Vascular Medicine & Surgery
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Vascular Diseases & Conditions
Vascular medicine and surgery focuses on the treatment of problems with blood vessels. Blood vessels are part of the circulatory system and include arteries, veins, and lymph vessels. Your arteries carry blood from the heart throughout your body, and veins carry blood back again to the heart and lungs.
The term vascular disease is a broad term that covers any condition that affects the blood vessels or lymphatic system. Vascular disease often involves the narrowing or widening of veins and arteries, impacting blood flow throughout your body.
If you experience leg pain during physical activity, wounds that don’t heal, or regular leg swelling, it may be a sign you have a vascular condition.
Learn about some of the most common vascular diseases:
- Aortic aneurysm
- Aortic dissection
- Carotid artery disease
- Carotid body tumor
- Deep vein thrombosis (DVT)
- Mesenteric artery disease
- Peripheral artery disease (PAD)
- Thoracic outlet syndrome
- Varicose veins and spider veins
- Vascular ulcers
Are you at risk for vascular disease?
The risk of vascular disease increases as you age. However, if you smoke or have a family history of vascular and heart disease, or an existing heart condition such as high cholesterol or high blood pressure, you may be at a greater risk.
Other risk factors that can contribute to vascular problems include obesity, lack of exercise and diabetes.
Symptoms of vascular disease
Your symptoms may vary depending on the type of vascular disease. Some common symptoms may include leg pain, swelling or cramps, bluish skin, tired or heavy limbs, thickened, opaque toenails, or wounds that won’t heal.
Some vascular diseases may show no symptoms until a heart attack or stroke occurs. Addressing your risk factors and implementing healthier lifestyle changes can reduce your risk of vascular disease while improving your overall cardiovascular health.
What is an aortic aneurysm?
An aortic aneurysm is a bulge that occurs in the body’s main artery, the aorta. The aorta carries blood from the heart to the body. Having an aortic aneurysm increases the risk of the aneurysm bursting (rupture).
Often the cause of an aortic aneurysm is unknown but can include atherosclerosis, inflammation of the arteries, or an injury to the aorta. Risk factors for aortic aneurysms include:
- Age: Growing older increases the risk of aortic aneurysms. Thoracic aortic aneurysms occur most often in people aged 65 and older.
- Tobacco use: Smoking and using tobacco greatly increases the risk of an aortic aneurysm.
- High blood pressure: Increased blood pressure damages the blood vessels in the body, raising the risk of an aneurysm.
- Buildup of plaque in the arteries: The buildup of fat and other substances in the blood can damage the lining of a blood vessel, increasing the risk of an aneurysm.
- Family history: Having a parent, brother, sister, or child with an aortic aneurysm increases the risk of an aortic aneurysm and rupture. You may develop aneurysms at a younger age.
How is an aortic aneurysm diagnosed?
Aortic aneurysms develop without any symptoms. Providers often discover aortic aneurysms during routine checkups. If you are at high risk of developing an aortic aneurysm or have any aneurysm symptoms, your provider may perform a screening ultrasound or CT to help find and diagnose the aortic aneurysm.
How is an aortic aneurysm treated?
The goal of treatment for an abdominal aortic aneurysm is to prevent the aneurysm from rupturing. Depending on the severity of the aortic aneurysm, your treatment options may include:
- Medical Monitoring: Monitoring or watchful waiting may be recommended if your aortic aneurysm is small and isn’t causing symptoms. Monitoring requires regular checkups and annual or biannual imaging tests to determine if the aneurysm is growing.
- Endovascular repair: During an endovascular repair, our vascular surgeons guide a thin, flexible tube (catheter) through it to the aorta. A graft is placed at the site of the aneurysm. The graft strengthens the weakened section of the aorta to prevent rupture.
- Open abdominal surgery: During open abdominal surgery, our vascular surgeons remove the damaged part of the aorta and replace it with a graft, which is sewn into place.
What is atherosclerosis?
Atherosclerosis occurs when fatty deposits (plaque) build up in the walls of the arteries, narrowing them and limiting blood flow. It is often a slow, progressive disease that may start as early as childhood. Because it is a slow progressing disease, there are often limited signs and symptoms. However, if a major artery is blocked, a heart attack, stroke or blood clot may occur.
