Author: Western Vascular Institute

Vascular Surgeons the real “vascular specialists”

If you only have a hammer you tend to see every problem as a nail.

Some vascular “specialists” perform one or two kinds of vascular interventions, so their patients tend to get those treatments. Vascular Surgeons are trained in all treatment modalities and are able to perform every type of procedure skillfully: open, complicated surgery and minimally invasive, in-office endovascular procedures. Some patients need one, some need the other, while many need no surgery at all. Vascular Surgeons are “treatment agnostic,” that is, they do not prefer any treatment over another.

Some types of surgeons come into your life to perform a procedure, make sure you heal and then leave; that’s their role. A vascular surgeon may be someone who treats you on an ongoing basis for decades. A vascular surgeon very often has long-term relationships with patients because vascular disease can be a long-term condition.

At Western Vascular Institute, patients will get the best treatment for their particular needs in a caring and safe environment by a vascular surgeon with a full toolbox of treatment options!

Ankle Brachial Index

An ankle-brachial index is a simple and non-invasive test performed to diagnose peripheral vascular disease. The index compares the blood pressure of the legs and arms and creates a ratio that shows the availability of blood to flow freely from one extremity to the other. The ABI is calculated by dividing the systolic blood pressure at the ankle by the systolic blood pressure in the arm.

During this test, patients lie on their back and a technician places blood pressure cuffs on the ankles and arms. The machine then inflates the cuffs alternating to get the ratio. This test may include exercise by walking on a treadmill for several minutes in order to simulate when a patient would feel pain due to peripheral artery disease and then takes the reading afterward to understand the severity of the said disease.

Peripheral Artery Disease

 

Artery

  •  An artery is a blood vessel that carries blood from the heart to other parts of the body.
  • Arteries are thicker than veins and have more robust, more elastic walls.
  • Arteries sometimes develop plaque within their walls in a process known as atherosclerosis.
  • These plaques can become fragile and rupture, leading to complications associated with diabetes, such as heart attacks and strokes.

Peripheral arteries

  • Peripheral arteries send oxygen-rich blood to all parts of the body.
  • In PAD, plaque builds up in the artery walls.
  • Just like coronary artery disease, plaque narrows the arteries and leaves less room for blood to flow through. 
  • If your legs do not get enough oxygen and nutrients, they will feel sore or tired when you walk or climb stairs.
  • Having PAD raises your chances of a heart attack or stroke.
  • With PAD, not enough oxygen-rich blood and energy can pass through the arteries due to narrowing. 


The following symptoms may indicate the disease:

weakness in legs; numbness or cramping in legs with walking; legs may feel cold; color change, dark pink, purplish, dusky.

The symptoms may be present or absent but are due to a lack of blood flow to the muscle group, resulting in pain in the affected muscle groups. However, if the individual has diabetes or neuropathy, they may not feel the pain.

The presence of an extremity ulcer is one of the more obvious clinical signs of poor circulation. Other common symptoms: pain with walking a short distance; pain at rest when legs are elevated, but lessens when legs are dangled over the side of the bed or sofa.

Additional warning signs:

  • If you have poor circulation, it will typically begin in your legs first
  • Pain in the calf muscles when you walk (claudication) is the most common symptom
  • Poor wound healing or decline in the pulses in your feet
  • These symptoms may indicate severe blockages in the vascular system
     

Peripheral Vascular Disease

 

What is Pelvic Congestion Syndrome?

Pelvic congestion syndrome, also known as vulvar varicosities or ovarian reflux, is a common cause of chronic pain in up to 40% of women. PCS is caused by dilation of the ovarian and Pelvic veins in the lower abdomen. The typical age range when a woman develops PCS is from age 20-45 years old.

