Vascular FAQs

At Progressive Physician Associates, we believe that being an informed patient helps equip you for your own essential role in the healing process and in maintaining a lifestyle that will enhance your long-term vascular wellness.

This page addresses concerns that patients most frequently express about the treatments we provide for vascular conditions. As always, you are welcome to contact Progressive Physician Associates with any additional questions or concerns about your vascular conditions or treatments.

Who are vascular surgeons?

Vascular surgeons are physicians who care for patients with diseases that affect the arteries and veins throughout the body. This medical specialty first emerged in the early 1950s as a hybrid between general and cardiac surgery. However, unlike most other surgical specialties, no parallel medical discipline evolved to treat these patients and vascular surgeons were left to manage the full spectrum of vascular disease. Over the next three decades, pioneers in this specialty expanded our knowledge of the disease processes that affect blood vessels and helped to develop many of the diagnostic modalities and treatments that we use today.

What kinds of problems do vascular surgeons treat?

Although there are a number of diseases that can affect arteries and veins throughout the body, the most common problem that vascular surgeons treat is atherosclerosis, or hardening of the arteries, as it is more commonly known. This condition affects virtually every artery within the body. However, its preference for several specific locations results in a limited number of disease patterns.

Blockage or narrowing of the arteries in the neck can predispose patients to suffer a stroke which occurs when a portion of the brain receives inadequate blood flow and dies. Since it is very difficult to reverse the damage once it has occurred, successful management of this condition requires early recognition of the disease, often even before symptoms occur, and prompt, safe treatment.

The aorta which is the main artery carrying blood from the heart to every part of the body can develop a focal weakness of its wall due to atherosclerosis. This results in the formation of a dilated segment, or aneurysm, which if left untreated, will continue to enlarge until it ruptures resulting often in the death of the patient. Other arteries, usually in the legs, can also become aneurismal. However, leg aneurysms rarely rupture. In fact, they are more likely to become filled with blood clot which can break off and go to other parts of the body. These clots, or emboli as they are called, can lead to complete obstruction of that artery and abrupt loss of circulation to the body part it supplies.

When the arteries to the legs are narrowed by atherosclerosis, a characteristic recurrent muscle pain occurs in the legs following exercise. This symptom, which is called intermittent claudication, usually is promptly relieved by rest alone and does not get progressively worse. In a small number of advanced cases, the pain may become constant and keep the patient from sleeping. If this “rest”¬†pain is ignored, approximately one patient in ten will develop gangrene and may require amputation of part, or all, of their leg. However, few patients with intermittent claudication ever develop this disastrous complication.

Several of the main arteries within the abdomen can become narrowed by atherosclerosis. When this affects the arteries to the kidneys, the patient can develop severe hypertension, or high blood pressure, and ultimately kidney failure. Although this problem occurs in less than 10% of people with high blood pressure, it is important to recognize because the patient’s high blood pressure can be completely cured, or dramatically improved, by restoring circulation to the kidneys.

Rarely, the main arteries to the intestines can become blocked by atherosclerosis or by a blood clot from another part of the body resulting in severe abdominal pain after meals and weight loss. If not recognized, this condition can result in gangrene of the intestines and death.

Although problems with the veins are not as dramatic as those that follow arterial obstruction, they are a source of pain, suffering and economic loss to patients. The superficial leg veins can become very dilated and tortuous. If left untreated, these varicose veins will continue to enlarge and may be complicated by the development of blood clots or in advanced cases, by leg ulcers.

The veins deep within the legs are prone to develop blood clots, especially in patients who are bedridden or following surgery. This results in a common, and serious, condition known as deep venous thrombosis, or DVT. Although this problem usually improves dramatically following the administration of anticoagulants, or “blood thinners”, these blood clots can break loose and go to the patient’s lungs. Five to 10 years later, the patients can develop disabling leg swelling and ulceration.

Do vascular surgeons always recommend a surgical procedure to treat these problems

Quite the contrary! Many problems seen by vascular surgeons, such as intermittent claudication and DVT, are usually treated medically. Others such as small, asymptomatic, abdominal aortic aneurysms or moderate narrowing of the neck arteries are followed with noninvasive tests. As long as there is no evidence of progression, these problems are also left alone.

For those conditions in which some form of intervention is necessary, a number of new, innovative techniques are available. Manipulation within the arteries, using specially designed balloons and catheters, can often restore circulation or the integrity of the vessel wall without the need for an open surgical procedure or extended hospital stay.

Because vascular surgeons are trained in all forms of treatment, from medical to catheter-guided procedures to open surgery, they are uniquely qualified to offer their patients a variety of therapeutic options while exposing them to the least risk.

What is a stroke?

When circulation to a part of the brain is interrupted for more than a few minutes, the brain cells in that region may die or malfunction and the patient will demonstrate loss of some bodily function such as vision, speech, movement of a body part or sensation. When the underlying disease process is temporary, the symptoms may be similarly temporary and the episode is known as a “transient ischemic attack” or TIA. Some people also refer to these as¬†“mini-strokes:.