How is atherosclerosis diagnosed?
Your care team will often start with a physical examination. When listening to your arteries, your provider may hear a whooshing sound. Depending on the result of your physical examination, you may have additional tests including: blood tests, electrocardiogram, echocardiogram, exercise stress test, ultrasounds, blood pressure tests, CT angiogram, or coronary calcium scan.
How is atherosclerosis treated?
Often the first step in treating atherosclerosis is through lifestyle changes and medications. However, if you have a more serious blockage, your care team may recommend an angioplasty or bypass surgery.
What is an aortic dissection?
An aortic dissection is a condition where a tear occurs in the body’s main artery, the aorta. The aorta carries blood from the heart to the body. If a tear in the aorta occurs, blood passes through the tear and normal blood flow throughout the body is disrupted or stopped. An aortic dissection begins abruptly and is a life-threatening condition that needs prompt and immediate treatment.
How is an aortic dissection diagnosed?
Diagnosing an aortic dissection can be difficult because early symptoms are similar to many other health problems. Symptoms of an aortic dissection may include sudden tearing or ripping chest pain, blood pressure differences between right and left arms, and the visible widening of the aorta on an x-ray.
A special test called a transesophageal echocardiogram (TEE) may be done to help diagnose an aortic dissection. During the test, an ultrasound probe is guided through the esophagus and placed near the heart to provide a clearer picture of the heart and aorta.
How is an aortic aneurysm treated?
Treatment of an aortic dissection often require immediate surgery. During surgery, surgeons will remove as much of the dissected aorta as possible to stop blood from leaking. A synthetic tube, graft, is then used to reconstruct the aorta.
Carotid artery disease
What is carotid artery disease?
Carotid artery disease occurs when plaques clog the blood vessels that deliver blood to the brain. The clog increases the risk of stroke, which occurs when the brain loses all or much of its blood supply and oxygen. It is often a slow, progressive disease and there are often limited signs and symptoms. The first sign you have the condition may be a stroke or a temporary shortage of blood flow to the brain.
How is carotid artery disease diagnosed?
Diagnosing carotid artery disease generally includes listening for a swooshing sound in the neck. This sound is caused by the narrowed artery. Imaging tests may also be used to diagnose carotid artery disease including ultrasounds, a CT or MRI, or an angiogram.
How is carotid artery disease treated?
The goal in treating carotid artery disease is to prevent a stroke. Specific treatments depend on the extent of blockage in your carotid arteries. Treatment of carotid artery disease usually involves a combination of lifestyle changes, medication and sometimes surgery.
If blockage is severe, or if you've already had a stroke, your care team may recommend removing the blockage from the artery. The options include:
- Carotid endarterectomy: Carotid endarterectomy is the most common treatment for severe carotid artery disease. During the procedure, our surgeons open your carotid artery and remove the plaque deposits that are causing the blockage. They then repair the artery with a patch made with an artificial material.
- Carotid stenting: During a carotid stent or transcarotid artery revascularization (TCAR), our surgeons place a tube directly into the artery and connect it to a transcarotid neuro-protection system (NPS). The NPS system reverses your blood flow away from the brain to protect against plaque that may come loose during the procedure. The plaque is collected in the device filter before returning the blood to a vessel in the leg. The surgeons then place an expandable mesh tube at the site of the blockage for long-term stroke prevention.
Carotid body tumor
What is carotid body tumor?
A carotid body tumor is a mass that grows close to the blood vessels of your neck (carotid arteries). These arteries carry blood from your heart to your head and brain.
A carotid body tumor may not cause any symptoms, but as the mass grows, it may press on nearby nerves and blood vessels, causing hoarseness, numbness in your tongue, sore throat, swallowing problems (dysphagia), or just a feeling of a lump in the neck. If hormonally active, it can cause uncontrolled hypertension, flushing or sweating, insulin resistance and diabetes.
How is carotid body tumor diagnosed?
An ultrasound or a CT scan with contrast dye of the blood vessels of the neck can detect a carotid body tumor. A urine or blood test can detect the abnormal production of hormones by the tumor.
