Vascular Disease

Vascular disease encompasses a large number of problems with the arteries and veins in our bodies. Arteries are the large vessels that carry blood from the heart to our vital organs and muscles. Problems occur in arteries when they become clogged or when the walls of the arteries deteriorate and begin to bulge.

Veins are the blood vessels that carry blood from our extremities and organs back to the heart. Veins can develop clots, become incompetent or form superficial weaknesses called varicose veins. There are various forms of disease that affect each of these blood vessel systems. Some of the more common problems with blood vessels include:    

Aortic Aneurysms
An aneurysm is a weakness in the wall of an artery that causes it to bulge and grow. Similar to a weak spot on a rubber hose, the bulge will burst when it becomes too large. Aortic aneurysms in the chest (thoracic aneurysms) or stomach (abdominal aortic aneurysms) occur in patients primarily over the age of fifty. These weaknesses or bulges, in the largest arteries in the body, can grow to a size where they eventually rupture causing lethal consequences. These types of aneurysms have often been called “silent killers” because patients experience very few symptoms before they rupture.

Advanced diagnostic techniques such as ultrasound and CT scanning allow for diagnosis of aneurysms before they rupture. Once diagnosed, a vascular surgeon can treat these dangerous entities before they cause catastrophic problems for the patient.

Risk factors for aortic aneurysm disease include:

While no one knows the exact reason why aortic aneurysms develop, control of these risk factors will reduce chances of aneurysm formation and growth.

Aneurysms can occasionally be diagnosed by physical examination. Frequently, they are found during an examination for an unassociated complaint. It is not uncommon to have an incidental finding of an aneurysm when an ultrasound or CT scan is performed to evaluate the chest or abdomen. An incidental finding of aneurysm can be a life saving event.

Once found, aneurysms may require immediate treatment. If the aneurysm is small, your physician may choose to monitor it. Most aortic aneurysms under 5 centimeters (about 2 ½ inches) don’t require immediate treatment and can be followed with serial ultrasound or CT examinations. An aortic aneurysm of significant size should be followed by a vascular specialist.

A variety of treatments are available for aortic aneurysm disease. Summit Vascular Specialists are recognized as one of the first practices in Northeastern Ohio to perform minimally invasive techniques when appropriate.                                               (TOP)


Carotid Artery Disease
Blockages in the main arteries in the neck (carotid arteries) are one of the leading causes of stroke in this country. Once a blockage develops, pieces can break off and travel through the vessel to the region of the head resulting in a stroke.

Another cause of stroke is when the artery blocks completely. Fortunately these blockages can be identified prior to causing a stroke. Once detected, treatment of arterial blockages will result in stroke prevention. Atherosclerosis (build up of plaque) in the carotid arteries is the main contributing factor for this type of problem. It is seen primarily in patients over the age of 60, but can affect younger patients who are at risk.

Risk factors for developing blockage in the carotid arteries include:

While there is no effective means of completely preventing plaque build up, controlling these risk factors can help minimize the progression.

The earliest sign of a blockage in the carotid arteries is an abnormal sound in the neck when listened to with a stethoscope. This sound, called a “bruit” (pronounced “broo ee”), will often prompt a doctor to do further testing.

A carotid ultrasound (dopplers, duplex) is performed to see if this sound is significant. If the ultrasound demonstrates blockage less than 50%, the risks are minimal and ongoing observation is suggested. Blockages over 50% are considered significant and patients are routinely referred to a vascular specialist for further evaluation. To clarify the severity of blockage, more specific non-invasive testing (CT or MRI scans) may be ordered to determine the degree of blockage.

While less critical levels of blockage are usually treated with medical therapy, higher levels of blockage require more aggressive treatment to prevent the increased risk of stroke. The physicians at Summit Vascular Specialists are trained and experienced in both minimally invasive and operative management of these blockages.        (TOP)


Peripheral Arterial Disease (PAD, PVD)
When the arteries to the legs begin to block they can cause a number of problems for patients. The most common condition is called claudication, which means pain in the legs when walking. While many conditions can cause this type of problem (joint disease, arthritis, back problems), the pain caused by artery blockage is typically a pain that comes after walking a certain distance that is almost always relieved after resting for a few minutes. When plaques build up in the arteries that supply the legs (in the abdomen or in the legs) they limit the flow of nourishing blood to the legs. This leads to pain when a person tries to exert their legs.

More serious conditions can occur when the blood supply is severely limited due to blockages. Some patients experience pain in the legs at night (rest pain) that awakens them from their sleep. Others develop sores or ulcers on the legs that won’t heal. In some situations, dry gangrene (dead tissue) can begin to develop. In the worst case, the leg can potentially require amputation due to poor circulation.

Factors leading to this type of plaque build up include:

Of these, smoking may be the most harmful and the one factor the can be potentially eliminated. Surprisingly, many patients continue to smoke even after losing more than one limb to amputation.

Most individuals who have PAD notice a coolness of the leg or foot on the affected side. Numbness, tingling and weakness may also occur but are not alone diagnostic for PAD. Lack of good pulses on physical examination is a common finding in patients who have PAD. Hair loss, shiny skin, and discoloration of the feet and toes can also indicate poor circulation.

