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Category: Carotid Artery Disease

Ankle Brachial Index

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Ankle Brachial Index

The Ankle-Brachial Index (ABI) is a simple and non-invasive test that measures the blood pressure in the ankles and arms to evaluate the presence of peripheral artery disease (PAD) or other vascular conditions. It is an essential diagnostic tool used by healthcare professionals to assess the circulation in the lower extremities. Here’s how the ABI works and why it is important:

Procedure:

During an ABI test, blood pressure measurements are taken at the ankles and arms using a blood pressure cuff and a Doppler ultrasound device.

The procedure typically involves the following steps:
  • The person undergoing the test lies down in a supine position.
  • Blood pressure cuffs are placed on the arms and ankles.
  • The healthcare provider uses a Doppler ultrasound device to detect and amplify the sounds of blood flow in the arteries.
  • The cuffs are inflated to temporarily stop blood flow, and then gradually deflated to measure the systolic blood pressure at each location.
  • The ratio of ankle pressure to arm pressure is calculated to determine the Ankle-Brachial Index.
    Interpretation:
  • The ABI is calculated by dividing the higher of the ankle pressures by the higher of the arm pressures. Here’s how the ABI results are interpreted:
Normal ABI (0.90-1.30): A normal range indicates that blood flow in the lower extremities is normal, and there is no significant obstruction or blockage in the arteries.
ABI < 0.90: A lower ABI value suggests the presence of peripheral artery disease (PAD), which indicates reduced blood flow to the legs and feet. The lower the ABI value, the more severe the blockage or narrowing of the arteries.
ABI > 1.30: A higher ABI value may indicate the presence of non-compressible arteries, often seen in individuals with calcified or hardened arteries.

 

Importance of ABI Testing: The ABI test is an important diagnostic tool for several reasons:

Early Detection of Peripheral Artery Disease (PAD):

ABI testing helps identify PAD at an early stage, allowing for timely intervention and management. Early detection and treatment can prevent the progression of PAD, reduce symptoms, and lower the risk of complications such as non-healing wounds or amputation.

Assessing Cardiovascular Risk:

PAD is often associated with an increased risk of cardiovascular events such as heart attack or stroke. ABI testing helps identify individuals who may be at a higher risk for these events, allowing for appropriate interventions and preventive measures.

Monitoring Treatment Effectiveness:

For individuals diagnosed with PAD, ABI testing can be used to monitor the effectiveness of treatment and track changes in blood flow over time. Regular ABI measurements help healthcare providers assess the response to interventions such as lifestyle modifications, medication, or surgical procedures.

Screening in High-Risk Populations:

ABI testing is recommended for individuals who are at a higher risk of developing PAD, such as those with diabetes, a history of smoking, hypertension, or high cholesterol. It is a valuable screening tool to identify early signs of peripheral artery disease in these populations.

Remember, ABI testing should be conducted by a qualified healthcare professional, such as a vascular specialist or a cardiologist, to ensure accurate results and appropriate interpretation. If you have concerns about your leg circulation or risk factors for peripheral artery disease, consult with your healthcare provider to determine if ABI testing is necessary.

 

What Causes A Stroke?

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What Causes A Stroke?

 

Type of Stroke:

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.

Stroke 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.

Stroke 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.

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.

Stroke Diagnosis:

Diagnosis of Carotid Artery Disease is generally diagnosed through a 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.

Stroke 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 for stroke prevention:

Carotid endarterectomy – generally performed when there is a blockage of 50% or above accompanied by 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

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The Joint Commission Certification

The Joint Commission, also known as TJC, is an independent, non-profit organization in the United States that accredits and certifies healthcare organizations and programs. It was founded in 1951 and is recognized as a leader in setting quality and safety standards for healthcare.

The goal of The Joint Commission:

The primary goal of The Joint Commission is to improve the quality and safety of patient care. They achieve this by establishing rigorous standards and conducting thorough evaluations of healthcare organizations to ensure compliance. Accreditation by The Joint Commission is voluntary but highly valued and widely recognized as a mark of quality in the healthcare industry.

The accreditation process:

The accreditation process involves an in-depth review of various aspects of an organization’s operations, including patient care, infection control, medication management, leadership, and performance improvement. Surveyors from The Joint Commission visit healthcare facilities to assess compliance with the standards. If an organization meets the standards, they are awarded accreditation, which is typically valid for a specific period.

The Joint Commission certification:

In addition to accreditation, The Joint Commission offers various certification programs for specific areas of healthcare, such as disease-specific care, primary stroke centers, and advanced certification in healthcare quality.

The Joint Commission & Patient Saftey:

The Joint Commission plays a crucial role in promoting patient safety and quality improvement in healthcare organizations. Their standards and accreditation process help organizations identify areas for improvement, implement evidence-based practices, and continuously enhance the quality of care provided to patients.

It’s important to note that while The Joint Commission sets standards and evaluates healthcare organizations, they do not have regulatory authority. Their focus is on voluntary accreditation and continuous improvement rather than enforcing compliance through legal means.

Western Vascular Institute is a Joint Commission Accredited vascular-surgery-center garnering the gold seal of approval. These certifications demonstrate a higher level of expertise and specialization in particular areas of care.

Vascular Ultrasound

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Vascular ultrasound

Vascular ultrasound, also known as duplex ultrasonography or Doppler ultrasound, is a non-invasive imaging technique used to evaluate blood vessels and blood flow in the body.

During this study, a small handheld device called a transducer is used to emit high-frequency sound waves into the body. These sound waves bounce back off the blood vessels and are detected by the transducer, which converts them into images that can be viewed on a monitor.

Vascular ultrasound is commonly used to diagnose and monitor various vascular conditions, including:

 

Peripheral artery disease (PAD):

Evaluating blood flow and detecting blockages or narrowing in the arteries of the legs, arms, or neck.

Deep vein thrombosis (DVT):

Detecting blood clots in the deep veins, usually in the legs.

Carotid artery disease:

Assessing the carotid arteries in the neck to detect plaques or other abnormalities that may increase the risk of stroke.

Abdominal aortic aneurysm (AAA):

Evaluating the aorta in the abdomen for the presence of an abnormal bulge or enlargement that could potentially rupture.

Venous insufficiency:

Assessing the veins and valves in the legs to identify valve dysfunction or venous reflux, which can lead to conditions like varicose veins.

Vascular ultrasound is a safe and painless procedure that does not involve radiation. It provides real-time images and can be used to measure blood flow velocity and direction using the Doppler effect, which allows the assessment of blood flow characteristics such as speed and turbulence.

The results of a vascular ultrasound can help vascular surgeons make accurate diagnoses, develop appropriate treatment plans, and monitor the effectiveness of interventions over time.

What is Atherosclerosis?

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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?

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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.

Introducing Dr. David J. Paolini

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Dr. David J. Paolini vascular surgeon in Arizona.
Dr. David J. Paolini Vascular Surgeon with Western Vascular Institute. Board Certified Vascular Surgeon

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