Answers to the most frequently asked questions about various Vascular Diseases
Coastal Vein and Vascular Specialists want to make sure you have all your questions addressed about your vascular disease. Below are the most commonly asked questions about various vascular diseases. If you need additional information, please feel free to contact us at:
Carotid Artery Disease
The carotid arteries are two main arteries that feed blood from your heart to the brain. These arteries course along the front of the neck on both sides. These arteries are at risk for developing a blockage as we age. This blockage is from plaque - the same plaque that develops in the heart and can cause a heart attack, can also form in the carotid arteries. Risk factors for developing carotid artery disease are smoking, coronary artery disease, renal insufficiency or failure, diabetes, prior family history of stroke, and age.
Is a blockage in the Carotid Artery serious?
Most blockages in the carotid artery can be monitored with a periodic ultrasound. If the blockage becomes severe, it can increase your risk of a stroke. If this occurs, treatment may be required to reduce your risk of stroke. Treatment can be either surgery or a stent – this depends on your particular disease and other medical risk factors. If your blockage is not severe, we will prescribe certain medications to reduce the risk of stroke by suppressing inflammatory changes that often occur with this blockage. These medications will not prevent the blockage from getting worse with time.
What are the symptoms of carotid artery disease?
Unfortunately, carotid artery disease is a silent disease process. The first clinical sign of carotid artery disease is a stroke or Transient Ischemic Attack (TIA), often referred to as a mini-stroke. However, Carotid artery disease can be found prior to symptoms of stroke or mini-stroke. This can be found through a good thorough physical exam, as well as through an ultrasound of your carotid arteries.
If you have any of the above stated risk factors, ask your doctor about being evaluated for carotid artery disease.
What is an Aneurysm?
An aneurysm is an abnormal enlarging of one of the blood vessels in your body. An aneurysm can occur in the Aorta in your abdomen, or chest. Other common areas an aneurysm can form is in the small arteries in your brain.
Abdominal aortic aneurysms (AAA) and thoracic aortic aneurysms (TAA) can be a serious health risk! If they get to large, they can rupture and cause serious internal bleeding and death.
8.2% of all patients that have had a procedure for coronary artery disease will have an aneurysm.
Other common causes for aneurysm formation are current or history of smoking and family history of aneurysm.
What are the symptoms of an aneurysm?
Unfortunately, most aneurysms to not have any symptoms. They are often found incidentally via ultrasounds or CT scans that were performed for other reasons. If an aneurysm does become symptomatic, pain is the most common symptom. For symptomatic abdominal aortic aneurysms (AAA), the pain may occur in the lower back or deep in the pelvis. For symptomatic thoracic aortic aneurysms (TAA), the pain may occur in the upper back or chest. The symptoms of pain from these aneurysms may be the result of the aneurysm sac being under tight pressure, or in the process of rupturing. If you know you have an aneurysm and experience any of these symptoms, call 911 immediately and get to the closest hospital! You may need emergent surgery to fix this problem.
What do I do for an asymptomatic aneurysm?
Aneurysms require periodic monitoring with either an ultrasound or a CT scan. Once an aneurysm becomes large enough, it will require surgical intervention. Most aneurysms can be fixed with a stent using small wires and catheters. However, some complex aneurysms will require an open operation. Please discuss options with your Vascular Specialist.
When should I be screened for an aneurysm?
In 2014, Medicare came out with very specific criteria for high risk patients that will require a AAA screening via an ultrasound. This ultrasound should be performed by a registered vascular technologist that is qualified to perform vascular ultrasounds. If you are a Male and has ever smoked 100 cigarettes at any point in your life, or if you have a first degree relative that had an aneurysm, you qualify for a free AAA screening ultrasound with your welcome to Medicare packet. If you are a Female and have a first degree relative that had an aneurysm, you would qualify for a free AAA screening ultrasound with your welcome to Medicare packet.
When does my aneurysm need to be treated?
Aneurysms do not need to be treated until they meet certain size criteria, or if there is evidence of a rapid rate of growth over a short period of time. Most aneurysms can be treated with a stent using small wires and catheters. Some aneurysms, however will require an open operation. Your vascular surgical specialist can discuss this topic with you in greater detail at your office appointment.
