Frequently Asked Questions

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Frequently Asked Questions

This page contains many of the questions we frequently receive at the Vascular Institute.


Click on one of the links below to jump ahead to specific questions:

 


How can the Vascular Institute help me?

Many times, vascular disease is about more than just diseased arteries and veins; there are a host of other issues that accompany it. The Vascular Institute has assembled a team of specialists that deal with vascular disease as well as its related conditions.

Our team will asses the specific conditions of every patient then design a personalized treatment plan. This team includes cardiologists, surgeons, interventional radiologists, internal medicine physicians, podiatrists and wound care specialists. We also work closely with Diabetes Treatment Center and Lymphedema Program. This team sets long-term health goals for the patient and monitors progress. A nurse navigator helps each patient every step of the way.

The Vascular Institute offers the most sophisticated imaging studies, interventional treatments and surgical options including magnetic resonance angiogram (MRA) and the revolutionary stenting procedure that repairs damaged arteries in the legs and prevents amputation. The institute also focuses on education to help patients learn ways to improve their health.

Who is at risk for developing vascular disease?

Although the symptoms of various vascular diseases differ depending on the affected area, the risk factors for developing any of these diseases are fairly consistent.

Smoking is by far the biggest risk factor for developing any type of vascular disease. Smoking promotes the narrowing of the blood vessels and increases the chance of developing a blood clot that can lead to acute problems, such as a heart attack or PAD. Smoking also reduces a body’s HDL, or “good” cholesterol, also leading to narrowing of the arteries, or atherosclerosis.

High blood pressure, high cholesterol and diabetes are other major, treatable risk factors for vascular disease. Obesity, advancing age, lack of exercise and stress are also risk factors for developing vascular disease.

Left untreated, vascular disease can lead to serious complications. Talk to your doctor about your risk factors and how you can reduce your risk of vascular disease.

What is peripheral arterial disease (PAD)?

PAD is a very serious and very widespread disease. It occurs when plaque build-up, or atherosclerosis, severely blocks the blood flow of the arteries outside the heart and brain. A common symptom of PAD is cramping in the hips, thighs or calves during exercise. This cramping occurs when the affected muscle does not receive enough blood due to blockage. When PAD becomes severe, symptoms include foot or toe pain, foot or toe sores that heal slowly or not at all, and changes in color or coolness of the foot. The most severe form of PAD is called critical limb ischemia.

How is PAD diagnosed?

PAD is diagnosed through an arterial doppler exam and ankle brachial index (ABI).

The arteries of the legs and ankles are checked using an ultrasound Doppler instrument that uses sound waves to produce an audible signal of the blood flow within your arteries. Blood pressure cuffs are placed on each ankle and each arm. Cuffs may also be placed on each thigh, calf and big toe. Using Doppler and the cuffs, a pressure is obtained in each arm by tightening the cuffs briefly. A pressure is also obtained in the same manner from each ankle using two different arteries near the ankle. The highest pressure of each ankle is then divided by the highest arm pressure to calculate the ABI. Pressures may also be taken in the toe, calf and thigh of each leg. This may be helpful in determining levels of disease within the leg, or even above the level of the leg.

The ABI may be repeated after exercise, usually walking, to determine if the pressures of the ankle arteries are abnormally lowered after exercise. If exercise is performed and the ankle pressures drop, this may confirm the arteries as the source of cramping or pain in the leg that occurs with exercise, often referred to as claudication.

If the results are abnormal, your physician my order more tests, such as MRI or angiography, to further evaluate the blood flow of the legs.

How is PAD treated?

Once PAD is diagnosed, there are a number of treatment options available. For many people, lifestyle modifications such as smoking cessation or a regular exercise program are all that is needed. If symptoms persist, medication is an option.

For advanced cases of PVD, or the disease does not respond to more conservative treatments, surgery may be considered. Bypass surgery, using either the patient’s own blood vessel or a synthetic material, can re-route blood around the blockage. Angioplasty, with or without stenting, is also available.

What is artery stenting?