Non-invasive tests such as ultrasound, CT scans and MRI can be done to assess the degree of artery blockage. A vascular specialist may order these tests to help diagnose the severity of the condition. Many patients with PAD can be treated with medication, but patients who do not receive significant benefit from medication may need more aggressive therapy. Summit Vascular Specialists provide multiple treatment options including angioplasty, stenting, surgery, stent grafts, atherectomy and laser procedures to treat PAD in addition to comprehensive medical management of this disease.               (TOP)

Deep Vein Thrombosis (DVT)
One of the more common problems in the veins of the legs is a condition known as deep vein thrombosis. Usually, patients will experience pain and swelling in the affected leg. In this situation, clots form in the main veins of the legs causing impaired blood return. In some cases, these clots can break free and travel through the heart to the lungs causing a very serious condition known as pulmonary embolism.

Causes of deep vein thrombosis:

Any one or a combination of these things can put one at risk for DVT:

Much effort is directed at preventing DVT. People who travel long distances should learn simple exercises to do that help keep the blood flowing in those situations. Stopping or getting up to walk every 11/2 to 2 hours will also help prevent this condition.

With an impending surgery, a discussion with your surgeon about blood clot risks is appropriate. While many surgeries require no special precautions, others will require more protection from clots in the period surrounding surgery. There are a number of effective ways to help prevent clots. These methods can be applied in many of the above listed high-risk situations.

Diagnosis and treatment of deep vein thrombosis can be challenging. In most cases, ultrasound can be used to make the diagnosis. Treatment will vary from patient to patient. Frequently, a single clot may need differing treatments at different times. Summit Vascular Specialists are often called upon to offer opinions and different treatment options to patients with this problem. A variety of medical strategies to treat this problem are available. As needed, minimally invasive procedures are performed to optimize patient care and protection in this situation.                                                   (TOP)


Varicose Veins
Approximately 20-25 million Americans suffer from varicose and spider veins causing pain, discomfort, and cosmetic concerns. It is the function of veins to return blood to the heart. When a vein loses its ability to return blood to the heart, it becomes enlarged due to congestion and pooling of the blood. Blood then collects in the veins in the lower extremities creating varicosities. Symptoms of varicose and spider veins include pain, heaviness, burning, throbbing, itching, tingling, cramping, swelling, and skin ulcers in advanced stages of vein disease.

Summit Vascular Specialists physicians recognized the need to treat varicose vein disease with the attention it deserves. Reflections Vein Center has been established to deal with this significant problem and offer state of the art diagnosis and treatment.

For a more extensive discussion of this condition please visit:
www.reflectionsveincenter.com                                             (TOP)


Venous Insufficiency
Chronic leg swelling is a very common problem in this country. In many situations, it may be caused by an underlying condition (heart disease, lung disease, and obesity), though some patients develop leg swelling as a result of problems in the veins.

Veins can become incompetent and allow for build up of back pressure causing swelling in the leg. In some situations this can be due to a prior clot causing damage to the vein and rendering it incompetent. It is common for patients to have a hereditary predisposition to this problem.

Venous insufficiency is very difficult to diagnose and there are few quick cures for this condition. It is important to determine the problem of venous insufficiency is not due to a more serious condition. Heart failure, chronic obstructive pulmonary disease, heart valve problems, kidney insufficiency, liver disease and medication incompatibilities can all be associated with leg swelling. If new onset of leg swelling is noted, consultation with your primary doctor should be obtained. If your primary physician feels this is due to chronic venous disease he may request a consult with a vascular specialist.                                                                                           (TOP)


Other Aneurysms
Aneurysms (weakness and bulging of the artery wall) can occur in any area of the body. Aneurysms in the small blood vessels in the brain can be a very serious problem and are usually addressed by neurosurgeons.

Aneurysms of the arteries in the neck, shoulders, groin and legs can occur in patients and are treated by vascular surgeons. While all the same risk factors apply as for aortic aneurysms, two that are most critical are:

Just as blockages can cause stroke, aneurysms of the neck (carotid artery aneurysm) can cause stroke. These rarely rupture but if they do the results are often fatal. Diagnosis can be made with ultrasound and confirmed with non-invasive CT or MR angiography. Treatment is recommended for all carotid aneurysms.

Subclavian artery aneurysms (shoulder area) can occur due to chronic degenerative changes or repetitive trauma. These aneurysms can block completely threatening circulation to the entire arm. In some cases, small particles from within the aneurysm shower out into the circulation of the arm and hand causing obstruction of smaller arteries. This can threaten use of the fingers and even risk the loss of the limb. Rupture is rare, but if rupture occurs the result can be catastrophic. Due to the risk of limb loss, most subclavian aneurysms are treated once appropriate size is diagnosed on ultrasound, MR angiography or CT angiography.

Groin (femoral) and knee (popliteal) aneurysms are often seen in patients who have or have had abdominal aortic aneurysms. Similar to an aneurysm in the shoulder, these aneurysms cause problems by blocking off completely (thrombosis) or showering clot farther down the leg. Rupture is an infrequent occurrence. Again, diagnosis is made with ultrasound, MR angiography, or CT angiography. Treatment is suggested once these aneurysms reach an appropriate size or causes symptoms.

When appropriate, Summit Vascular Specialists physicians utilize minimally invasive therapies to treat patients with aneurysms. Minimally invasive therapies are used to treat aneurysm that are difficult to expose and treat with open surgery. A full range of open and minimally invasive treatment modalities is available through our practitioners.                                                                      (TOP)