Vascular Services

Aortic Disease

aorta-in-body1The aorta is the largest blood vessel in the body. It originates from the left ventricle of the heart and courses up through the chest than down into the lower half of the body. It provides direct branches to all the limbs and major organs. The wall of the aorta, as in all arteries, consists of three layers known as the adventitia (outer), media (middle), and intima (inner).  The aorta can be affected by aneurysmal disease, dissection, and atherosclerosis.

Aneurysmal disease is very closely associated with cigarette smoking. In aneurysmal disease, degradation of the protiens that make up the arterial wall results in loss of elasticity and dilation of the artery as the wall remodels. As the aorta dilates, the wall weakens and there is a risk that it may rupture. The risk for rupture increases with size. In the ascending aorta this may also affect how blood

leaves the heart by way of the aortic valve. In the descending thoracic (chest) portion and abdominal portions of the aorta the more common problem is rupture. The descending thoracic aorta should be evaluated for surgical treatment when it reaches 6 cm and the abdominal aorta when it reaches 5 cm. There are currently minimally invasive treatment options for both. Our practice is certified to offer both therapies.
Carotid Artery Disease and Stroke

There are two carotid arteries, left and right. The left is a direct branch of the aorta, the right originates from a primary branch of the aorta called the brachiocephalic artery.  The artery than divides into the internal and the external carotid artery. The internal carotid artery flows directly to the brain. The external carotid artery supplies the face. This fork is a common site for atherosclerosis, an inflammatory buildup of plaque that can narrow the common or internal carotid artery. The plaque can be stable and asymptomatic, or it can be a source of embolization. Emboli (small pieces of atheroma) may break off from the plaque and travel through the circulation to blood vessels in the brain, blocking these vessels causing ischemia (loss of blood flow). This ischemia can either be temporary giving a transient ischemic attack (small temporary stroke), or permanent resulting in a major stroke. Carotid disease accounts for roughly one-third of all strokes.

DVT, Blood Clots, and Thrombophlebitis

In medicine, deep vein thrombosis (also known as deep venous thrombosis and usually abbreviated as DVT) is the formation of a blood clot ("thrombus") in a deep vein. Deep vein thrombosis commonly affects the leg veins (such as the femoral vein or the popliteal vein) or the deep veins of the pelvis. Occasionally the veins of the arm are affected. A DVT can occur without symptoms, but in many cases the affected extremity will be painful, swollen, red, warm and the superficial veins may be engorged. The most serious complication of a DVT is that the clot could dislodge and travel to the lungs, which is called a pulmonary embolism (PE). DVT is a medical emergency. Limb swellings however trivial, should be evaluated for DVT.

Dialysis Access Creation/Maintenance

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.

Lower Extremity Arterial Disease

Peripheral artery disease, also known as peripheral vascular disease or atherosclerosis, is the end result of the accumulation of atheromatous plaques within the walls of the leg arteries that supply the muscles of the leg with oxygen and nutrients. 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.

Renal and Mesenteric Artery Disease

The renal arteries normally arise off the side of the abdominal aorta, immediately below the superior mesenteric artery, and supply the kidneys with blood. Each is directed across the crus of the diaphragm, so as to form nearly a right angle with the aorta.  The renal arteries carry a large portion of total blood flow to the kidneys. Up to a third of total cardiac output can pass through the renal arteries to be filtered by the kidneys.  The arterial supply of the kidneys is variable and there may be one or more renal arteries supplying each kidney. It is located above the renal vein. Supernumerary renal arteries(two or more arteries to a single kidney) are the most common renovascular anomaly, occurance ranging from 25% to 40% of kidneys.


Varicose Veins

Varicose veins are veins that have become enlarged and tortuous. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere. Veins have bivalve leaflet valves to prevent blood from flowing backwards (retrograde). Leg muscles pump the veins to return blood to the heart, against the effects of gravity. When veins become varicose, the leaflets of the valves no longer meet properly, and the valves do not work. This allows blood to flow backwards and the veins enlarge further. Varicose veins are most common in the superficial veins of the legs, which are subject to high pressure when standing although you can have failure of the valves within the deep veins of the leg as well. Besides cosmetic problems, varicose veins are often painful, especially when standing or walking. Serious complications are rare.

Vascular Disease Screening

In order to confirm a cerebrovascular disease, few additional tests may be required whenever there are doubts in what the diagnosis concerns. These may include tests such as the cerebral angiography (carotid angiogram). This test is made by inserting a catheter into the patient's artery in the leg with the help of a needle through the vessels in the abdomen and chest, until it reaches the arteries of the neck. The coronary angiogram is basically the same procedure which is however utilized for detecting cardiovascular conditions. The carotid duplex (carotid ultrasound) is another type of noninvasive

Venous Insufficiency and Venous Ulcers

As functional venous valves are required to provide for efficient blood return from the lower extremities, CVI often occurs in the veins of the legs. Itching (pruritis) is sometimes a symptom, along with hyperpigmentation of the legs. Symptoms of CVI include phlebetic lymphedema and chronic swelling of the legs and ankles. The skin may react with varicose eczema, local inflammation, discoloration, thickening, and an increased risk of ulcers and cellulitis. The condition has been known since ancient times and Hippocrates used bandaging to treat it. It is better described