (x-ray) guidance in the operating room under general anesthesia. The patient often goes home the following day and is back to normal within a week or two.
Peripheral Arterial Disease (PAD)
Blockage to the circulation to your legs and feet
- Indications for intervention include: lower extremity pain at rest, lifestyle-inhibiting leg pain with walking (claudication), non-healing lower extremity wounds.
- The circulation to your legs and feet can be blocked at several levels: in the abdomen and pelvis (aorto-iliac); the thighs (femoral/popliteal); and below the knees (tibial).
- These blockages are typically caused by a buildup of cholesterol plaque within the walls of your blood vessels that ultimately block the flow of blood to your legs.
- Risk factor modification is essential; this includes: quitting smoking, controlling cholesterol and high blood pressure, managing diabetes and exercising regularly.
- Medication may be prescribed, such as an aspirin or other agents to prevent platelets from clotting in the blood. A statin may be prescribed to help control cholesterol and prevent plaque progression.
- Further evaluation of the blockage in your circulation can be obtained by a Duplex study (ultrasound) or by angiogram. An angiogram is an X-ray test in which dye is released into your bloodstream; images are obtained of the blockages. Based on the location and characteristics of the blockages, a plan for treatment will be discussed with you. Many blockages can be opened by a balloon (angioplasty). A stent may be required as a scaffolding to keep the blockage from reforming. Angioplasty and stenting can usually be done at the time of the angiogram.
- Your blockage may require a surgical bypass to create a detour around the blockage.
Blockage in the arteries supplying your kidneys (Renovascular Hypertension)
- These blockages may be contributing to your high blood pressure. People who are on three or more blood pressure medications should have their renal arteries evaluated. Opening these blockages with a balloon and stent my allow reduction in blood pressure medications and improve kidney function.
Blockage in the arteries supplying the intestinal tract (Mesenteric Ischemia)
- These blockages may result in chronic pain with food intake, leading to profound weight loss. These symptoms can be relieved by opening these blockages with a balloon and stent.
Carotid Artery Disease
- Atherosclerotic blockages within the carotid arteries are an important cause of stroke. Stroke occurs when bits of plaque, cholesterol or clot break away from the carotid blockage and are carried by blood flow to the brain. Some patients will have warning symptoms, or ‘mini-strokes” (transient ischemic attacks or TIAs) in which stroke-like signs and symptoms occur but then resolve completely within 24 hours. Carotid endarterectomy may be recommended for carotid artery disease. This is a surgical procedure in which the plaque is removed from the diseased carotid artery, leaving a smooth, wide open vessel. Carotid endarterectomy is a time-tested procedure that has been shown to prevent stroke.