Category: Peripheral Arterial Vascular

What is Vascular Surgery?

What is Vascular Surgery?

Vascular surgery is a surgical specialty that deals with diseases of the blood vessels. It is a relatively new specialty, having been founded in the early 1970s. The first residency program was started at the University of Minnesota in 1973.

The specialty of vascular surgery is divided into two main branches: open surgery and endovascular surgery.

Open surgery is the traditional form of surgery, where the surgeon makes a large incision in the patient’s body in order to access the blood vessels. Endovascular surgery is a newer form of surgery that uses tiny instruments and a camera to access the blood vessels through small incisions.

Vascular surgery is a highly specialized field, and there are only a few hundred surgeons in the United States who specialize in it. The majority of vascular surgeons are based in large metropolitan areas, and there are few rural areas that have vascular surgeons.

 Treating a variety of diseases and conditions, including:

Vascular surgery is a life-saving procedure in many cases. For example, an aortic aneurysm is a life-threatening condition that can lead to a ruptured aorta. If the aneurysm is detected early, it can be treated with surgery. It is a highly specialized field, and patients should seek out a vascular surgeon who is experienced in treating the specific condition that they have.

Diabetes and Vascular Disease

Diabetes and Vascular Disease: Understanding the Connection and Taking Control

Diabetes is a chronic condition that affects millions of people worldwide. While most individuals are aware of the impact of diabetes on blood sugar control, many may not fully understand the profound effect it can have on the vascular system. Diabetes significantly increases the risk of developing various vascular diseases, emphasizing the importance of managing the condition effectively. Let’s delve into the connection between diabetes and vascular disease and explore strategies to minimize its impact.

Understanding the Link:

Diabetes is characterized by elevated blood glucose levels, which can damage blood vessels over time. The persistently high levels of glucose in the bloodstream can lead to the accumulation of fatty deposits in the vessel walls, causing a condition called atherosclerosis. Atherosclerosis is a significant contributor to various vascular diseases, including:

Peripheral Artery Disease (PAD):

Diabetes increases the risk of developing PAD, which affects the blood vessels supplying the legs and feet. Reduced blood flow to the lower extremities can result in pain, slow wound healing, and an increased risk of infections and amputations.

Coronary Artery Disease (CAD):

Individuals with diabetes are more prone to CAD, a condition that affects the blood vessels supplying the heart. Narrowed or blocked arteries can lead to chest pain (angina), heart attacks, and other cardiovascular complications.


Diabetes raises the risk of stroke by accelerating the development of atherosclerosis in the arteries supplying the brain. A clot or rupture in these arteries can result in a stroke, causing lasting damage or even death.

Diabetic Retinopathy:

The blood vessels in the retina can be damaged by diabetes, leading to diabetic retinopathy. This condition can cause vision loss or even blindness if left untreated.

Diabetic Nephropathy:

High blood glucose levels can impair the kidneys’ ability to filter waste products, leading to diabetic nephropathy. It is a progressive kidney disease that can eventually result in kidney failure.

Managing Diabetes and Vascular Disease:

While the connection between diabetes and vascular disease may seem daunting, it’s important to remember that taking proactive steps can significantly reduce the risks. Here are some strategies to manage diabetes and minimize the impact on the vascular system:

Maintain Blood Sugar Levels:

Consistently monitoring and managing blood sugar levels through a healthy diet, regular exercise, and appropriate medication or insulin therapy is crucial. Keeping blood glucose within target ranges helps minimize damage to blood vessels.

Control Blood Pressure and Cholesterol:

High blood pressure and elevated cholesterol levels further contribute to vascular disease. Regular monitoring and effective management of these factors through lifestyle modifications and medications are essential.

Adopt a Healthy Lifestyle:

Engage in regular physical activity, such as walking, swimming, or cycling, to improve circulation and maintain a healthy weight. Follow a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats while limiting sugary and processed foods.

Quit Smoking:

Smoking damages blood vessels and significantly increases the risk of vascular disease. Quitting smoking is one of the most beneficial steps individuals with diabetes can take to protect their vascular health.

Regular Check-ups:

Maintain regular check-ups with healthcare professionals to monitor blood sugar control, blood pressure, cholesterol levels, and overall vascular health. Early detection and intervention can prevent or minimize the progression of vascular diseases.

Diabetes and vascular disease are intricately linked, underscoring the importance of proactive management. By effectively managing blood sugar levels, controlling blood pressure and cholesterol, adopting a healthy lifestyle, and seeking regular medical care, individuals with diabetes can significantly reduce their risk of developing or worsening vascular disease. Empower yourself with knowledge, take control of your diabetes, and prioritize your vascular health for a better quality of life.


Common treatments for PAD

Common treatments for PAD 

The treatment of peripheral artery disease (PAD) aims to reduce symptoms, improve quality of life, and prevent complications. The specific treatment approach may vary based on the severity of the condition and individual patient factors. Here are some of the most common treatments for PAD:

Lifestyle Modifications:

Making certain lifestyle changes can help manage PAD effectively. These may include quitting smoking, adopting a healthy diet low in saturated fats and high in fruits and vegetables, regular exercise, and maintaining a healthy weight. Lifestyle modifications can improve overall cardiovascular health and reduce symptoms.

Antiplatelet Medications:

Medications such as aspirin or clopidogrel are commonly prescribed to reduce the risk of blood clots and improve blood flow.

Cholesterol-lowering Medications:

Statins are often prescribed to control cholesterol levels and slow down the progression of atherosclerosis.

Blood Pressure Medications:

Controlling high blood pressure is crucial in managing PAD and reducing the risk of complications.

Symptom-relief Medications:

Medications such as cilostazol may be prescribed to relieve leg pain and improve walking distance.
Exercise Therapy:

Supervised exercise:

Supervised exercise programs, known as supervised exercise therapy (SET), can improve symptoms and walking distance in PAD. These programs typically involve structured exercise routines tailored to individual abilities and needs.

Endovascular Interventions:


Angioplasty and Stenting:

In this minimally invasive procedure, a catheter is inserted into the affected artery to inflate a small balloon, which helps open the blocked or narrowed artery. In some cases, a stent may be placed to help keep the artery open.


This procedure involves using a catheter with a rotating device or laser to remove plaque buildup from the artery walls, improving blood flow.
Bypass Surgery: In severe cases of PAD, bypass surgery may be necessary. During this procedure, a blood vessel graft is used to create a detour around the blocked or narrowed artery, allowing blood to bypass the affected area.

Wound Care and Amputation Prevention:

For individuals with PAD-related wounds or ulcers, proper wound care is crucial to prevent infection and promote healing. Specialized wound care techniques and treatments may be employed to facilitate healing and avoid amputations.

It’s important to note that the appropriate treatment plan for PAD should be determined by a healthcare professional based on individual circumstances. Early diagnosis, lifestyle modifications, and adherence to the prescribed treatment plan can significantly improve outcomes, alleviate symptoms, and reduce the risk of complications associated with peripheral artery disease.


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.

Intrasight Mobile IVUS

Intrasight Mobile IVUS

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.



Ankle Brachial Index

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:


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.
  • 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.


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.

What is Atherosclerosis?

Atherosclerosisis 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.


Introducing Dr. David J. Paolini

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