Symptoms:

  • Pelvic or low back pain that increases after long periods of sitting or standing
  • Pain after intercourse (dyspareunia)
  • Pain before the menstrual cycle
  • Visible varicose veins around the vulva, vagina, inner thigh, and sometimes the buttocks and legs
  • Painful menstruation (dysmenorrhea)
  • Abnormal bleeding during menstruation
  • Fatigue, depression
  • Swelling of the vagina or vulva
  • Abnormal tenderness, increased urination, hip pain, and dragging sensation
  • 50% of women with PCS have cystic ovaries

Diagnosis:

  • Transvaginal Ultrasounds (the Gold-Standard test)
  • Magnetic Resonance Imaging (MRI)
  • Computed Tomography (CT) will provide visualization of incompetent veins and allow for a proper treatment plan
  • Pelvic Venography is used to provide a definitive diagnosis and provide treatment at the same time

Risk factors:

  • Pregnancy
  • Hormones
  • May-Thurner Syndrome ( Compression of the left Iliac vein by the right iliac artery )
  • Left renal stenosis
  • Tumors
  • Fibroids
  • Endometriosis, or scarring.

Treatment

  • Medications such as NSAIDs or non-steroidal anti-inflammatory drugs, chronic pain medications such as gabapentin and amitriptyline may be used to treat PCS.
  • Surgical intervention: Ovarian / pelvic vein coil embolization treatment. A catheter is placed into the vein wherein coil emboli (Small medical-grade spheres) are placed into the affected vein blocking the flow of blood in that area, allowing the blood to reroute through healthier veins. This procedure can be done in an outpatient setting and has a 98% success rate and a decrease in pain of 83% of patients in long-term follow-up.

What Causes A Stroke?

Strokes are caused by an interruption of blood flow to the brain and are classified by the type of blood flow interruption as listed below.

 

Ischemic stroke – occurs when blood vessel blockage prevents blood flow to the brain due to a plaque build-up in the carotid arteries.

Hemorrhagic stroke – occurs when the vessel ruptures inside of the brain and bleeds.

Transient Ischemic stroke or TIA – is a temporary blockage or mini-stroke which can cause permanent damage and are a sign of more severe stroke in the future.

Like Peripheral Arterial/Vascular Disease, Carotid Artery Disease is a narrowed blood flow through the vessel. This narrowing or blocked vessel becomes occluded by fatty deposits of plaque built up along the vessel wall leading to atherosclerotic disease. The Carotid artery is the primary source of blood to your brain. Therefore, a narrowing or blockage in the carotid artery is a serious complication and requires thorough and appropriate diagnosis and treatment.

Symptoms

Many people with Carotid Artery Disease do not experience symptoms even with quite a bit of arterial blockage. Generally, this condition is found after the patient experiences a stroke or by a routine patient examination.

Causes

Generally, Carotid Artery Disease is caused by atherosclerosis, where a build-up of plaque in the arteries reduces the flow of blood or blocks the flow entirely. This lack of blood flow and reduced oxygen supply to the brain can lead to stroke.

Risk Factors include:

Sedentary lifestyle, Overweight obesity, Diabetes, smoking, high cholesterol levels, high blood pressure, Family history, high fat diet, and age above 75 are all factors.

Diagnosis

Diagnosis of Carotid Artery Disease is generally diagnosed through thorough physical examination and medical history. Your physician will also most likely be looking for a (bruit) swooshing sound in the carotid artery that is indicative of a narrowed artery. A Carotid Artery duplex ultrasound scan will also be performed to assess the flow of blood through the artery as well as the pressure.

Treatments

The reason for the treatment of carotid artery disease is to reduce or mitigate the possibility of stroke.

For mild blockage:

Lifestyle changes such as eating a healthier diet, reducing salt intake, exercising regularly, losing weight, and quitting smoking are all ways that patients themselves can manage the disease and reduce the chance of blockage and stroke.

Medication management:

Medications may be given to lower the amount of cholesterol in the blood and lower your blood pressure. Additionally, blood thinner medications may be given to prevent blood clots.

Surgical intervention:

Carotid endarterectomy – generally performed when there is a blockage of 50% or above accompanied with symptoms such as a stroke.

