Author: Western Vascular Institute

Carotid Artery Disease: How to Lower Your Risk of Stroke

Are you aware that a stroke is the leading cause of long-term disability in adults in the United States? More specifically, one third of all strokes are due to carotid artery disease. Your two carotid arteries are located on either side of your neck, and their main purpose is to deliver blood and oxygen to your brain. A stroke occurs when blood is interrupted or something slows down the flow of blood. Let’s understand more about carotid artery disease and how to lower your risk of stroke.

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Carotid Endarterectomy

Carotid endarterectomy is a surgical procedure that involves removing plaque buildup from the carotid arteries, which are located in the neck and supply blood to the brain. This blog post aims to provide you with a comprehensive understanding of carotid endarterectomy, including its purpose, procedure, and why you might need one.

What is Carotid Artery Disease?

Before delving into carotid endarterectomy, it’s essential to grasp the concept of carotid artery disease. Over time, the carotid arteries can become narrowed due to the accumulation of fatty deposits called plaques. This condition, known as atherosclerosis, restricts blood flow to the brain, potentially leading to a stroke or transient ischemic attack (TIA), often referred to as a mini-stroke.

Purpose of Carotid Endarterectomy:

Carotid endarterectomy aims to reduce the risk of stroke by removing the plaque buildup from the carotid arteries. By restoring normal blood flow, the procedure helps prevent the development of vascular surgeon in the or.a full-blown stroke or TIA.

Indications for Carotid Endarterectomy:

Significant carotid artery narrowing: Typically, a stenosis of 70% or more is considered significant, but the decision to undergo surgery depends on several factors, including your overall health and the presence of symptoms.
Experienced a recent TIA or minor stroke: If you’ve had a transient ischemic attack or a minor stroke, carotid endarterectomy may be recommended to prevent further, more severe strokes.
Asymptomatic with high-grade stenosis: In some cases, carotid endarterectomy may be considered for individuals without symptoms but with high-grade carotid stenosis (greater than 80%) due to the increased risk of future strokes.

The Carotid Endarterectomy Procedure:

Here’s a general overview of what you can expect during a carotid endarterectomy procedure:

Anesthesia: You will be given either general anesthesia (where you’re asleep) or local anesthesia (where only the neck is numbed).

Incision: A small incision is made in the neck over the affected carotid artery.

Artery Access: The vascular surgeon carefully opens the carotid artery to access the plaque inside.

Plaque Removal: The plaque is removed from the artery, aiming to restore normal blood flow.

Closure: The artery is then closed, and the incision in the neck is stitched or stapled.

Recovery: After the procedure, you will be closely monitored in the hospital for a day or two before being discharged. The recovery period may vary, but most individuals can resume their normal activities within a few weeks.

Carotid endarterectomy is a well-established procedure aimed at reducing the risk of stroke in individuals with significant carotid artery disease. By removing plaque buildup from the carotid arteries, the procedure helps restore normal blood flow to the brain, potentially preventing future strokes. If you’ve been recommended to undergo carotid endarterectomy, it’s crucial to discuss any concerns or questions you may have with your healthcare provider. Remember, the decision to undergo the procedure should be made based on a careful assessment of your individual medical condition and the risks and benefits involved.

The “Five P’s” of Peripheral Vascular Disease

The “Five P’s” of Peripheral Vascular Disease

The “Five P’s” of Peripheral Vascular Disease (PVD) are a set of clinical signs and symptoms used to assess and diagnose vascular compromise in the extremities. These indicators help healthcare professionals evaluate the severity and progression of PVD. The Five P’s include:


Patients with PVD may experience pain in the affected limb, typically described as cramping, aching, or sharp discomfort. The pain may occur during physical activity (intermittent claudication) and subside with rest. In advanced cases, pain may persist even at rest or during the night.


Pallor refers to the pale appearance of the skin in the affected limb. Reduced blood flow due to narrowed or blocked arteries can result in decreased oxygen supply to the tissues, leading to paleness.


Pulselessness indicates the absence or diminished quality of the peripheral pulses in the affected limb. A weak or absent pulse may suggest arterial insufficiency due to PVD.


Paralysis refers to the loss of motor function in the affected limb. Severe PVD, often associated with advanced stages or acute arterial occlusion, can cause muscle weakness or even complete paralysis.


Paresthesia refers to abnormal sensations in the affected limb, such as tingling, numbness, or a “pins and needles” sensation. Reduced blood flow and nerve damage associated with PVD can lead to altered or diminished sensation.

