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Peripheral Vascular Disease


Vascular surgery is surgery to treat diseases of the vascular (arteries and veins) system. It is a medical specialty that evolved from general and cardiac (heart) surgery.

Vascular surgeons are trained in the diagnosis and management of diseases affecting all parts of the vascular system, except of the heart—which is handled by cardiothoracic surgeons—and the brain, which is handled by neurosurgeons.

Most, but not all, vascular diseases fall under two general categories: peripheral venous disease and peripheral artery disease.

Through a team approach, Oregon Heart & Vascular Institute at RiverBend offers a variety of diagnostic tests, procedures and surgeries to help patients with vascular diseases. Contact us at the number above to learn more about the comprehensive services and exceptional patient care available.

Peripheral Artery Disease

About Peripheral Artery Disease

Peripheral artery disease is a general term for damage, defects or blockage in the peripheral arteries that carry blood and supply oxygen to the hands and feet.

Peripheral artery disease of the legs is the most common type of the condition, which also affects other parts of the body. For example:

  • Carotid artery disease occurs in the arteries of the neck.
  • In renal artery disease, the arteries leading to the kidneys are blocked.
  • Mesenteric artery disease is a narrowing or blockage of one of the arteries supplying the large and small intestines.
  • Abdominal aortic aneurysm involves an abnormal widening of the aorta, the main blood vessel that carries blood from the heart to the rest of the body.

Atherosclerosis, or hardening of the arteries that results from a buildup of fat and cholesterol, is one of the main causes of peripheral artery disease. The buildup—known as plaque—clogs arteries. Peripheral artery disease can also develop from clots that form in the veins when the walls become weak and blood flow slows.

The most common symptom of peripheral artery disease is leg pain, particularly when walking or exercising. Other symptoms include numbness and tingling in the lower legs and feet, coldness in the lower legs and feet, and leg sores that do not heal.

Your doctor will examine your blood pressure and heart in an effort to diagnose peripheral artery disease. You may also have to undergo additional tests such as:

In some cases, lifestyle changes—such as quitting smoking, exercising and controlling weight—can keep peripheral artery disease under control.

Procedures that do not require surgery include:

In severe cases, you may have to undergo surgery. A number of proven surgical procedures have been developed to treat peripheral artery disease. They include carotid endarterectomy, femoropopliteal bypass, tibioperoneal bypass, mesenteric bypass, and abdominal aortic bypass. Your doctor will recommend the best treatment for your particular condition.

If you are over 50 and are experiencing certain symptoms, Oregon Heart & Vascular Institute offers regular screenings.

Types of Peripheral Artery Disease

Peripheral artery diseases include:

  • Carotid artery disease
  • Abdominal aortic aneurysm
  • Mesenteric artery disease
  • Renal artery disease
  • Peripheral artery disease of the legs

Carotid artery disease is damage or blockage in the carotid arteries, which are located in the neck and carry oxygen-rich blood to the head and brain. While there are no specific symptoms of carotid artery disease, the general warning signs of stroke—headache; dizziness; confusion; trouble swallowing; and numbness of the face, legs, or arms—may indicate blockage in the carotid arteries.

Abdominal aortic aneurysm is an abnormal bulging or stretching of the section of the aorta located in the upper part of the stomach, or abdomen. The aorta is the main artery that carries oxygen-rich blood to all other parts of the body. The exact causes of an abdominal aortic aneurysm are not known. Generally, an aneurysm does not cause symptoms, even when it is about to burst. If not treated, the aneurysm could rupture (burst). Ruptured aneurysms are one of the leading causes of death in the United States.

Mesenteric artery disease is a narrowing or blockage of one or more of the three mesenteric arteries that carry oxygen-rich blood to the intestines. The blockage is often caused by a blood clot that breaks away from the heart. If the condition is chronic, symptoms are stomach pain after eating and occasional diarrhea. If it is acute (sudden), symptoms include intense stomach pain, vomiting, and diarrhea. Acute mesenteric artery disease requires immediate medical attention.

Renal artery disease is a narrowing or blockage of the artery that carries oxygen-rich blood to the kidneys. In most cases, the condition affects the arteries leading to only one kidney. If not treated, it can lead to permanent kidney damage. In people over age 50, the condition is usually caused by atherosclerosis. In people under age 40, particularly women, the disease is usually caused by a muscle disorder in which abnormal tissue grows in the renal artery.

Peripheral artery disease of the legs is a narrowing and hardening of the arteries that carry oxygen-rich blood to the legs and feet. A decrease in blood flow can damage nerves and tissues in the legs and feet. Peripheral artery disease of the legs is usually caused by atherosclerosis.

