Arterial Disease
Peripheral Arterial Disease (PAD)
Peripheral arterial disease (PAD) refers to the hardening or narrowing of the arteries that reduces blood flow going to the legs.
The reduced blood flow can cause muscle cramping and leg pain while walking (also known as claudication), changes in skin color and temperature, poor wound healing, and in its most severe form, can result in amputation.
Risk factors for developing PAD include smoking, diabetes, high cholesterol, high blood pressure, family history, poor nutrition and lack of exercise.
Treatment consists of two main categories. We always recommend and prefer to start with conservative therapy. This means reducing your risk factors by quitting smoking, lowering cholesterol and blood pressure, managing blood glucose, maintaining a healthy diet, and getting regular exercise.
In some patients, conservative measures do not work and peripheral arterial disease significantly impairs with your quality of life. If it severe enough, peripheral arterial disease can become limb or life threatening. In these patients, we offer bypass surgery or endovascular surgery to improve the blood flow. You can read about angiograms and angioplasty here (link to angiogram).
Carotid Artery Stenosis (CAS)
Carotid arteries supply the blood flow to the brain. Narrowing or blockage of these arteries can lead to a stroke.
The symptoms of stroke include weakness or numbness on one part of the body, loss of vision in one eye, or difficulty speaking clearly.
To help prevent stroke, we recommend quitting smoking, lowering blood pressure and cholesterol, and use of medications to prevent blood clot formation.
Our team can treat severe carotid artery stenosis with a variety of surgical and endovascular treatments to effectively open carotid arteries and decrease the risk of a stroke.
Aneurysms
When a blood vessel wall becomes weakened and abnormally dilates it is called an aneurysm.
A common site for aneurysm is the aorta, which is the largest artery in your body, and carries blood away from your heart to all parts of your body.
Most people do not produce symptoms, and it may be found on a routine physical examinations. Aneurysms are a serious health risk because they can rupture. A ruptured aneurysm can cause severe internal bleeding, which can rapidly lead to shock or death.
To help prevent aneurysms, we recommend quiting smoking, lowering blood pressure and cholesterol levels.
To help detect an aneurysm before it ruptures, we recommend that all patients with risk factors undergo an ultrasound to screen for aneurysms.
Our physicians can perform a variety of procedures for an aneurysm that is at risk for rupturing. You can read about endovascular aneurysm repair (EVAR) here (linke to EVAR).
Wound Care and Amputation Prevention
A non-healing wound is when a wound shows little or no improvement after four weeks or does not heal in eight weeks.
A non-healing wound it as higher risk of an infection, which could lead to a more serious condition, such as amputation.
An important part of healing the wound is determining what is causing it. For all wounds in the legs, with these risk factors, we recommend ultrasound to help determine if you have adequate blood supply to heal the wound.
Generally, wounds in the foot can be due to arterial causes, and wounds around the ankle are due to vein causes, but often overlap. Our specialists will help sort out the best treatments to help heal the wound and do everything we can to prevent an amputation. These treatments often mean conservative measures such as wound care, but may involve surgery or endovascular surgery. You can read about angiogram and angioplasty here.
Dialysis Access
If your kidneys fail you will need dialysis treatment to clean and filter your blood until you get a kidney transplant. There are four main types of dialysis access.
A temporary catheter, called a tunnelled dialysis line, may be used to help filter your blood. We recommend more longterm access that is less prone to infection, such as a peritoneal dialysis, an AV graft, or an AV fistula.
Peritoneal dialysis involves inserting a small catheter or tube into your abdomen. The lining of your abdomen is called the peritoneum and this can be used to filter your blood at home.
About EVAR (endovascular aneurysm repair)
In deciding whether to repair your aneurysm, we look at its size, its location, how fast it is growing, how complicated it is, and your overall health.
EVAR requires only small incisions and is less invasive than open surgery. It allows you to heal faster and go home sooner.
EVAR surgery invokes a small catheter being placed into one of your groin arteries through a small incision. Guided by x-rays, a fabric covered tube called a stent graft is inserted through the catheter to your aneurysm. The fabric covered stent is opened in the aneurysm that allows blood to flow from healthy artery to healthy artery, and stops flow to your aneurysm.
About Angiograms and Angioplasty
Angiograms can be performed for diagnosis as well as part of treatment. Angiograms are usually performed with some sedation and some numbing medication at the access site. A small needle is inserted into an artery, usually your groin or femoral artery. From one site, areas all over the body can be treated. A contrast dye is injected into your artery to see blockages that may be causing your symptoms.
If a blockage is seen, angioplasty can be used to open the blockages. We cross the blockage with a wire and introduce a special device equipped with an inflatable balloon. The balloon is inflated to expand the artery and compress the blockage. The balloon is then deflated and removed while keeping the wire in place across the area that has been treated. Next, contrast dye is injected to assess the result. We consider angioplasty a success if blood flow is improved and less than 30% of the blockage remains. If the vessel is still considerably narrowed, placing a stent may be the next step.
Stents are used to prop open an artery at the site of a narrowing. Stents are generally placed after balloon angioplasty when there is residual narrowing or insufficient blood flow in a treated vessel. There are many different types of stent. Stents that are used in the leg are constructed of a nickel-titanium alloy (Nitinol), a memory-shaped metal that opens up at body temperate. Stents are made to resist kinking and are flexible so that you can be as active as possible.