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Peripheral Vascular Care

Our specialized physicians (cardiologists, interventional radiologists, heart and vascular surgeons) work closely together to determine the best treatment plan for your vascular disease.  Treatments for heart and vascular disease may require medical management, endovascular (interventional) treatments or surgery and preventative care.  Often your treatments will involve more than one approach.

Test & Diagnostics

Ankle Brachial Index (ABI): A simple, non-invasive
test that measures the ratio of the blood pressure in
your ankle to that in your arm.

Doppler Ultrasound: a non-invasive test using sound
waves to provide an image of the inside of the blood
vessel to determine if a specific artery has plaque buildup.

Angiogram: A special dye is injected into the arteries
under local anesthetic and x-rays are taken to reveal the
arteries and the presence of any narrowing or blockages.

Conditions

Peripheral vascular disease (PVD) or peripheral artery disease (PAD): This condition is caused by the same atherosclerotic plaque ( a build up of fatty deposits in the blood vessels) that causes coronary artery disease (CAD).  This build-up of plaque in the arteries outside your heart (peripheral arteries) reduces the flow of blood. As a result, some parts of your body don't get the oxygen they need. Some of the more commonly affected peripheral areas are the arteries in the legs, arms, kidneys and neck (that supply to the brain). Some patients may have both coronary artery disease and peripheral vascular disease. 
Symptoms may include the following:

  1. Claudication (dull, cramping pain in hips, thighs or calf muscles during exertion or exercise)
  2. Buttock pain
  3. Changes in skin color (pale bluish or reddish discoloration)
  4. Changes in skin temperature; coolness
  5. Impotence
  6. Infection/sores that do not heal
  7. Ulceration or gangrene
  8. Kidney failure
  9. Uncontrolled hypertension (high blood pressure)
  10. Blurred vision or temporary blindness

Aneurysms: These are arteries which have enlarged or widened.  They can rupture leading to bleeding of the blood supply can stop and clot off the artery and cause gangrene.

Venous Disease: This condition is a result of poor blood return back to the heart.  This includes several related problems such as: acute venous thrombosis (phlebitis); Pulmonary embolism (venous clots moving to the lungs); chronic venous hypertension including leg swelling, pain and ulceration; varicose veins and spider veins

Thoracic Outlet Syndrome: This condition is a result of compression of nerves and blood vessels in the upper chest and arm by structures of the shoulder and the neck.  Symptoms include pain, numbness in the hands or arms, swelling of the arm, discoloration of fingers, blood clots in arteries or veins of the arm.
Treatments & Surgeries

Medication Management: Medications can be used alone or in combination with one of the treatments.  While medications do not eliminate the narrowing of arteries, they can help improve the efficiency of the heart and reduce symptoms such as chest pain, leg pain/claudication, and high blood pressure (hypertension).  Some medications may be used to thin the blood. 

Physical therapy and Exercise: This therapy is useful for treating and preventing conditions such as claudication and thoracic outlet syndrome.  Your doctor or physical therapist will prescribe an exercise plan for you based on your condition and symptoms.

Aneurysm repair: An aneurysm is a widened and weakened area of a blood vessel.  Over time that area can get bigger and rupture. Aneurysms are repaired or replaced with synthetic grafts or your own veins to bypass the widened or weakened area.. Aneurysm repairs can be done either surgically (cutting into the skin) or by using special catheters, stents and grafts.

Bypass Surgery: Peripheral bypass surgery uses either a synthetic graft material or harvested veins to provide blood flow around diseased areas in the lower extremities.

Endarterectomy: This is a surgical procedure that removes plaque from the artery. The artery may be closed using a patch of your own vein or synthetic material. 

Angioplasty: A special dye injected into the arteries under local anesthetic and x-rays are taken. The dye shows up on the x-rays, revealing the arteries and the presence of any narrowing or blockages. Next, a wire is inserted inside the guiding catheter into the artery and through the area of the narrowing or blockage. A catheter with a deflated “balloon” on its tip is then guided over the wire and positioned within the blocked artery. Once the balloon catheter is in place, the balloon is inflated to compress the fatty material called plaque, which is creating the blockage, against the walls of the artery. Once the artery is open with the balloon catheter, a tiny, flexible, stainless steel tube called a stent is used to help keep open a narrowed blood vessel. Then the balloon is deflated and removed, leaving the stent in the artery.

Foot care: A person with peripheral artery disease and diabetes may develop poor circulation or neuropathy. The diabetic foot requires special care because decreased circulation and loss of nerve sensitivity can result in many foot complications. Major foot problems can be avoided by following specific recommendations to care for your feet.