If you have symptoms of a peripheral artery disease, see your doctor or schedule an Oregon Heart & Vascular Institute screening.

Tests and Procedures

Your doctor will conduct a physical examination to make a proper diagnosis. In some cases, your doctor can tell if there is a blockage by checking major pulses and by listening to your blood flow through your arteries. But to be sure, your doctor may call for additional tests, including:

Carotid duplex ultrasound is a noninvasive 15-30-minute test that uses high-frequency sound waves (ultrasound) to detect blood clots, plaque (fatty material), or other problems with blood flow in the arteries in the neck that carry blood to the head and brain.

Duplex ultrasound is another noninvasive 15-30-minute procedure that uses ultrasound to measure the speed of the blood flow and to detect blood clots, plaque (fatty material), or other problems with blood flow in the arteries. The test combines the two types of sound waves used in carotid duplex ultrasound and in Doppler ultrasound.

Arteriography—also called angiography—is a general term for a minimally invasive test that uses x-rays to examine arteries. The image created by the x-ray is called an arteriogram or angiogram. The procedure, which varies slightly depending on the site of the artery being examined, takes place in the hospital and involves a local anesthetic and a mild sedative.

Renal arteriography—also called renal angiography—uses x-rays to examine the arteries of the kidneys.

A computed tomography (CT) scan—also called a computed axial tomography (CAT) scan—is a noninvasive, painless 15-30-minute test that uses an x-ray to make detailed pictures of structures inside the body. Directed by a scanner, the x-ray beam circles the body, helping produce many images. The images are stored in a computer and can be printed on film or viewed on a monitor. The computer can create three-dimensional models of parts of the body by assembling the individual images.

Magnetic resonance angiography (MRA)—also called magnetic resonance imaging and nuclear magnetic resonance imaging—is a noninvasive 30-90-minute test that uses powerful but harmless magnets and radio waves to make detailed pictures of arteries and veins. The images are stored in a computer and can be printed on film or viewed on a monitor. MRA can often detect problems in arteries or veins that x-rays and other forms of imaging cannot. The test takes place in the outpatient center.

Contact us at the number above to learn more about these and other services available at Oregon Heart & Vascular Institute.

Nonsurgical Treatment

Your diagnosis as well as the site and degree of peripheral artery disease will determine which types of treatments your doctor recommends.

Suggested lifestyle changes include:

  • Lowering cholesterol
  • Controlling high blood pressure
  • Losing weight
  • Quitting smoking
  • Exercising regularly

In some cases, doctors prescribe a daily dose of aspirin or blood-thinning medications.

If your condition continues to be a problem, your doctor may suggest one of the following procedures, which are done in a lab by a team of medical professionals led by a vascular surgeon (a doctor who specializes in the treatment of blood vessels) or an interventional radiologist and result in much quicker recovery than surgery.

Carotid stenting is a procedure in which a tiny mesh tube called a stent is inserted into a blocked carotid artery to keep it open and to keep the blood flowing.

Angioplasty—also called balloon angioplasty—is a general term for a procedure in which a balloon is inserted into a narrowed or blocked vein or artery. When used to open arteries in the legs, it is more specifically called angioplasty for peripheral artery disease of the legs.

Renal artery angioplasty with stent is a procedure in which a stent is inserted into a blocked renal artery to keep it open and to keep the blood flowing. The renal arteries carry blood to the kidneys.

An abdominal aortic stent graft—also called endovascular repair of abdominal aortic aneurysms—is a procedure in which a stent graft is inserted in an aneurysm (bulge) in the aorta. The aorta is the main artery that carries blood from the heart to the rest of the body. The stent graft creates a bypass through the aneurysm that allows blood to flow while taking pressure off the wall of the aneurysm.

Contact us at the number above to learn more about these and other services available at Oregon Heart & Vascular Institute.

Surgical Treatment

Several surgical procedures are used to treat peripheral artery disease.

Abdominal aortic bypass is performed in the hospital by a team of medical professionals led by a thoracic surgeon (doctor specializing in surgery of the heart, chest and lungs) or a vascular surgeon (doctor specializing in the treatment of blood vessels) to repair or reroute blood around an aneurysm (bulge) in the aorta, the main artery that carries blood from the heart to the rest of the body. The procedure is done before the aneurysm is dangerously large. If the aneurysm is in danger of bursting, surgery is done to remove it.

Mesenteric bypass is a procedure performed in the hospital by a team of medical professionals led by a vascular surgeon (doctor specializing in the treatment of blood vessels) to reroute blood around blocked or damaged mesenteric arteries. The three mesenteric arteries carry blood to the intestines.

