Vascular Conditions and Treatments

 Peripheral arterial disease (PAD) 

Arteries are vessels that take blood from your heart to your extremities. Peripheral arterial disease results from narrowings and blockages in the arteries in your legs, and is usually related to a combination of high blood pressure, high cholesterol, diabetes, and/or smoking. PAD decreases blood flow to your legs when you walk or exercise, resulting in pain in your buttocks, thighs, or calves, known as claudication. When PAD is severe it can result in constant pain, non-healing wounds, ulcers, or gangrene, which can be very disabling or even result in an amputation.

We treat mild PAD with medications and lifestyle changes. For patients who require treatment for more severe symptoms, we tailor treatment to each patient’s overall condition, symptoms, and pattern of disease. Options include minimally-invasive treatment of narrowings from the inside of the artery with a balloon or stent, removal or bypass of extensive blockages through surgery, or a combination of these.

Patients with the most severe disease develop non-healing wounds or gangrene are at very high risk for leg amputation without restoration of blood flow to their foot. For these patients, we closely collaborate with colleagues in wound care, podiatry, and infectious disease to come up with a plan to save their leg.

Carotid artery stenosis 

Carotid stenosis is a narrowing in one or both of the main arteries to your brain and can result in a stroke. In patients who have had a stroke or mini-stroke, or who are at risk for these events they often require treatment to expand the narrowing with a stent, or we remove the narrowing altogether (carotid endarterectomy). Patients with lower risk carotid stenosis are treated with medications, lifestyle changes, and periodic ultrasounds to track the severity of the blockage.

Aneurysms 

An aneurysm is an enlarged artery, which can occur throughout the body, and are primarily related to smoking and family risk. Aneurysms are concerning because they can rupture from ongoing enlargement, resulting in internal bleeding that is usually fatal. In addition, aneurysms behind the knee (popliteal aneurysms) can form blood clots that can cut off circulation to the foot, leading to leg pain or even limb loss. The most common type is an abdominal aortic aneurysm (AAA), but aneurysms can also develop in the large arteries in the chest, pelvis, or leg.

We can treat thoracic and abdominal aortic aneurysms, and aneurysms of the iliac, femoral, and popliteal arteries. For patients with relatively small aneurysms, we help coordinate periodic ultrasounds to track growth. For patients with aneurysms that need to be repaired, we offer minimally invasive repair with a stent-graft (endovascular aortic aneurysm repair, EVAR), or open repair depending on each patient’s condition and specific anatomy.

Venous disease 

Veins are blood vessels that take blood from your extremities back to your heart. In the leg, healthy veins have valves in them to help blood flow back to your heart against gravity when you are standing. If these valves don’t work properly, pressure can build in the veins leading to spider and varicose veins, swelling, pain, and even non-healing wounds. This condition, known as venous reflux or venous insufficiency, can be treated initially with compression stockings. For patients with persistent or severe symptoms, we offer a combination of radiofrequency ablation (RFA), phlebectomy (vein removal), and sclerotherapy (injections), which we tailor to each patient’s symptoms and disease.

Blood clots in the veins, known as deep venous thrombosis, can lead to severe leg swelling and pain, which can be an emergency. We perform minimally invasive clot removal (thrombectomy and thrombolysis) to restore blood flow. Often, this is due to an underlying narrowing of one of the pelvic veins, known as May-Thurner Syndrome, which requires treatment with a stent to prop the vein open. Stenting can also be beneficial for patients who have chronic leg pain and wounds following a prior blood clot in their leg (known as post-thrombotic syndrome).

Finally, some patients require placement of a filter in the inferior vena cava (IVC filter) to prevent blood clots from traveling from their legs to their lungs, which is known as pulmonary embolism. We offer retrievable filter placement when needed. However, many patients with such filters in place never have them removed, which can lead to long-term complications, so we also offer IVC filter removal to patients with filters in place.

Dialysis access

Patients with kidney failure need dialysis to filter their blood, a procedure which requires a connection between the body and the dialysis machine. Hemodialysis (known as HD) refers to direct filtering of the blood. The simplest way to perform hemodialysis is through a tunneled catheter, which is a large IV that is put through the skin. However, these have significant risks, including potential infection and scarring of the veins in the chest, so we try to use these as little as possible. For patients needing long-term HD, we perform arteriovenous fistula or graft creation, which involves a surgery to make a connection between an artery and vein in your arm, which is then used for dialysis. Unfortunately, these often develop issues such as narrowing (stenosis), enlargement (aneurysm), ulceration or abnormal flow (steal syndrome) that require additional procedures to fix, and we offer the full range of dialysis access maintenance and revision procedures. For patients with limited dialysis access options, we can insert HeRO catheters or perform complex access creation.

Another option for dialysis is by filtering the fluid in your abdomen, known as peritoneal dialysis. This requires a special tube inserted through your abdominal wall, which we can insert via a minimally invasive surgery.

For more information, please also visit patient information from the Society for Vascular Surgery:

https://vascular.org/patient-resources/vascular-health-fliers

https://vascular.org/patient-resources/vascular-treatments