Assessing and documenting the presence of the Five P’s can aid in diagnosing PVD and determining the appropriate treatment course. However, it is important to note that not all individuals with PVD will exhibit all five signs, and the severity of each symptom can vary depending on the extent of the vascular compromise.

Prompt medical evaluation is crucial for individuals experiencing the Five P’s, as it may indicate significant vascular compromise requiring immediate intervention to restore blood flow and prevent potential complications, such as tissue damage or limb loss. Healthcare professionals, particularly those specializing in vascular medicine, use the Five P’s as part of a comprehensive assessment to guide diagnosis, treatment planning, and ongoing management of patients with suspected or confirmed PVD.

Intravascular Ultrasound (IVUS)

Intravascular Ultrasound

Intravascular ultrasound (IVUS) is a medical imaging technique that allows for the visualization of blood vessels from the inside. It involves the use of a tiny ultrasound probe that is threaded into the blood vessels through a catheter, providing detailed images of the vessel walls and structures.

Here’s how intravascular ultrasound works and why it is used in clinical practice:


Insertion of the Catheter:

A catheter, which has a small ultrasound probe at its tip, is inserted into a blood vessel, typically through the groin or the arm. The catheter is carefully guided through the blood vessels until it reaches the area of interest.

Ultrasound Imaging:

Once the catheter is in place, high-frequency sound waves are emitted from the ultrasound probe. These sound waves bounce off the vessel walls and other structures inside the blood vessel.

Image Capture:

The reflected sound waves are picked up by the probe and converted into real-time images. These images are then displayed on a monitor and can be recorded for further analysis.

Benefits and Applications of Intravascular Ultrasound:


Detailed Visualization:

IVUS provides high-resolution, cross-sectional images of blood vessels, allowing vascular surgeons to assess the vessel size, structure, and any abnormalities present. IVUS provides more detailed information compared to other imaging techniques.

Assessment of Atherosclerosis:

IVUS is commonly used in the evaluation of atherosclerosis, a condition characterized by the buildup of plaque inside the arteries. Intravascular ultrasound also helps determine the extent and composition of the plaque, identify areas of vessel narrowing or blockage, and guide treatment decisions.

Guidance for Interventions:

IVUS is often utilized during various vascular procedures, such as angioplasty or stent placement. IVUS provides real-time feedback to guide the placement of devices and assess their effectiveness in improving blood flow.

Assessment of Stent Deployment:

IVUS can evaluate the proper positioning and expansion of stents within the blood vessels. IVUS helps ensure that the stent is fully expanded and properly apposed to the vessel walls, reducing the risk of complications.

Research and Clinical Trials:

Intravascular ultrasound is also utilized in research studies and clinical trials to investigate new treatment approaches, assess the effectiveness of medications, and gather data on vascular conditions.

IVUS is a valuable tool in the field of vascular medicine. It helps vascular surgeons make accurate diagnoses, guide treatment decisions, and monitor the progress of interventions. The information obtained through IVUS enhances patient care by providing detailed insights into the condition of the blood vessels, allowing for personalized treatment plans and improved outcomes.

Transcatheter Deep Vein Arterialization

Transcatheter Deep Vein Arterialization

Transcatheter arterialization of the deep vein system is a minimally invasive procedure used to treat chronic limb-threatening ischemia (CLI). CLI is a condition in which the blood supply to the limbs is severely reduced, leading to pain, ulcers, gangrene, and possibly amputation.


In this procedure, a catheter is inserted into a blood vessel in the groin and threaded up to the deep veins in the leg. A small balloon is inflated at the tip of the catheter to create a new pathway for blood flow. A stent, a mesh tube, is then placed in the new pathway to keep it open.

Deep vein arterialization (DVA) is not a novel procedure;  Creating arterial-venous bypass, reverses venous flow, and limb perfusion can restore after the arterialization. It is however a new use of deep vein materialization in its treatment of Critical Limb Ischemia and its use for patients who are not eligible for other treatments such as angioplasty or surgery.

Deep vein arterialization is performed under general anesthesia. The procedure typically takes about two hours. Patients typically stay in the hospital for one to two days after the procedure.

Side Effects:

The most common side effects of Deep vein arterialization are pain, bruising, and swelling at the injection site. Other potential side effects include bleeding, infection, and blood clots.

Deep vein arterialization is a promising new treatment for CLI. It is a less invasive alternative to surgery and angioplasty, and it has been shown to be safe and effective in clinical trials.

What is Deep Vein Thrombosis?

DVT occurs when a blood clot forms in the deep veins, obstructing blood flow. If left untreated, the clot can break loose and travel to the lungs, causing a pulmonary embolism, a life-threatening complication. This potentially life-threatening condition occurs when a blood clot forms in one of the deep veins, typically in the legs. It is crucial to raise awareness about DVT and its potential risks, symptoms, and prevention strategies.