How is carotid body tumor treated?
Carotid body tumors are most often removed surgically. If the mass is larger than 3 centimeters, embolization of the blood supply of the tumor few weeks before surgery may help decrease surgical bleeding.
What is claudication?
Claudication is pain caused by too little blood flow to muscles during exercise. It is also referred to as intermittent claudication because the pain usually isn’t constant. It begins with exercise and ends with rest. Claudication is usually an indicator of another vascular condition, most often peripheral artery disease.
How is claudication diagnosed?
Claudication may go undiagnosed because some may consider the pain to be a natural part of aging. Some people simply reduce their activity level to reduce the pain. Common tests used to diagnose claudication may include pulse measurement, blood pressure tests, exercise testing, ultrasounds or an CT or MR angiogram.
How is claudication treated?
The goal of treating claudication is to reduce pain and manage the risk factors that contribute to heart and vascular disease. Your treatment may include:
- Exercise: Exercise reduces pain and improves vascular health. A walking program or supervised exercise may be recommended
- Medications: Medications may be prescribed to manage your pain, high cholesterol, high blood pressure or other cardiovascular risks
- Angioplasty: An angioplasty uses a tiny balloon catheter that is inserted in a blocked blood vessel to widen it and improve blood flow to your leg. An angioplasty may be combined with the placement of a small wire mesh tube called a stent.
Deep vein thrombosis (DVT)
What is deep vein thrombosis?
Deep vein thrombosis is a blood clot that forms in a deep vein, typically in the leg. DVT can cause leg pain and swelling or sometimes present no symptoms. It can be dangerous if the clot breaks off and travels to the lungs, blocking blood flow, which is called a pulmonary embolism.
How is DVT diagnosed?
To diagnose DVT, your care team will often start with a physical exam, ask questions about your symptoms, and check your legs for swelling, tenderness, or changes in skin color.
Additional tests may be done depending on if you are at a low or a high risk of DVT. Tests used to diagnose DVT include blood tests, echo, ultrasounds, or CT Angiogram.
How is DVT treated?
The goals of treating DVT is to prevent the clot from getting bigger, prevent the clot from breaking loose, and reduce the chances of another DVT occurring. DVT treatment options may include blood thinning medication, medication used to break up the clot, compression stockings, and filters. Filters are placed into a large vein within the stomach to prevent clots that break loose from entering the lungs.
Mesenteric artery disease
What is mesenteric artery disease?
Mesenteric artery disease is a condition that happens when narrowed or blocked arteries restrict blood flow to your small intestine. Decreased blood flow can permanently damage the small intestine.
Sudden loss of blood flow to the small intestine is called acute mesenteric ischemia. The acute type is often caused by a blood clot and requires immediate treatment. Mesenteric ischemia that develops over time is called chronic mesenteric ischemia. The chronic type is usually caused by a buildup of fatty deposits in the arteries.
Chronic mesenteric ischemia can become acute if it's not treated. It also can lead to severe weight loss and malnutrition.
How is mesenteric artery disease diagnosed?
Symptoms of mesenteric ischemia include stomach pain that starts about 30 minutes after eating and goes away after 2-3 hours, nausea, vomiting, or diarrhea. Sometimes, sudden, severe stomach pain or unintentional weight loss may occur. An ultrasound or a CT scan with contrast dye of the blood vessels of the intestine can show the narrowing or blockage.
How is mesenteric artery disease treated?
The narrowing or blockage of the intestinal blood vessels can be treated with either stent or surgical bypass.
Peripheral artery disease
What is peripheral artery disease?
Peripheral artery disease (PAD) is a condition in which plaque buildup in the arteries limits blood flow to the limbs, causing pain and other symptoms including:
- Painful cramping in one or both of your hips, thighs or calf muscles after certain activities, such as walking or climbing stairs
- Leg numbness or weakness
- Coldness in your lower leg or foot, especially when compared with the other side
- Sores on your toes, feet or legs that won't heal
- A change in the color of your legs
- Hair loss or slower hair growth on your feet and legs
- Slower growth of your toenails
- Shiny skin on your legs
- No pulse or a weak pulse in your legs or feet
- Erectile dysfunction in men
How is peripheral artery disease diagnosed?