When the underlying blockage is fixed, the loss of function may be permanent and the patient will have a “stroke” or CVA (cerebrovascular accident). Although brain cells do not regenerate once they have died, surrounding areas of brain can assume some of the functions performed by the dead cells and thus, the patient can recover lost function following a stroke. If the doctors suspect that a patient has suffered a stroke, they may order a computerized tomogram, or CT scan, or a magnet resonance image, or MRI, to confirm the diagnosis and to measure the extent of damage. Strokes can result from many causes and surgical correction of a lesion in the carotid artery will be necessary in only a small percentage of patients.

How does narrowing of my neck arteries cause a stroke?

There are four principal arteries, two on each side, that supply blood to the brain. The left and right carotid arteries, which lie on either side of the neck, carry more than 80% of the flow. When atherosclerosis, or hardening of the arteries, develops in one of these vessels, small pieces of this plaque can break loose, go to the brain where they obstruct circulation to a small region of the brain and cause a temporary or permanent loss of function known as a stroke.

Studies have shown that the risk of stroke appears to be directly related to the severity of the narrowing. When more than 70% of one carotid artery is narrowed by atherosclerosis, the likelihood that the patient will have a stroke within the next several years on that side is greater than the danger of an operation to remove the blockage. In such patients, it may be necessary to consider a procedure to prevent stroke, even if the patient is having NO symptoms!

Since it is difficult to restore function once a stroke has occurred, it is important to detect threatening lesions before they cause trouble. Patients who have evidence of atherosclerosis elsewhere in their body or who are experiencing brief episodes of numbness, paralysis, loss of speech or vision, etc. should undergo careful ultrasound examination of their carotid arteries. Ultrasound scanning can accurately measure blood flow in the carotid arteries and identify significant degrees of narrowing which increase the patient’s risk of stroke.

Because the margin for error is so small, it is important that any surgery on the carotid artery only be performed by surgeons who have been specifically trained to do this procedure safely. The best results often are achieved by surgeons who perform this operation frequently and prospective patients should not be afraid to ask their surgeon how often he/she has performed the operation and what his stroke and death rates are following it. Depending on the patient’s condition and the reasons for the surgery, the combined risk of stroke and death after this procedure should range between 3 and 10%.

Recently, some physicians have begun treating narrowing of the carotid arteries using balloon dilation with/without the addition of metal stents to keep the dilated segment open. This has the advantage of avoiding open surgery but appears to be associated with an increased risk of stroke. Currently, there are clinical trials comparing this treatment with conventional surgery in equally matched patients. Until the results of these trials is available, this method of treating carotid disease must be considered experimental, despite the claims of its proponents.

What causes varicose veins?

The most important factor predisposing to varicose veins is a strong history of similar problems occurring in other blood relatives, such as mothers and aunts. With such a family history, individuals presumably inherit weakened valves in the superficial veins of their legs and under the right set of conditions, the veins become tortuous and dilated. Typically, factors that seem to predispose to the development of varicose veins include jobs which require prolonged standing or conditions which result in increased pressure within the abdomen, such as pregnancy or recurrent constipation.

Are varicose veins and spider veins the same thing?

No. Although they frequently occur together in the same leg, spider veins and varicose veins are different. If you think you have varicose veins, you should be able to close your eyes and FEEL the dilated veins beneath the skin of your legs. By contrast, spider veins which are tangled clusters of minute veins WITHIN the skin cannot ordinarily be felt. When varicose veins and/or spider veins are sufficiently disfiguring or symptomatic to warrant therapy, treatment of the two conditions is different. If varicose veins extend above the knee and are quite extensive, some form of surgery will usually be part of the treatment. This may include STRIPPING out the entire diseased segment, tying off the dilated vein in the groin and/or making multiple small incisions in the leg to “fish out” the damaged vein. This type of treatment is never necessary for spider veins!

Although sclerotherapy, or the injection of irritating chemicals into the vein, is frequently used for localized varicose veins or for the treatment of residual veins following surgical excision, it is a main stay in the treatment of spider veins. Finally, laser therapy is often used for the treatment of spider veins, but rarely, if ever, used to treat varicose veins.

What causes leg ulcers and how should they be treated?

Leg ulcers can be due to a variety of causes ranging from poor circulation to infection to an injury. However, the most frequent cause is related to the veins within the leg. If varicose veins become quite severe and are ignored, the legs can become very swollen, and congested. Eventually, the skin may break down following minor injury resulting in the formation of painful, non-healing ulcers just above the ankle.

An even more common occurrence is seen in patients who develop blood clots within the deep veins of their legs. This condition, known as thrombophlebitis or DVT, typically occurs in patients who have recently been bedridden or who have sustained a major leg injury. Following the injury, the combination of sluggish blood flow within the veins due to inactivity and possibly direct injury to the vein itself result in clotting of the blood. In a percentage of patients, abnormal “clotability” of the blood contributes to the problem.

Once the clot forms, the body attempts to break it up in order to restore “normal” blood flow within the vein. However, during this process, the valves normally present within the vein to prevent blood from flowing backwards down the vein when the patient is upright are damaged or destroyed. This, in turn, results in serious stagnation of blood within the legs, severe swelling and eventually, ulceration! This condition has been appropriately named chronic venous insufficiency. The cornerstones of treatment for this problem are: periodic leg elevation, properly fitted elastic stockings and meticulous care of the skin of the lower legs. Although the patient will almost always have to make some adjustments in his/her lifestyle, such as avoiding prolonged standing or sitting, a perfectly normal, active life is possible.