Understanding DVT:

Deep Vein Thrombosis (DVT) is a condition that often goes unnoticed until it becomes a serious health concernDeep Vein Thrombosis.. Anyone can develop DVT, but certain factors increase the risk, such as prolonged immobility, surgery, pregnancy, obesity, smoking, and a family history of blood clots.

Recognizing the Symptoms:

DVT may present with various symptoms, including leg pain, swelling, warmth, and redness. However, it’s important to note that some individuals may not experience any noticeable signs. If you notice any unusual leg symptoms or suspect DVT, it’s crucial to seek medical attention promptly.

How To Prevent DVT

Fortunately, there are several preventive measures that can significantly reduce the risk of developing DVT. Regular exercise, especially leg movement during long periods of sitting or standing, can improve blood circulation. Maintaining a healthy weight, quitting smoking, and avoiding excessive alcohol consumption also contribute to reducing the risk.

For individuals at higher risk, such as those undergoing surgery or prolonged immobility, preventive measures like wearing compression stockings or taking blood thinners may be recommended. It is important to discuss these options with your healthcare provider.

How DVT Is Diagnosed

If DVT is suspected, diagnostic tests such as ultrasound imaging can confirm the presence of a blood clot. Early diagnosis is crucial for timely treatment and to prevent complications.

How DVT Is Treated

Treatment often involves the use of blood thinners to prevent the clot from growing and to reduce the risk of pulmonary embolism. In some cases, procedures like thrombolysis or placement of a filter in the vein may be necessary to manage the clot effectively.

Raising Awareness and Sharing Knowledge:

By increasing awareness about DVT, we can empower individuals to recognize the symptoms, seek early medical attention, and adopt preventive measures. Remember, DVT can affect anyone, so it is essential to spread the word and educate others about this silent threat.

If you have concerns about DVT or if you fall into a high-risk category, consult with your Western Vascular Institute. Together, we can work towards preventing DVT and promoting healthier lives.


Endovascular surgery

Endovascular surgery, also known as endovascular therapy or intervention, is a minimally invasive procedure performed to treat various conditions within blood vessels, typically in the arteries and veins. Unlike traditional open surgery, which requires large incisions, endovascular surgery involves accessing the affected blood vessels through small punctures or incisions.

What conditions do healthcare providers treat with endovascular surgery?


It is a condition characterized by the buildup of plaque within the arteries, narrowing the vessel and obstructing blood flow. Endovascular procedures like angioplasty and stenting can be performed to open up the blocked or narrowed arteries and restore blood flow.


An aneurysm is a weakened area in the blood vessel wall that bulges or balloons out. Endovascular techniques, such as endovascular aneurysm repair (EVAR) or endovascular coiling, can be used to reinforce the weakened vessel wall or fill the aneurysm with coils to prevent rupture.

Peripheral artery disease (PAD):

PAD occurs when arteries supplying blood to the limbs (usually the legs) become narrowed or blocked. Endovascular procedures like angioplasty, atherectomy, or stenting can be performed to improve blood flow and relieve symptoms.

Deep vein thrombosis (DVT):

DVT is the formation of blood clots in the deep veins, typically in the legs. Endovascular techniques, such as catheter-directed thrombolysis or thrombectomy, can be used to dissolve or remove the blood clot and restore normal blood flow.

Varicose veins:

Endovascular treatments like endovenous laser ablation (EVLA) or radiofrequency ablation (RFA) can be used to close off and seal malfunctioning varicose veins, redirecting blood flow to healthier veins.

Endovascular surgery offers several advantages over traditional open surgery, including smaller incisions, reduced blood loss, shorter hospital stays, faster recovery times, and fewer complications. However, not all conditions can be treated using endovascular techniques, and the suitability of the procedure depends on the specific case and the patient’s overall health. It is essential to consult with a vascular surgeon to determine the most appropriate treatment approach.

How common is vascular disease?

According to recent data, there are approximately 200 million people affected by peripheral artery disease (PAD), one of the most common types of vascular disease. In the United States alone, PAD affects around 8 to 12 million people, with the incidence rising with age. Additionally, another prevalent vascular condition is deep vein thrombosis (DVT), which affects an estimated 900,000 individuals in the United States annually. When it comes to aortic aneurysms, statistics indicate that around 1.5 million people worldwide are living with this condition, with men over the age of 65 being particularly susceptible. These numbers show how common vascular disease is and emphasize the importance of awareness, early detection, and timely treatment to improve patient outcomes.