Artery stenting is a treatment option for severely blocked arteries below the knee. Leg artery stenting is typically considered for people who have foot pain even when at rest (meaning the PAD is advanced) or foot sores that are either slow to heal or will not heal. This procedure can only be accomplished if a small wire can be passed through the blocked artery for the stenting.

Inserting a stent is a minimally-invasive procedure in which angioplasty is performed and a stent is put in place. Angioplasty opens the artery using a tiny balloon attached to a catheter. The stent is then inserted into the blocked artery permanently. This procedure allows the artery to heal in an open position, keeping blood flowing in the lower leg.

If leg stenting is performed before sores appear, it leads to prevention of amputation 95 percent of the time. In addition, one year post-surgery the vast majority of patients – 95 percent – experience significant pain relief and tissue healing.

Because it is difficult to predict how quickly vascular disease will progress, persistent leg pain or claudication (discomfort that occurs in the calf or thigh with walking and relieved with rest) should be evaluated as soon as possible by a physician.

What is abdominal aortic aneurysm? How is it detected and treated?

Abdominal aortic aneurysm (AAA) is caused when the wall of the abdominal aorta weakens enough that the pressure inside causes it to balloon outward. Most patients with this condition have no symptoms, which is cause for concern because, if the aneurysm ruptures, the internal bleeding can cause a life-threatening situation.

An ultrasound screening is suggested for people who are considered high-risk. Patients at the greatest risk for AAA are usually older than 65 and have atherosclerosis (plaque build-up in the arteries) or a connective-tissue disorder. AAA tends to be more common in males, and smokers have a higher occurrence. You should also be screened if anyone in your family has had an aneurysm.

With early detections, aortic aneurysm can be caught before it becomes an emergency situation. If an aneurysm that is smaller than 5.5 centimeters in diameter is detected, it can be monitored with regular ultrasounds. If it is larger than 5.5 centimeters in diameter, the risk of rupture increases and surgery may be necessary.

What is venous insufficiency?

Venous insufficiency is a very common condition resulting from decreased blood flow from the leg veins up to the heart, with pooling of blood in the veins. Normally, one-way valves in the veins keep blood flowing toward the heart, against the force of gravity. When the valves become weak and don’t close properly, they allow blood to flow backward, a condition called “reflux.”

What are varicose veins?

Veins that have lost their valve effectiveness become elongated, rope-like, bulged, and thickened. These enlarged, swollen vessels are known as varicose veins and are a direct result of increased pressure from reflux. A common cause of varicose veins in the legs is reflux in the thigh vein called the great saphenous, which leads to pooling in the visible varicose veins below.

How is venous insufficiency diagnosed?

Duplex Ultrasound is used to assess the venous anatomy, vein valve function, and venous blood flow changes, which can assist in diagnosing venous insufficiency. The interventional radiologist will map the greater saphenous vein and examine the deep and superficial venous systems to determine if the veins are open and to pinpoint any reflux. This will help your interventional radiologist to determine if you are a candidate for a minimally invasive treatment known as vein ablation.

What is vein ablation treatment?

This minimally-invasive treatment is an outpatient procedure performed using imaging guidance.

After applying local anesthetic to the vein, a thin catheter, about the size of a strand of spaghetti, is inserted into the vein to guide the tip to the great saphenous vein in the thigh. Then laser, or radiofrequency energy, is applied to the inside of the vein. This heats the vein and seals the vein closed. By closing the great saphenous vein, the twisted and varicosed branch veins, which are close to the skin, shrink and improve in appearance. Once the diseased vein is closed, other healthy veins take over to carry blood from the leg, re-establishing normal flow. The two-year success rate for vein ablation is 93 to 95 percent.

Are there other treatments for varicose veins?

Ambulatory phlebectomy and injection sclerotherapy are also used. Ambulatory phlebectomy is a minimally-invasive surgical technique used to treat varicose veins that are not caused by saphenous vein reflux. The abnormal vein is removed through a tiny incision or incisions using a special set of tools. The procedure is done under local anesthesia, and typically, takes under an hour. Recovery is rapid, and most patients do not need to interrupt regular activity after ambulatory phlebectomy.

 

Call 414-585-1670 if you have additional questions or to schedule an appointment.

 

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