A carotid endarterectomy is a procedure performed in the hospital by a team of medical professionals led by a vascular surgeon (doctor specializing in the treatment of blood vessels) to remove plaque (fatty material) from the carotid arteries, which carry blood to the head and brain. Blocked carotid arteries can lead to stroke.

Femoropopliteal bypass is a procedure performed in the hospital by a team of medical professionals led by a vascular surgeon (doctor specializing in the treatment of blood vessels) to reroute blood around blocked or damaged femoral or popliteal arteries. The femoral artery is the main artery that goes through the thigh. As it goes behind the knee, it becomes the popliteal artery. Femoropopliteal bypass surgery is performed when the blockage—known as atherosclerosis (hardening of the arteries)—is severe enough to damage the nerves and tissues of the legs and feet.

Tibioperoneal bypass is a procedure performed in the hospital by a team of medical professionals led by a vascular surgeon (doctor specializing in the treatment of blood vessels) to reroute blood around blocked or damaged tibial arteries. These are the arteries in the lower part of the leg. Two tibial arteries go through each leg. Tibioperoneal bypass surgery is performed when the blockage—known as atherosclerosis (hardening of the arteries)—is severe enough to damage the nerves and tissues of the legs and feet.

Contact us at the numbers above to learn more about these and other services available at Oregon Heart & Vascular Institute.

 

Peripheral Venous Disease (PVD)

About Peripheral Venous Disease (PVD)

Peripheral venous disease is a term describing damage, defects or blockage in the veins that carry blood from the hands and feet to the heart. Peripheral venous disease can occur almost anywhere in the body but is mostly seen in the arms and legs.

The most common cause of peripheral venous disease is a blood clot that blocks a vein. A clot forms when vein walls become weak and blood flow slows. When the clot is in a vein deep within the body, it is called deep vein thrombosis. When the clot is in a vein closer to the skin, it is called superficial thrombophlebitis.

Vein walls can become weak because of:

  • Injury
  • A long period of bed rest or inactivity
  • Major surgery
  • Pregnancy
  • Being overweight
  • Smoking, some cancers, and the use of birth control pills may also cause walls of the vein to become weak.

The most common symptom of peripheral venous disease is pain where the blood clot is located. You may also feel a warm area or notice an area of redness or swelling over the affected vein.

Peripheral venous disease is diagnosed after a physical examination that includes a check of your blood pressure and heart. Your doctor can usually tell if you have a blood clot. However, you may have to undergo additional tests, including:

Sometimes, peripheral venous disease clears up by itself. Home treatment—such as exercising, bandaging or elevating the affected area, or wearing special compression stockings—can help ease the condition.

Anti-coagulant therapy, angioplasty and stenting, and sclerotherapy are a few non-surgical options for peripheral venous disease.

Surgery may be needed if the blood clot is deep in the vein.

Your doctor will recommend the best treatment for your particular condition.

Types of Peripheral Venous Disease

Peripheral venous diseases include:

Chronic venous insufficiency is a condition in which blood in one or more veins of the legs does not drain properly and does not return to the heart to get oxygen resulting in blood pooling in the legs and feet. It is also caused by:

  • Abnormal blood vessels in the legs
  • Blood clot-damaged veins
  • A leg injury
  • Certain abdominal or pelvic area cancers

The most common symptom of CVI is swelling of the leg, usually around the ankle. People who suffer from chronic venous insufficiency experience many of the symptoms of varicose veins.

Thrombophlebitis is the occurrence of a blood clot and inflammation in a vein in your legs. When the blood clot is near the surface of your skin, it is called superficial thrombophlebitis. When the clot is deep within the body, it is called deep vein thrombosis.

Thrombophlebitis is caused by long periods of inactivity such as lying in bed after surgery or sitting for a long time in a car or airplane. Inactivity decreases blood flow and may cause a clot to form. Other causes may include paralysis and certain types of cancer.

The most common symptom of a problem with a vein near the surface is tenderness or pain over the affected area. A hard red cord may appear just under the surface of the skin. Sometimes, but not always, inflammation or redness of the skin may occur.

When the problem is in a vein deeper within the body, your leg may become painful and swollen, particularly when you walk or stand. Some people also have a fever. But often there are no symptoms to warn you of deep vein thrombosis.

Varicose veins are twisted, swollen blood vessels that appear near the surface of the skin. They develop from standing for long periods of time or by being overweight or pregnant. Normal aging, hormonal changes, and genetics (family history) may also contribute to varicose veins.