What happens before endovascular surgery?

During an endovascular procedure, a vascular surgeon uses imaging guidance, such as fluoroscopy or ultrasound, to navigate thin, flexible catheters and medical instruments through the blood vessels to the targeted site. These instruments can be used for diagnostic purposes, as well as for therapeutic interventions.

What happens after endovascular surgery?

After your endovascular surgery, it’s important to continue with follow-up care to ensure your blood vessels heal properly. Before you leave the hospital, your healthcare provider will discuss your post-surgical plan with you. This plan includes regular visits to see your healthcare provider and undergo imaging tests. These visits are designed to check how your blood vessels are healing. Your healthcare provider will review the results of the imaging tests to make sure everything is progressing well. By following through with these follow-up visits and tests, you and your healthcare team can keep a close eye on your recovery and address any issues that may arise, leading to a successful outcome after your endovascular surgery.

Wound Care

Wound Care and the Role of a Vascular Surgeon


Wound care is a critical aspect of healthcare, especially for individuals with underlying vascular conditions. Vascular surgeons play a crucial role in managing and treating wounds, particularly those related to compromised blood flow. In this section, we will explore the significance of wound care and how vascular surgeons contribute to this field.

Understanding Wound Care:

Wounds can occur due to various reasons, such as injuries, surgical procedures, or underlying health conditions. Proper wound care involves a comprehensive approach to promote healing, prevent infections, and minimize complications. Key aspects of wound care include:

Cleaning and Dressing:

Thoroughly cleaning the wound and applying appropriate dressings help create a clean environment for healing. Dressings may vary depending on the type and severity of the wound.

Infection Prevention:

Preventing infection is crucial for successful wound healing. This involves maintaining proper hygiene, using sterile techniques, and administering antibiotics when necessary.


In some cases, removing dead or infected tissue from the wound (debridement) is necessary to promote healing and prevent the spread of infection.

Moisture Control:

Managing the moisture level of the wound is important. Some wounds may require moisture to aid in healing, while others may benefit from dry environments. Healthcare professionals assess each wound’s needs and employ appropriate techniques.

Offloading and Pressure Redistribution:

For wounds caused by pressure, such as pressure ulcers, offloading techniques and specialized devices are used to relieve pressure on affected areas and promote healing.

The Role of a Vascular Surgeon in Wound Care:

Vascular surgeons play a vital role in wound care, particularly when wounds are associated with vascular conditions. Here’s how they contribute:

Diagnosis and Assessment:

Vascular surgeons assess wounds in the context of a patient’s vascular health. They examine blood flow, identify potential circulation issues, and determine if underlying vascular conditions contribute to delayed wound healing.

Vascular Interventions:

In cases where compromised blood flow contributes to poor wound healing, vascular surgeons may perform interventions to restore circulation. This may involve procedures such as angioplasty, stent placement, or bypass surgeries to improve blood flow to the affected area.

Collaborative Care:

Vascular surgeons work closely with other healthcare professionals involved in wound care, such as wound care nurses, plastic surgeons, and infectious disease specialists. They provide expertise on vascular aspects and ensure a comprehensive approach to wound management.

Long-Term Management:

Vascular surgeons not only address the immediate wound care needs but also focus on long-term management. They develop personalized treatment plans to optimize vascular health, prevent future wounds, and promote overall well-being.


Wound care is a critical aspect of healthcare, and vascular surgeons play a crucial role, especially when wounds are associated with vascular conditions. By addressing underlying circulation issues, vascular surgeons contribute to improved wound healing and overall patient outcomes. Their expertise in diagnosing, treating, and managing vascular conditions ensures comprehensive and effective wound care. Collaborative efforts among healthcare professionals involved in wound care result in holistic approaches tailored to individual patient needs. If you have wounds associated with vascular conditions, consulting with a vascular surgeon can provide valuable insights and appropriate interventions for optimal wound healing and vascular health.


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Why are vascular ultrasounds necessary?

Why are vascular ultrasounds necessary?


Detailed Vascular Assessment:

A vascular ultrasound study is necessary because it provides a non-invasive and painless way to evaluate your blood vessels. It helps identify blockages, narrowing, or abnormalities in the arteries and veins throughout your body. This detailed assessment aids in diagnosing various vascular conditions.

Early Detection of Problems:

By undergoing a vascular ultrasound study, potential issues can be detected at an early stage. Early detection allows for prompt intervention and treatment, helping prevent further complications and ensuring better outcomes.

Monitoring Vascular Health:

For individuals with existing vascular conditions, regular ultrasound studies are essential for monitoring disease progression and treatment effectiveness. This consistent monitoring enables vascular surgeons to make informed decisions and adjust treatment plans as needed.

