Tag: Vascular Disease

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.

Understanding Deep Vein Thrombosis (DVT)

Symptoms:

can occur without warning signs
Also felt as discomfort in the affected area including Swelling and pain the affected leg. Additionally, redness and warmth along the vein where the clot is found.

Causes


Coagulation of blood is an important process that helps to prevent excessive bleeding during injury. However, in the absence of Injury, when the blood is not flowing properly or if it pools in the veins the platelets in the blood that help with coagulation can stick together and cause it to clot.

a. Inactivity- During a long flight or drive
b. Damage to a vein
c. Cancer or other diseases that cause your blood to clot more easily
d. Medications
e. Hormones


Risk Factors

a. Age
b. Obesity
c. Pregnancy
d. Family History of DVT
e. Having a catheter placed in a vein
f. Deep vein injury
g. Smoking

Diagnosis


Your vascular surgeon will ask questions about your symptoms and medical history as well as performing a thorough physical examination.

a. Duplex ultrasound to check the flow of blood in the area of the perceived clot. A Venograph can also be done by injecting a contrast dye into the vein under x-ray to see where the dye is allowed to pass through. The X-ray will show a mapping of your veins and show the area where the contrast dye was unable to pass through. Although DVT’s can generally be diagnosed by duplex ultrasound, venography is another option Western Vascular Institute has available to confirm the diagnosis.

Treatments


Most often a Deep Vein Thrombosis or DVT can be treated by a medication known as blood thinners or anticoagulants. These medications help prevent the blood from clotting and over time reduce the size and consistency of the clot.

Staying Healthy


Maintain good overall health including a healthy diet and staying physically active will help reduce the risk of a DVT. It is likewise important to maintain a healthy weight and make sure to follow up with your vascular surgeon to discuss the possibility of long-term blood thinner medications.

Diabetes & Vascular Disease

Diabetes is one of the strongest risk factors for any form of vascular disease. Diabetes can cause many complications that worsen the vascular disease. Some of these complications include vein weakness, weight gain, venous ulcers, DVT’s, and Peripheral Vascular Disease. Many with diabetes worry they can’t be treated for varicose veins and other vascular complications. However, it is because of their diabetes that they should be treated by a vascular surgeon sooner rather than later.

Endovenous Radiofrequency Ablation or RFA procedure

Endovenous radiofrequency ablation is a minimally invasive procedure performed by a vascular surgeon that utilizes radiofrequency energy to heat a catheter element which, when inserted into the vein, shrinks the wall of the vessel. This shrinkage or ablation of the vein closes off the blood flow to the incompetent area of the vein allowing the vein to create new healthy pathways where it is needed.

TransCarotid Artery Revascularization

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.

 

Peripheral Artery Disease Awareness month

September is Peripheral vascular disease awareness month.  PVD or PAD / Peripheral Arterial Disease is a chronic disease where plaque gradually builds up in the arteries leading to limited blood flow or entirely block the flow of blood also called an occlusion.

This Plaque that builds up in your arteries and veins is a waxy fatty substance caused by high levels of cholesterol and worsened by smoking. The plaque builds up on the arterial or vessel wall as it passes through the vessels along with the blood and can lead to the hardening or atherosclerosis of the arteries and eventual occlusion. Peripheral arterial disease is a very common disease affecting 1 in 20 Americans over the age of 50.

 

 

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