Common Vascular Problems
Leg Pain

Leg pain is far and away the most common reason patients visit the office.

Leg pain has many different origins and not every patient who presents to our office  has pain that is related to disease of the arteries or the veins. Pain may be neuroligic (spine or nerve caused) or musculoskeletal (joints and muscles) in origin. Leg pain that is secondary to peripheral arterial disease (poor blood flow in the arteries of the legs) typically causes pain with exercise and is relieved with rest. The pain is the result of poor blood flow to the exercising muscles; its the same reason that patients with coronary artery disease get chest (heart) pain. The pain is also very reproducible in that it occurs with exertion of the same type. The complaint is commonly stated as pain that is associated with walking a certain distance, relieved by a short period of rest, and recurs with walking the same distance. The pain may occur sooner when walking up an incline.  

 
Dialysis Access

Dialysis Access is another common reason patients visit the office. The vascular surgeon is involved in providing access for dialysis.

The simplest way to explain dialysis is to describe it as removing naturally occuring substances, excess water and dissolved products of metabolism, from the blood by a process of diffusion and filtration. The need for dialysis occurs when the kidneys no longer function properly; the need may be short or long term. The two main ways of receiving dialysis are hemodialysis and peritoneal dialysis. In both methods there is a semi-permeable  membrane which allows for the passage of water and dissolved substances from areas of high concentration (the blood of the patient) to areas of low concentration, the dialysate fluid. A semipermeable membrane allows the passage of some substances while inhibiting the passage of others.

 
Catheters

Catheters for hemodialysis, often referred to by the generic term Perm-cath, are typically double barrel plastic tubes inserted into one of the large veins of the body to allow for the removal and reinfusion of large volumes of blood. Peritoneal dialysis catheters are typically single barrel and are placed through the wall of the abdomen into the abdominal cavity. Catheters have the advantage of being  available for use upon insertion and aside from the discomfort of insertion, are associated with minimal discomfort during dialysis. The downside is that it leaves the patient with an externally protruding catheter, makes bathing difficult, and are prone to infection and clotting. These are placed by vascular surgeons, interventional radiologists, general surgeons, and some nephrologists.

 
AV (arteriovenous) fistulas and AV grafts

AV (arteriovenous) fistulas and AV grafts are surgical procedures that are performed primarily by vascular surgeons but also some general surgeons. In creating an AV fistula, a vein in the arm is directly connected to an artery. The high pressure high flow of arterial blood shunted into the vein causes the vein to dilate and thicken. This than allows the dialysis nurse to place needles in the vein to both withdraw and reinfuse blood for dialysis. An AV graft creates this connection from the artery to the vein using a plastic tube which is placed beneath the skin. The draw back for both is that there is some minor pain involved with placement of needles although this tends to lessen over time. AV fistulas require 8 to 12 weeks to mature before use; AV grafts 2 to 3 weeks. Fistulas are more desirable in that they are less prone to clotting, have a lower infection rate, and when not being dialyzed there is nothing external to interfere with the activities of daily living. AV grafts have a slightly higher infection rate and clotting rate than AV fistulas but there is nothing external when not being dialyzed.