November is Diabetes awareness month. The risk of dying from a vascular disease with diabetes is 3-4 times higher than those without diabetes. It is extremely important for individuals with diabetes to be seen by a vascular surgeon and get the care they need and deserve!
Western Vascular Institute is excited and honored to announce that we have been chosen as 1 of only 6 locations globally to apply a new intravascular ultrasound technology, the IntraSight Mobile IVUS by Philips.
This amazing new technology provides smart, accurate images inside vessels allowing vascular surgeons the ability to more accurately visualize, plan, diagnosis, and treat peripheral vascular disease during interventional procedures.
We are grateful for this opportunity to be a part of the rollout of this new device. It is not only an incredible honor, but it also shows the caliber of Doctors and staff here at Western Vascular Institute.
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.
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.
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.
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 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.
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.
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.
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.
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.
A Vascular Ultrasound or Duplex study is a non-invasive test performed to evaluate a patient’s blood flow through the arteries and veins. The test provides Vascular Surgeons with the information they need to provide a diagnosis and set a course of treatment for each patient. All the ultrasound technicians at Western Vascular Institute are trained specifically in Vascular sonography, and the IAC Intersocietal Accreditation Commission accredits our facilities for vascular sonography.
Patients can rely on accreditation to indicate that the facility that performs their examination has proven a commitment to providing quality testing for the diagnosis of vascular disease. Patients can rest assured that accredited facilities have been carefully critiqued on all aspects of their operations considered relevant by medical experts in the field of vascular technology.
Health care organizations are held to very high levels of accountability by peers and the general public. In numerous states, reimbursement directives that require accreditation of the facility have been instituted by Medicare carriers and private, third-party insurers. Similar draft payment policies are pending throughout the United States. Facilities attaining accreditation before it is required for reimbursement demonstrate a willingness to surpass current expectations.
The general public and the vascular testing community members will recognize an unmatched commitment to providing quality health care by facilities that achieve IAC Vascular Testing accreditation.
Atherosclerosis – is a disease process that leads to the hardening or clogging of arteries. The build-up over time of substances such as fat, cholesterol, & calcium, collectively called plaque, narrows the artery and restricts the amount of blood able to pass through the arteries, and provides oxygen-rich blood to the body. This stenosis or narrowing of the artery can lead to serious problems such as stroke, amputation, heart attack, and death.
What is Carotid Artery Disease? Dr. Dawn Olsen Vascular Surgeon and Kailin George physician liaison discuss the signs, symptoms, causes, & treatments of carotid artery disease. Additionally, as seen below are some photos taken from a recent TCAR or Trans Carotid Artery Revascularization procedure performed by Dr. Dawn Olsen on a patient in the hospital. It can be clearly recognized where the carotid artery had become nearly occluded prior to the procedure and post-procedure including stenting the artery had become nice and open allowing for optimal blood flow to the brain. Also of note is the photo where plaque filtered out through the TCAR device can be seen in abundance.
Dr. David Paolini is a Vascular Surgeon with over 15 years of Vascular Surgery experience. Dr. Paolini recently joined Western Vascular Institute as one of our acclaimed vascular surgeons from the Jobst vascular center in Toledo, Ohio. Dr. Paolini has had a passion for medicine and physics from a young age, feeling that Vascular Surgery is the perfect combination of the two scientific areas. Dr. Paolini completed his medical school training from Temple University (One of the best Medical Schools in the united states) in 1999 and after that moved to New Mexico to begin his residency at the University of New Mexico Health Sciences Center Department of Surgery. After completing a 5-year surgical residency Dr. Paolini then moved to Toledo, Ohio to complete a Vascular Surgery specific fellowship at the prestigious Jobst Vascular Center. Dr. Paolini quickly gained accolades as one of the most innovative and competent vascular surgeons in the area as well as being heavily invested in Vascular Surgery research and publications. Dr. Paolini’s care philosophy is “ to take care of patients like you would want your kids’ taken care of ”. As a father of two wonderful children and supported by his beautiful wife Dr. Paolini is poised to join the ranks of the great caring vascular surgeons here at Western Vascular Institute. Dr. Paolini’s previous patients have described dr. Paolini as being kind, compassionate, & honest. We are excited to have Dr. Paolini as part Western Vascular Institute. Dr. Paolini is now accepting new patients in the Mesa and Payson office locations. For an appointment with Dr. Paolini please contact one of our new patient coordinators at (480) 668-5000 ext. 332
A small incision is made just above the collar bone to expose the common carotid artery. A soft, flexible sheath is placed directly into the carotid artery and connected to a system that will reverse the flow of blood away from the brain to protect against fragments of plaque that may come loose during the procedure. The blood is filtered and returned through a second sheath placed in the femoral vein in the patient’s thigh. The Neuroprotection system allows balloon angioplasty and stenting to be performed while blood flow is reversed. After the stent is placed successfully to stabilize the plaque in the carotid artery, flow reversal is turned off and blood flow to the brain resumes in its normal direction.
Silk Road’s TCAR Procedure is designed to protect the brain from most sizes and types of embolic debris when introducing interventional devices into the carotid artery. Small emboli, not large enough to cause a major stroke, can still cause a minor brain infarction and impact cognitive function.1-3 A sensitive imaging technology called Diffusion Weighted -Magnetic Resonance Imaging (DW-MRI) can be used to detect these small brain infarctions.
TCAR is a surgically inspired procedure and is designed to mimic the arterial access and safeguards of surgery. In carotid artery surgery, the arteries are clamped above and below the blockage to block blood flow and prevent plaque from traveling to the brain during treatment. Similarly, the ENROUTE® Transcarotid Neuroprotection System isolates the blockage from forward blood flow during stent placement by actually reversing blood flow away from the brain. Because the flow reversal method does not rely on a distally placed filter to capture emboli before they reach the brain, it collects both small and large debris.