Your venous system is made up of a network of veins including superficial veins (veins located close to the surface of the skin) and deep veins (larger veins located deep in the leg) and perforator veins which connect the superficial veins to the deep veins. After the arteries deliver blood to all of your extremities, the veins carry the blood back to the heart. Muscle contractions and one way valves help move the blood towards the heart. When these valves do not open and close properly, the blood can pool in the veins especially in the legs secondary to gravity. The veins become enlarged/engorged and are called varicose veins. Spider veins are the smaller veins on the surface of the skin that are sometimes red or purple and prominent. Varicose veins can be more than just unsightly they can be downright painful! They are often the cause of leg pain and swelling. You may also feel a heaviness in the legs along with aching, burning, throbbing, itching, cramping, restlessness and/or fatigue of the legs. There are usually two options for spider veins, conservative treatment such as compression stockings and leg elevation if that doesn’t help then a procedure known as sclerotherapy to remove the veins. Sclerotherapy involves injecting a sclerosing agent into the tiny veins and thus obliterating them making these veins disappear. This procedure is performed in our office and is usually quick and painless. Phlebectomy is used to treat varicose veins that are unsightly and painful. It is performed as an outpatient in the operating room through a number of tiny incisions. Reflux of the Great Saphenous Vein in the lower extremities is treated by a VNUS closure procedure performed in our office. This procedure uses ultrasound guidance to place the Closure catheter into the vein through a small opening in the skin. The catheter is then powered by radio frequency energy which delivers heat to the vein wall. The vein wall shrinks and the vein wall is sealed closed. When the diseased vein is closed blood is re-directed to other healthy veins. Another procedure for larger veins is called stripping and ligation which is performed in the hospital as an outpatient. This procedure involves a small incision in the groin and distally in the leg and stripping of the entire vein. Post operative recovery will only take a few days.
Peripheral Arterial Disease- PAD
Arteries in your body carry oxygen rich blood away from your heart to your arms and legs. Healthy arteries are smooth and unobstructed and allows blood to flow freely to your arms and legs providing oxygen, glucose and other nutrients that your body needs. PAD is caused by plaque build-up in the arteries making them narrow or obstructed. The narrowing of the arteries to the legs and arms limits blood flow.
If left untreated PAD can cause pain or aching in your legs while walking which is called claudication. It can also result in rest pain in your feet/toes at night while in bed, non-healing ulcers or infection and eventually can lead to gangrene and limb loss/amputation. Usually an ultrasound study can document PAD. PAD is treated with medical management, minimally invasive endovascular procedures like angioplasty and stenting or in more serious cases open bypass procedures.
Abdominal Aortic Aneurysm- AAA
This is an enlargement or “bulge” that develops in a weakened area within the largest artery in the abdomen. The pressure generated by each heartbeat pushes against the weakened aortic wall, causing the “bulge” or aneurysm to enlarge. If the AAA remains undetected the aortic wall continues to weaken and the aneursym continues to grow. Eventually the aneurysm becomes so large and weak that the wall ruptures. If this happens massive internal bleeding occurs and it is usually fatal. AAA can be diagnosed early by a diagnostic ultrasound. Most people do not have any symptoms and an AAA is most often detected when testing is conducted for other medical reasons. Symptoms may include a pulsating feeling in the abdomen, unexplained or severe pain in the abdomen or lower back. Medicare offers qualified seniors a one-time AAA ultrasound screening as part of their welcome to medicare physical. This physical must be conducted during the first 12 months of enrollment. If you are diagnosed with an AAA you will be advised if conservative treatment including an ultrasound yearly or surgery is indicated based on the size of your aneurysm. If surgery is needed there are two options. The minimally invasive endovascular repair or open repair. Depending on the size of the aneurysm, technical aspects, your age and overall medical condition the doctor will advise you which procedure is best for you.
Carotid Artery Disease- Stroke
Carotid Artery Disease (CAD) results from atherosclerosis of the internal carotid arteries which supply blood to the brain. It is a leading cause of strokes. The carotid arteries may become narrow or obstructed, limiting blood flow to the brain. When the blockage is severe it can cause a stroke. Sometimes patients will experience a “mini stroke” called a transient ischemic attack (TIA) as the first sign of carotid artery disease. Symptoms may include visual changes, difficulty with speech, or trouble moving the arms/legs. With TIAs the symptoms are similar to a stroke but the they resolve usually within minutes/hours. If you have experienced a TIA you should seek immediate medical attention. A stroke occurs when part of the brain is damaged due lack of oxygen. Depending on the severity a stroke can be fatal or leave a devastating impact on the patient. Some survivors are left with significant functional deficits such as paralysis of an arm or leg, inability to speak or blindness. Strokes are the 3rd leading cause of death in the US according to the National Center for Health Statistics. CAD can be easily and accurately diagnosed with an ultrasound scan (carotid duplex) that is simple, painless and takes only a few minutes. In the event you are diagnosed with carotid disease you will be advised if you will require conservative care with yearly Ultrasounds or surgery which may be an open procedure (carotid endarterectomy) or an angioplasty and stent depending on the severity of disease and your overall medical condition.
The functions of the kidneys are to cleanse the body of waste products and regulate the amount of water and electrolytes in the blood . Dialysis helps patients whose kidneys no longer function. In order to go on dialysis(hemodialysis or peritoneal dialysis) patients need special access which can be placed only by a vascular surgeon. Peritoneal dialysis is conducted through a small tube surgically placed in the lower part of the abdomen. In Hemodialysis, blood is removed through a needle and cleansed by running it through a dialysis machine. The blood is returned to the body though a second needle. Inorder to clean/filter the blood in a relatively short amount of time a large volume of blood needs to be cycled through the dialysis machine. This can only be done if a vascular surgeon creates an arteri-venous fistula or graft in your arms. Catheters can be placed into a large vein in the neck area temporarily in case of emergent dialysis. There is a increased risk of infection and venous stenosis with long term catheter use. A better solution is the creation of an Arterio-venous fistula where an artery and vein are sewn together. Arteries carry the blood at high pressure from the heart and the veins collect the blood and carry it at low pressure back to the heart. Attaching the artery to the vein causes the vein to balloon out as high pressure blood flows directly into it from the artery. The fistula takes several weeks before it can be used for dialysis. Sometimes the patient requires an arteriovenous graft (AVG) when they have poor veins in their arms. Synthetic conduit/graft is used to connect the vein and artery and dialysis can be performed by puncturing the graft with the dialysis needles. An AVG is ready for use in approximately 2 weeks.
Patients sometimes need access for medical drug therapy such as chemotherapy or long term antibiotics. A catheter or port (portacath or mediport) can usually be placed in the chest wall which can then be used on a daily or weekly basis for medications, fluids and blood work. Once treatment is completed the catheter/port can be removed. Both the insertion and removal of a catheter/port is an outpatient procedure at the hospital.