TCAR – Western Vascular Institute is pioneering the use of a breakthrough technology called TransCarotid Artery Revascularization (TCAR) to treat patients with carotid artery disease who are at risk for open surgery. While any repair of the carotid artery carries some risk of causing a stroke because of the repair itself, TCAR was designed to help minimize that risk by keeping potential stroke-causing fragments away from the brain.

Carotid angioplasty/stenting – This procedure is performed to treat narrowed or occluded carotid arteries. In this procedure, the Vascular Surgeon inserts a wire through the groin and guided via x-ray imaging to the carotid artery. Once there, the balloon is placed to expand the narrowed section, and a stent is left in place afterward to maintain the vessel diameter and allow the blood to flow through the artery.

 

 

What is Claudication?

Claudication, also referred to as intermittent claudication, is pain caused by reduced blood flow to the lower extremities.  Claudication is a symptom of the disease called Peripheral artery or peripheral vascular disease (PAD or PVD) rather than a disease itself.

Claudication can cause:

  • Pain in calves, thighs, feet, or other parts of the lower extremities
  • Pain at rest, that gets worse with movement
  • Discolored skin
  • Weakness in leg
  • Aching or burning sensation in extremities

Radio-Frequency Ablation for Varicose Veins.

 

Radiofrequency closure, also known as radiofrequency ablation, addresses the venous reflex disease that often causes varicose veins. It serves as an alternative to traditional vein stripping, which requires invasive surgical removal of the diseased veins. Instead, radiofrequency ablation uses heat energy to prompt the closure of diseased veins.

The surgeon starts by numbing the area with a topical and local anesthetic. Then, by way of a small incision, he or she passes a catheter or similar tool into the affected vein. The catheter serves as a channel through which the surgeon introduces an electrode.

When the surgeon pulls back on the catheter to expose the end of the fiber or electrode, energy passes into the vein as heat. This heat shrinks the collagen in the vein wall, which in turn causes the vein to shrink and close. The surgeon then removes the catheter and the patient’s body proceeds to heal the closure by rerouting blood to healthy veins.

 

Sclero-Therapy for Spider Veins.

 

Sclerotherapy is a minimally invasive procedure performed by injecting a saline solution into the varicose vein. This irritation to the vein causes the defective vein to collapse.

The body reroutes the blood supply to bypass the damaged vein, which is eventually reabsorbed into the body.

To begin a typical sclerotherapy procedure, a physician uses a fine needle to inject the salt solution into the vein itself.

Any discomfort felt is most often mild and resolves in less than two minutes, though the full procedure may take up to half an hour.

This may include injection into multiple veins, depending on the location and size of the affected vessel.

Most patients undergo the procedure in an outpatient setting and can drive themselves home afterward.

 

Arteriovenous Fistula Creation

 

An Arteriovenous fistula or AV Fistula creation is a surgical connection made by a Vascular Surgeon between an artery and a vein for a patient diagnosed with End-Stage Renal Disease or ESRD. Typically they are located in the arm and are created to allow for long-term Hemo-Dialysis access. AV Fistula connections are the preferred access method for patients needing long-term dialysis because of their long-term functionality.

The Joint Commission Gold Seal Of Approval / Certification

The Joint Commission?

What is it?

The Joint Commission is an independent non-profit organization that accredits and certifies healthcare organizations in the United States. A Joint Commission accreditation and Gold Seal of approval is a symbol of Quality and Excellence that reflects an organization’s commitment to meeting and exceeding performance and safety standards.

Why should you care?

Hospitals are required to be joint commission accredited in order to provide the safest and appropriate care for their patients. But Accreditation is not required for outpatient centers such as Western Vascular Institute. Western Vascular requests these audits and subjects themselves to intense scrutiny to show our patients our continued commitment to quality care & outcomes in vein and artery treatments.

Are All Vein and Vascular centers accredited?

No, in fact, Western Vascular Institute is the only Vein and Vascular group in Arizona providing in-office care, dedicated to peripheral vascular disease accredited by The Joint Commission.

We believe that quality is the result of excellent work without compromise.

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