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