Avoiding Invasive Procedures:

In many cases, a vascular ultrasound study can provide valuable information without the need for invasive procedures. It reduces the need for exploratory surgeries, minimizing risks, discomfort, and recovery time.

Customized Treatment Plans:

The results of a vascular ultrasound study help vascular surgeons develop personalized treatment plans tailored to your specific needs. This individualized approach ensures that you receive the most appropriate interventions, medications, or lifestyle modifications for optimal vascular health.

Preventing Serious Complications:

Conditions like deep vein thrombosis, arterial stenosis, aneurysms, and peripheral artery disease can have severe consequences if left untreated. A vascular ultrasound study aids in early identification, allowing for timely interventions to prevent potentially life-threatening complications.

Empowering Patient Education:

Undergoing a vascular ultrasound study gives you a clearer understanding of your vascular health. By seeing the images and discussing the findings with your vascular surgeon, you can actively participate in your care, make informed decisions, and take proactive steps toward better vascular wellness.

Schedule Your Vascular Ultrasound Study:

If you have risk factors such as diabetes, high blood pressure, smoking, or a family history of vascular disease, or if you’re experiencing symptoms like leg pain or swelling, it’s crucial to discuss the possibility of a vascular ultrasound study with your vascular surgeon. Don’t delay—early detection and prevention are key!


What is Claudication?

Claudication is a medical condition that affects many individuals, causing discomfort and limitations in daily activities. If you experience pain or cramping in your legs during physical exertion, you might be dealing with claudication. In this blog post, we will delve into the causes, symptoms, and treatment options for this condition to help you better understand and manage it.

Causes of Claudication:

The primary cause of claudication is atherosclerosis, a condition characterized by the buildup of plaque in the arteries. Plaque is composed of cholesterol, fat, and other substances that adhere to the arterial walls, causing them to narrow. This narrowing restricts blood flow and triggers symptoms of claudication.

Claudication is a symptom commonly associated with peripheral artery disease (PAD), which occurs when there is a narrowing or blockage in the arteries that supply blood to the legs. The reduced blood flow deprives the muscles of oxygen and nutrients, leading to pain, cramping, or fatigue in the affected leg muscles during activities such as walking or exercising.

Other Potential Causes of Claudication

Blood clots:

Blood clots can obstruct blood flow in the arteries, leading to claudication symptoms.


Inflammatory conditions such as vasculitis can cause damage to the blood vessels and contribute to claudication.

Structural abnormalities:

Rarely, structural abnormalities in the blood vessels or muscles can lead to claudication.

Symptoms of Claudication:

The hallmark symptom of claudication is leg pain or cramping that typically occurs during physical activity and subsides with rest.

Common characteristics of claudication include:

  • Pain, cramping, or fatigue in the calf muscles, thighs, or buttocks.
  • Discomfort that worsens with activity and improves with rest.
  • Numbness or weakness in the affected leg(s).
  • Coldness or paleness in the leg(s).

How Is Claudication Diagnosed and Treated:

If you suspect claudication, it is essential to consult a healthcare professional for an accurate diagnosis. They will review your medical history, conduct a physical examination, and may recommend additional tests, such as:

Ankle-brachial index (ABI):

Measures the blood pressure in the ankle and arm to assess blood flow in the legs.
Doppler ultrasound: Uses sound waves to evaluate blood flow in the arteries.
Angiography: Involves injecting a contrast dye into the blood vessels to visualize any blockages or narrowing.
Treatment for claudication aims to manage symptoms, improve circulation, and prevent further complications. Common approaches include:

Lifestyle modifications:

Quitting smoking, maintaining a healthy weight, regular exercise, and a balanced diet can improve symptoms and overall vascular health.


Your doctor may prescribe medications to manage risk factors like high blood pressure, cholesterol, and blood clot prevention.

Exercise therapy:

Supervised exercise programs that gradually increase physical activity can improve walking distance and decrease symptoms.

Endovascular procedures:

In some cases, minimally invasive procedures like angioplasty or stenting may be performed to restore blood flow in the affected arteries.


Severe cases of claudication that do not respond to other treatments may require surgical interventions, such as bypass grafting, to reroute blood flow around the blocked arteries.

Claudication can significantly impact the quality of life of individuals affected by peripheral artery disease. Recognizing the symptoms and seeking timely medical attention is crucial for proper diagnosis and treatment. With lifestyle modifications, medication, exercise therapy, and, in some cases, medical procedures, claudication symptoms can be effectively managed, allowing individuals to lead a more