In addition to a physical examination by your health care provider, tests may be done to diagnose peripheral artery disease including blood tests, blood pressure tests, ultrasounds of the legs and feet, or an angiogram.
How is peripheral artery disease treated?
Treatment for peripheral artery disease has two major goals:
- Manage symptoms, such as leg pain, so that you can resume physical activities.
- Stop the progression of the plaque buildup throughout your body to reduce your risk of heart attack and stroke.
You may be able to accomplish these goals with lifestyle changes, especially early in the course of peripheral artery disease. If you smoke, quitting is the single most important thing you can do to reduce your risk of complications.
If your peripheral artery disease is more severe, your care team may recommend an angioplasty or atherectomy procedure.
Thoracic outlet syndrome
What is thoracic outlet syndrome?
Thoracic outlet syndrome (TOS) is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib become compressed, causing shoulder or neck pain and numbness in your fingers.
TOS is often caused by physical trauma from a car accident, repetitive injuries from job or sports, pregnancy, or certain anatomical defects like having an extra rib.
How is thoracic outlet syndrome diagnosed?
In addition to a physical examination by your health care provider, tests may be done to help diagnose TOS including ultrasounds, X-rays, CT scan, or MRI.
How is thoracic outlet syndrome treated?
In most cases of TOS, conservative treatment may be most effective, especially if diagnosed early. Conservative treatment may include physical therapy or medications to help reduce pain and encourage muscle relaxation.
Surgery may be recommended if conservative treatments haven’t been effective or if you are experiencing ongoing or worsening symptoms. Surgery to treat TOS is called thoracic outlet decompression, which involves removing muscle and a portion of the rib to relieve compression.
Varicose veins and spider veins
Varicose veins are swollen, twisted veins that usually occur in the legs. They happen when valves in the veins don’t work properly, causing blood to pool and the veins to bulge. Spider veins are a mild form of varicose veins. Varicose veins may not cause any symptoms. But in more severe cases, some symptoms can include:
- Veins that are dark purple or blue
- Veins that appear twisted and bulging, often like cords
- An achy or heavy feeling in your legs
- Muscle cramping, burning, throbbing or swelling in your lower legs
- Itching around your veins
- Increased pain after sitting or standing for a long time
- Bleeding from varicose veins
- Skin ulcers near your ankle
How are varicose veins and spider veins diagnosed?
To diagnose varicose veins, your health care team might recommend a test called a venous Doppler ultrasound. A Doppler ultrasound is a noninvasive test that uses sound waves to look at blood flow through the valves in the veins.
How are varicose veins and spider veins treated?
You may have heard stories from the past about vein stripping or other invasive treatments for varicose veins. These treatments required a long recovery time and left long scars on the legs. Technology has advanced, and there are many minimally invasive treatment options that can make a difference with little-to-no downtime or scarring, including:
- Ablation and laser surgeries: Heat or light is used to damage the vein, causing it to collapse and fade away.
- Sclerotherapy: A solution is injected into the vein, causing it to collapse.
- Stab avulsion phlebectomy: Tiny incisions are made directly over a large varicose vein and it is removed in specific sections. The incisions usually are less than a half centimeter, and you will have little or no pain.
The process of destroying the veins with these techniques begins immediately, and most people see full results in about two months. After the treatment, your blood circulation is not reduced because it already has been rerouted to other healthy veins nearby.
What are vascular ulcers?
Vascular ulcers are open, slow-healing wounds that develop on the skin as a result of poor blood circulation in an affected area. These ulcers typically occur in the lower legs and feet are often the result of another underlying vascular disease like peripheral artery disease or venous disease.
How are vascular ulcers diagnosed?
Your healthcare team can quickly diagnose a vascular ulcer by examining it. However, additional tests and examinations may be needed to help diagnose what is causing the ulcer which can include blood pressure tests, blood tests, checking your pulse, and imaging.
How are vascular ulcers treated?
Your vascular ulcer treatment will depend on the severity of the ulcer and the cause. Some treatment options may include medications, supervised walking, bandaging or compression garments, hyperbaric oxygen therapy, or surgery.