Vascular Disease
When people discuss vascular disease, they’re usually referring to peripheral arterial disease. The arteries are pipes that take blood to your body parts. These pipes can become clogged with plaque, decreasing the amount of blood going to your body parts. If this occurs in the legs, it can lead to pain in your legs when you walk. This condition is called “claudication.” As this advances, you can have worsening symptoms such as pain in your legs when you lay down. The risk factors for this type of disease include smoking, diabetes, hypertension, high cholesterol. This type of blockage can occur in your carotid arteries as well. If the carotid artery disease become symptomatic it can lead to stroke. The risk factors for carotid disease are less well defined.
Education, Reassurance and Follow Up are the guiding philosophy of our practice.
Carotid disease
Carotid artery stenosis (CAS) is a phenomenon that happens in the neck. The peak for CAS is in the 60 to 80-year-old range. The majority of the time CAS is asymptomatic. Carotid disease is one of the three major causes of strokes along with atrial fibrillation and hypertension. When plaque builds up in the vessel it can send particles up in the brain and cause a stroke or transient ischemic attack.
Evaluation & Treatment
Evaluation of carotid stenosis is relatively easy. Anti-platelet therapy such as aspirin and/or Plavix is commonly used to treat this condition. This can be treated with either an open surgery or placement of a carotid stent. Carotid endarterectomy is the gold standard for treatment.
Aortic disease
The aorta is the largest blood vessel in your body. It can be affected by the plaque that builds up in your lower extremities as well. This can cause a gradual narrowing of the aorta or the iliac arteries. The claudication is similar to what occurs in the legs, but it can also cause pain in your buttocks and thighs. We more commonly see aneurysmal formation of the aorta, when the order has weakened and become larger. Aortic aneurysms are usually asymptomatic and found incidentally. The vessel expands due to the pressure and the enlargement in size increases the risk of rupture.
Evaluation & Treatment
Screening is usually done with an ultrasound and should occur between 65 and 75 years old in individuals who have never smoked. Screening should start at age 60 if the individual has a first-degree relative like a father or mother who had an abdominal aortic aneurysm.
Occlusive aortic disease affects these vessels as well. Instead of dilating the vessels fill with plaque and narrowed. Severe Aortoiliac occlusive disease can present with buttocks claudication, non-palpable pulses in the femoral area, and impotence. The internal iliac arteries which (supply blood flow to the pelvis and provide for normal erectile function)
Lower extremity arterial disease
Peripheral arterial disease (PAD) affects 8 million people in America. Much of this goes undetected as people become more sedentary. In the lower extremities, PAD it is not unlike business where supply and demand rule the day. When supply does not meet the demand there is lactic acid buildup which results in pain. This is the first indication of lower extremity arterial disease. This pain does not occur at rest and it is reproducible. Exercise and lifestyle modifications can arrest the progression of the disease and procedures can be performed to normalize the flow.
Evaluation & Treatment
The risk factors for PAD include diabetes, smoking, elevated cholesterol, sedentary lifestyle, and hypertension. Modifying the risk factors by stopping smoking, controlling your blood pressure and diabetes and adding exercise your routine can greatly reduce your chances of falling victim to PAD.
Deep vein thrombosis
Deep vein thrombosis (DVT) usually occurs in the larger veins of the legs. The clot in the vein can be substantial and usually causes some sort of swelling. When the clot breaks off it can travel to the lungs and cause a pulmonary embolism. A large pulmonary embolism can cause instant death.
Evaluation & Treatment
With deep vein thrombosis, the symptoms can range from mild fullness in your leg to painful swelling of the entire leg. In 5 to 8% of patients, some sort of abnormality in the clotting mechanisms of their blood to put people at risk for DVT. In 50% of the people that have DVT may suffer long-term symptoms. About one third will have a recurrence over their lifetime.
The risk factors that puts individuals at risk for deep vein thrombosis are greater than 40 years old, obesity, hormone replacement therapy, pregnancy, a personal or family history of DVT and the presence of some type of cancers.
Venous reflux disease
The most common of all vascular diseases is superficial venous reflux disease (SVR). Over time the valves in the superficial veins fail and cause SVR. Risk factors for development of venous reflux are pregnancy, obesity, sedentary lifestyle, sitting or standing for long periods of time and family history.
Evaluation & Treatment
Symptoms include leg fatigue, swelling, varicose veins, and cramps. If left untreated large varicosities, ulceration, and skin changes can occur. Treatments for SVR are simple and office-based.