Varicose veins can cause tired, heavy and achy legs, but in most cases are not a medical problem. However, varicose veins may be a sign of a more serious condition—deep vein thrombosis—which requires a doctor’s attention.

If you think you may have a peripheral venous disease, contact your doctor for a thorough physical exam.

Tests and Procedures

In order to make a proper diagnosis, your doctor will first perform a physical exam and possibly also recommend that you undergo one of the following tests:

Doppler Ultrasound Imaging is a simple, 15-30-minute non-invasive test done in the lab to see if there is anything blocking blood flow in your veins. The ultrasound reflects sound waves and helps a doctor evaluate blood flow through a vein on the arms, neck or legs.

Venography is a two-hour test using dyes and an x-ray to show the site of any blood clots or unusual blockage or narrowing in the veins of the arms or legs. Using a narrow, flexible tube called a catheter, the technician injects a dye into the veins of your arm or leg. The dye makes it easier to see your veins during the x-ray, which is called a venogram.

A VQ scan is a one-hour test, done in Sacred Heart Medical Center’s Nuclear Medicine, used to determine if you have a potentially fatal blood clot in the lungs. For the scan, you lie on a table while a special camera takes a number of pictures of your chest from different angles. Using a thin, flexible tube called a catheter, the technician injects a slightly radioactive solution into a vein in your arm or leg. The technician also asks you to breathe through a tube that contains a mixture of air, oxygen and a slightly radioactive gas called xenon. The special camera detects the radioactive materials, which help measure oxygen in the blood and airflow in the lungs. The test is safe and painless. The radioactivity you will be exposed to is too small to cause complications or side effects. From the pictures taken during the test, your doctor can determine the probability of your having a blood clot in your lungs and decide the next course of action.

Contact us at the number above to learn more about these and other services available at Oregon Heart & Vascular Institute.

Nonsurgical Treatment

Your diagnosis and degree of disease will determine which type of treatment your doctor recommends.

Home treatment includes:

  • Elevating the affected leg above your heart to help pooled blood drain properly.
  • Avoiding long periods of standing or sitting. If you must sit for a long period, stretch and flex your legs every 5 minutes or so to keep blood flowing.
  • Wearing elastic compression stockings that squeeze the veins and keep the blood flowing in your legs, which makes it more difficult for blood clots to form.

Depending on your condition, your doctor may recommend taking an oral anticoagulant medication such as Coumadin to prevent blood from clotting. Coumadin and other blood thinners prevent new blood clots from forming and stop existing clots from growing.

If a vein is narrowed or damaged, a non-surgical treatment called “angioplasty and stenting” may be called for. Angioplasty and stenting is a common and safe procedure best known as a treatment for heart problems. It is also used to open up blocked or clotted veins to increase blood flow.

Here’s how it works: A vascular surgeon or interventional radiologist makes a small cut in a vein in your arm or groin area. Then, using x-rays for guidance, the surgeon threads a narrow, flexible tube called a catheter through the vein into the blockage. Through the catheter, the physician passes a small mesh tube called a stent. A tiny balloon is placed inside the stent and inflated. The pressure from the inflated balloon opens the stent and sets it in the vein. The balloon is then deflated and removed while the stent settles in the vein to keep it open and the blood flowing.

Sclerotherapy is an effective, common and safe procedure to treat varicose veins that can be done in your doctor’s office without anesthesia. It usually takes between 5 and 30 minutes. In sclerotherapy, a thin, flexible tube called a catheter is inserted into the veins. Through the tube, the doctor injects a chemical substance called a sclerosant that causes the veins to close and scar over. This forces the blood to reroute itself and flow through healthier nearby veins.

Contact us at the number above to learn more about these and other services available at Oregon Heart & Vascular Institute.

Surgical Treatment

In rare cases, a surgical technique called vein stripping is used to remove the diseased part of the vein.

Vein stripping is generally done on large varicose veins and requires that you be placed under a general anesthesia during surgery. The surgeon will make incisions at your groin (the top of the vein) and near your ankle (the bottom of the vein). Then the surgeon will insert a thin, flexible instrument into the vein and strip it from the inside. Stripping removes the diseased part of the vein. The vein may be stripped or removed entirely.

Vein stripping has the same risks as any other general surgery: the possibility of infection, bleeding, and reaction to anesthesia. But overall, vein stripping is a proven and safe surgical procedure.

Even the loss of a few veins is no problem for most people: When veins are surgically removed, remaining veins deeper in the body adapt by stretching so they can hold larger volumes of blood. The normal flow of blood continues.

Contact us at the number above to learn more about these and other services available at Oregon Heart & Vascular Institute.