Vascular Health

• Non-invasive treatment of claudication 
• Angioplasty and stenting 
• Lower extremity bypass 
• Hybrid procedures 
• Treatment of failed revascularization procedures 

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 endarterectomy 
• Carotid stenting 

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.

• Surveillance of small aneurysms
• Endovascular (stent-graft) repair for thoracic aortic aneurysms 
• Open and endovascular repair for abdominal aortic aneurysms (AAA)
• Open and endovascular repair for iliac aneurysms 
• Popliteal and other peripheral aneurysm repair

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.

• Radiofrequency ablation for venous reflux 
• Phlebectomy for varicose veins 
• Sclerotherapy for varicose and spider veins 
• Venous stenting for May-Thurner syndrome 
• Thrombectomy/thrombolysis for deep venous thrombosis 
• Treatment of post-thrombotic syndrome 
• Placement and removal of IVC filters 

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.

• Arteriovenous fistula or graft creation 
• Maintenance procedures for narrowed or failing fistula/grafts 
• Fistula/graft revision for ulcerations, steal syndrome, aneurysm, or other complications 
• HeRO catheter insertion 
• Peritoneal dialysis catheter insertion 

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.

• Mesenteric and renal artery disease 
• Subclavian artery stenosis
• Amputation
• Vascular duplex/ultrasound testing 

Imaging studies are performed using X-ray, CT or MRI; often with the aid of a contrast material, to view blood vessels in great detail and to evaluate blood flow and determine areas of blockage.

A catheter is threaded up through the groin to the point of narrowing or blockage, and a tiny balloon at the tip of the catheter is inflated to open the narrowed or blocked artery or vein. It is then deflated and removed, restoring adequate blood supply to the chest, abdomen or legs.

There is a silent killer among us. Known as Triple A, or AAA, abdominal aortic aneurysm is the third leading cause of death in men over age 60. When AAA ruptures, it carries a 75-90% mortality rate. AAA is an aneurysm (blood-filled bulge) occurring in the abdominal aorta, an artery located behind the belly near your back that carries blood to the lower part of the body. You don't feel it and, until it ruptures, you rarely have symptoms. It is estimated that more than a million people are living with an undiagnosed AAA. Often found by accident during a screening for back or abdominal pain, Valley Medical Center’s Vascular Clinic surgeons repair these deadly bulges.

Stenting is used to help prevent rupture of aneurysm (a weakened, bulging area of an artery or vein) in the abdomen, chest or neck. It can also be used to treat severe peripheral vascular disease (PVD). Using a catheter as the mode of transport, a thin mesh tube is threaded through the groin. It is placed to serve as permanent reinforcement to hold open the walls of an artery or vein.  Stenting is often performed in conjunction with balloon angioplasty. Stents can be coated with time-release medication. These are known as drug-eluting stents, and help prevent the artery from narrowing or becoming blocked again (restenosis) as tissue grows over the stent. Today, a million Americans a year receive stents.

Clot-busting drugs or tools are introduced directly into an artery or vein via catheter to dissolve or manually break up a clot.  Thrombolysis is performed as an emergency treatment for stroke to restore blood flow in the brain. It may also be a scheduled procedure, such as therapy to treat a blocked access graft or deep vein thrombosis.

Surgical bypass grafts (aortic/iliac/peripheral)
Not all patients are candidates for endovascular procedures. We also perform traditional surgical bypass grafts in the chest, abdomen and legs to improve blood flow, “detouring” blood from diseased arteries and veins and rerouting the flow through a stronger, healthier bypass section made of Dacron fabric or a healthy vein taken from your own arm or leg.