Category: News

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.

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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Amputation Prevention

Amputation Prevention: Empowering Lives, Preserving Limbs

Amputation is a life-altering event that can have profound physical, emotional, and social implications. However, in many cases, amputation can be prevented with timely intervention, proactive healthcare, and patient education. Let’s explore the importance of amputation prevention and the strategies that can make a significant difference in preserving limbs and improving quality of life.

Early Detection and Treatment:

One of the key factors in amputation prevention is early detection and prompt treatment of underlying conditions that can lead to limb-threatening complications. This includes conditions such as peripheral artery disease (PAD), diabetic foot ulcers, infections, and severe trauma. Regular check-ups, routine screenings, and proactive management of chronic diseases are vital in identifying potential risks early on.

Comprehensive Wound Care:

Effective wound care is critical in preventing infections and promoting healing, particularly in individuals with chronic wounds or ulcers. Prompt attention to any cuts, sores, or wounds, especially in high-risk populations such as diabetic patients, can significantly reduce the risk of complications that may necessitate amputation. This involves proper cleaning, dressing, and close monitoring of wounds, along with the use of advanced wound care techniques and therapies.

Managing Underlying Conditions:

Managing underlying conditions that contribute to limb-threatening complications is crucial in amputation prevention. For individuals with diabetes, maintaining optimal blood sugar control is essential to prevent peripheral nerve damage and impaired circulation. Controlling blood pressure and cholesterol levels, as well as adopting a healthy lifestyle with regular exercise and a balanced diet, can help manage conditions like PAD and reduce the risk of amputation.

Multidisciplinary Care and Patient Education:

Collaboration among healthcare professionals from various specialties is paramount in preventing amputation. A multidisciplinary approach involving vascular surgeons, podiatrists, wound care specialists, physical therapists, and other relevant healthcare providers can offer comprehensive care tailored to individual needs. Patient education plays a vital role in empowering individuals to understand their conditions, recognize warning signs, and actively participate in their own care. Education on proper foot care, self-examination techniques, and lifestyle modifications can significantly contribute to preventing complications.

Prosthetics, Rehabilitation, and Support:

In cases where amputation is unavoidable, comprehensive rehabilitation services and access to quality prosthetics play a crucial role in restoring functionality and improving the overall quality of life for individuals. Adequate support networks, including counseling services and peer support groups, can help individuals navigate the emotional and social challenges associated with limb loss.

Amputation is not always an inevitable outcome.

Through proactive measures, early intervention, and comprehensive care, we can significantly reduce the number of amputations and empower individuals to live fulfilling lives with all their limbs intact. Together, let’s promote amputation prevention, raise awareness, and make a positive impact on the lives of countless individuals.

Introducing Daniel Krcelic M.D.

Introducing Daniel Krcelic M.D.


Daniel Krcelic, MD a vascular surgeon in Arizona.

Western Vascular Institute is excited to introduce Daniel Krcelic M.D. has joined our group of exceptional vascular surgeons. We are very grateful for his addition and look forward to the unparalleled vascular care he will provide to the WVI patients.

Doctor Krcelic is trained in all aspects of vascular surgery in both the inpatient and outpatient settings. He completed his fellowship in vascular surgery at Carolinas Medical Center and Sanger Heart & Vascular Institute in Charlotte. Dr. Krcelic said. “I care deeply about my patients, and joining Western Vascular Institute brings another skilled vascular specialist to meet the needs of patients in the Phoenix Metro Area,”.


Western Vascular Institute Voted Arizona’s Best Medical Specialists

Lovin’ Life After 50 has awarded Western Vascular Institute as America’s Best Medical Specialist!

We are grateful to be voted as the best medical specialist recommended by readers and peers in the Lovin’ Life after 50 Magazine and website.

Check out our award in Lovin’ Life After 50 (see page 34)!

Visit Western Vascular Institute Today!

If you are in the Phoenix, Arizona area and looking for a vein or vascular clinic, visit Western Vascular Institute today! Our board-certified surgeons specialize in utilizing the latest in technology to provide the best in vein and vascular care. For more information, call (480) 668-5000 and schedule an appointment today!


What is a Unna Boot?

An Unna Boot is a type of compression bandage that is specifically designed to treat and manage venous leg ulcers. It consists of a layer of zinc-impregnated, semi-rigid gauze wrapped around the affected leg, followed by an outer layer of cohesive compression bandage.

What is the purpose of an Unna Boot?

The purpose of an Unna Boot is to provide sustained, therapeutic compression to the lower leg, which helps improve venous circulation, reduce swelling, and promote the healing of venous ulcers. Here are some key benefits and functions of a Unna Boot:


The primary purpose of an Unna Boot is to apply compression to the affected leg. The bandage provides consistent and graduated pressure, typically ranging from 20-30 mmHg, which helps to reduce venous congestion and increase blood flow toward the heart. Compression aids in controlling edema (swelling) and enhances venous return, thereby improving overall circulation.

Healing Environment:

The zinc-impregnated gauze layer within the Unna Boot provides several benefits. Zinc is known for its antibacterial and antimicrobial properties, which help create an optimal environment for wound healing by reducing the risk of infection. The semi-rigid nature of the gauze offers support and protection to the wound site.

Moisture Management:

The gauze layer in the Unna Boot acts as a moisture barrier, helping to absorb excess exudate (fluid) from the wound and maintain an appropriate level of moisture for wound healing. It prevents the wound from becoming too dry or too moist, facilitating the healing process.


The Unna Boot offers some degree of immobilization, which helps prevent excessive movement of the affected leg. Immobilization can reduce pain and irritation, allowing the wound to heal more effectively.

Convenience and Long-lasting Effect:

The Unna Boot remains in place once applied, for an extended period (typically 1 to 2 weeks) without requiring frequent changes. This convenience reduces the need for frequent dressing changes and provides a continuous, therapeutic compression effect.

Unna Boot applications should be performed by a vascular surgeon with expertise in wound care. The bandage needs to be applied correctly, ensuring appropriate tension and coverage, to achieve optimal therapeutic benefits. Regular monitoring and assessment by a healthcare provider are essential to evaluate the progress of wound healing, adjust compression levels, and address any potential complications.

If you have a venous leg ulcer or a similar condition, consult with a vascular surgeon to determine if an Unna Boot is suitable for your situation and to receive proper guidance on its application and usage.

Vascular Surgeons the real “vascular specialists”

Vascular Surgeons diagnose, treat, and manage the full spectrum of vascular diseases.

“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 is 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!

The Joint Commission

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

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.