What is Peripheral Artery Disease or PAD?
Peripheral artery disease is a process where plaque can build up in the arteries in your leg. Over time this plaque can get worse and a blockage can form. This blockage in your leg can lead to symptoms of various severity. This can also be called peripheral vascular disease (PVD) by many doctors.
What are the symptoms of Peripheral Artery Disease (PAD, PVD)?
Early signs of PAD/PVD is muscle cramping with walking and this cramping is relieved with rest. How the process works is this: When you walk and use your muscles, your muscles require more oxygen carrying blood. If there is a blockage in your leg preventing the blood from reaching the muscle, the muscle will start to cramp. As you continue to walk, the cramping will continue to get worse. When you stop and rest, you are not using your muscles and the cramping goes away. When you start walking again, the cramping symptoms can recur. This process is often referred to as Claudication. The degree of claudication and time of onset (how far you walk) will vary depending on how severe the blockage in your leg is. The greater the severity of the blockage, the sooner the time of onset of the muscle cramping. Also, the claudication symptoms may be worse when walking uphill.
If the blockage in the leg is not treated in timely manner, the blockage can progress and get worse. As this blockage gets worse, the symptoms in the leg and foot may get more severe. In the more advanced stages, patients may experience foot pain even at rest. And the pain can be worse if the foot is elevated. Some patients need to dangle the leg over the side of the bed to get relief from the pain.
As the peripheral vascular disease continues to get worse, ulcers or wounds may form on the foot or toes. This is the most advanced stage of peripheral artery disease called Critical Leg Ischemia (CLI). This critical state of poor blood flow to the foot puts the patient at serious risk for a toe amputation or major leg amputation – either with a below knee amputation, or above knee amputation. In this scenario, we will put the patient in our dedicated Amputation Prevention Program where we use a team of specialists from Coastal Vein and Vascular, as well as other physicians including podiatrists, wound care physicians, infection disease physicians who will work diligently to prevent an amputation. This often takes several weeks to months for these wounds to heal. But through a dedicated program provided at CVVS, we can be successful at preventing an amputation!
What are the muscles in my leg where can I feel PAD/PVD?
The muscles affected by PAD/PVD will vary depending on where the blockage is. The most common muscles involved are the calf muscles. Also, the thigh muscles or buttock muscles can be affected as well.
What are the risk factors for developing PAD/PVD?
The most common risk factors for developing PAD/PVD are:
History of Smoking
Renal insufficiency or failure
High Blood Pressure
What are the treatment options?
Our vein clinic specialists are committed to the most advanced minimally invasive treatment techniques for treating PAD. Most cases are able to be treated with an endovascular procedure using small wires and catheters to get across the blockage. There are many minimally invasive endovascular treatment options available – including balloon angioplasty of the blockage, placement of a stent in the leg, or performing an atherectomy in the leg which is sort of like using a Rota-Rooter device to clear the plaque from the leg. Most often, we need to use a combination of all these during a single procedure. The procedure is often performed as an outpatient. You can go home the same day! We usually require two days of rest after the procedure with no heavy lifting or strenuous activity. After which you may resume your normal daily activities.
Rarely, and in the most severe of cases, we need to perform a surgical bypass where we route blood from one area of the leg to a different area of the leg. This requires hospital admission for several days and may require several weeks of recovery.
What is a Fistula for Dialysis?
If you have kidney disease, you may be at risk eventually developing chronic kidney failure and need long term hemodialysis. In this case, you will require a dialysis access procedure in order to be able to get dialysis. This procedure may be insertion of an arterio-venous fistula (AVF), or arterio-venous graft (AVG) into your arm. We will always try to perform the AV Fistula first. An AV Fistula provides the lowest risk of complications and longest patency rate. However, you must have an adequate sized vein for us to use for the AV Fistula. We can determine the size of your veins in our vascular ultrasound lab in our office.
If an adequate sized vein cannot be found in your arm on the ultrasound evaluation, the surgeon may be required to use an artificial graft and place an AV Graft in your arm.
If you have any additional questions or concerns about any vascular frequently asked questions, please feel free to give us a call or schedule an appointment.