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Vascular disordersVascular disorders affect the veins and arteries, which carry blood and nutrients (including oxygen) throughout the body. Veins and arteries may become inflamed or swollen, partially or totally blocked, or experience other types of disease processes, injury or stress. Vascular disease can also be caused by arteriosclerosis, or hardening of the arteries. The Vascular Center at Aurora St. Luke's Medical Center offers specialized vascular experts and the widest selection of treatment options available in Wisconsin. Below are some of the common vascular disorders treated here. Abdominal aortic aneurysm | Venous disease | Deep vein thrombosis | Peripheral artery disease | Carotid disease Abdominal Aortic Aneurysm (AAA)Definition: An abdominal aortic aneurysm is an abnormal bulge or enlargement in a certain area of the aorta, the largest artery in the body. The enlargement results from a weakening in the walls of the aorta. The aorta carries oxygen-rich blood from the heart to various arteries and veins to supply all areas of the body with nutrients. The abdominal aorta travels down from the chest through the abdomen. Causes: Diseases, such as atherosclerosis (hardening of the arteries) and hypertension (high blood pressure), or injury may contribute to the formation of AAA. About one-quarter of abdominal aortic aneurysms run in families. If you have a close relative who has AAA, you may be more likely to develop one, too. Smoking is another risk factor. Symptoms: Often, there are no symptoms. Sometimes there is abdominal pain, low back pain or a pulsing sensation in the abdomen. Severe pain in these areas or sudden collapse may mean the aorta has burst or is about to. Seek medical attention immediately. Sometimes a blood clot will break off from the aneurysm and block blood supply to the leg, causing pain or tissue death. This is also a medical emergency. Diagnosis: A physician may be able to feel the aneurysm or a pulsating mass during examination. Sometimes the hardening of the aneurysm wall will show up on an x-ray. Routine ultrasound also will reveal the condition. Cross-sectional ultrasound or CT (computed tomography) diagnose the width and length of the aneurysm. To help determine the dimensions of the aneurysm and plan treatment, aortography may be performed. A dye-like material is injected into the aorta, which illuminates the aneurysm when a series of x-rays are taken. Treatments: When an AAA expands rapidly in a short time or reaches a certain size (typically more than 5 centimeters or 2 inches), surgery may be recommended. When appropriate, surgery prior to the aneurysm bursting or bleeding rather than in an emergency situation offers the best results. Two types of surgery are available including traditional open surgery in which a large incision is made in the abdomen, the aneurysm is removed and a man-made synthetic graft is put in its place. For some patients, a minimally invasive graft procedure can be performed without an open incision. Catheters – tiny tubes – are inserted into a small incision in the upper thigh and navigated through the arterial system to the aneurysm site where a stent is placed to keep the aorta from bursting. [ Visit our medical encyclopedia to learn more ] Venous diseaseDefinition: Venous disease, also known as chronic venous insufficiency, occurs when blood pools in the lower leg veins. Causes: Typically, blood in the leg veins flows upward toward the heart to be infused with oxygen. When the valves in these veins become damaged, blood flows back down and pools in the legs. Valve damage most often occurs as a result of varicose veins, calf muscle damage or a blood clot in the vein. Family history, obesity, age and inactivity all may contribute to the development of venous disease. Symptoms: Symptoms include ankle and leg swelling, pale yellow fluid leaking through leg skin, a reddish-brown skin discoloration, or legs that ache, feel heavy or skin that looks and feels like leather. Diagnosis: A thorough medical history, physician examination and an ultrasound of leg veins (called a duplex scanner) are most often used to diagnose this disease. Treatments: Treatment often includes compression stockings, which squeeze the veins to keep blood flowing in the right direction, wet compresses on the leg or in some cases antibiotics. [ Visit our medical encyclopedia to learn more ] Deep Vein Thrombosis (DVT)Definition: Deep vein thrombosis is a blood clot (thrombus) located in the large veins of the pelvic area or legs. Deep veins are located deeper in the body's tissues rather than just below the surface of the skin. DVT can cause a life-threatening pulmonary embolism if the clot breaks free and travels through the body's blood system to lodge in a lung artery. However, with prompt diagnosis and treatment, most DVT conditions are not life-threatening. Causes: Deep vein thrombosis is typically caused by a combination of conditions including inflammation or irritation of the vein's inner lining, slow blood flow through a deep vein and the tendency of the individual's blood to clot more quickly than usual. Inflammation may occur after a medical procedure or serious injury. Blood flow may slow or result in a clot if the individual is confined to bed rest, has cancer or is receiving cancer treatment. DVT may also occur in people who have had recent hip or knee surgery, or who are unable to walk for awhile, such as during lengthy car trips or air travel. A history of close family members who have had blood clots may make you more likely to experience DVT. Certain conditions increase the risk of developing DVT, including chronic respiratory failure, congestive heart failure, a history of smoking, severe obesity, a sedentary lifestyle, pregnancy (particularly the later stages), varicose veins and estrogen hormone treatment. Symptoms: About 50% of DVT patients have no symptoms. Symptoms may develop suddenly or over a short time. They include leg pain, tender calf muscles, swelling or change of color (to blue or purple) in one leg. If symptoms occur, contact your doctor immediately. Symptoms of a pulmonary embolism are similar to some other medical conditions and include shortness of breath, chest pain, a fast pulse or cough. Anxiety, fainting or sweating may also be present. Seek medical attention immediately. Diagnosis: Diagnostic tests may include ultrasound, venography (a dye-like substance is injected into the leg to illuminate the clot on x-rays) or a blood test to check the level of D dimer, a clot-dissolving substance produced by the body. Treatments: Treatments may include elevating the leg periodically throughout the day, wearing compression stockings and taking medications (anticoagulants) to prevent blood clotting. Anti-coagulants include heparin given by injection or intravenously and warfarin (Coumadin), which is taken by mouth for several months. Thrombolysis may be recommended for more severe DVT cases in addition to anticoagulants. In this case, a tiny, long tube (catheter) is inserted into a vein and navigated to the site of the blood clot where a clot-dissolving medication is administered. The catheter may also be used to vacuum out the clot. Particularly in the case of DVT in the iliac veins of the pelvic area, a tiny balloon or stent may be deployed through the catheter to open the vein or keep it open after the clot is removed. For patients who can't have thrombolysis medication, the clot may be removed through a small incision. [ Visit our medical encyclopedia to learn more ] Peripheral Artery Disease (PAD)Definition: PAD is a narrowing of the central arteries, typically in the legs, which decreases blood flow. Sometimes the smaller veins around the narrowing become larger to allow increased blood flow. Over time, the artery may become completely blocked, stopping blood flow and causing critical leg ischemia with serious damage to nearby tissues. Causes: It is caused by atherosclerosis (“hardening” of the arteries) in which plaque in the blood, including cholesterol, attaches to the walls of the arteries. Risk factors include high cholesterol, smoking, diabetes or heart disease. People age 50 or older are at increased risk for PAD. A family history of cardiovascular disease can be a risk factor for PAD. Symptoms: Often there are no symptoms until the artery is significantly narrowed. While walking, leg muscles may cramp. Muscles may feel weak, numb or heavy. There may be burning or pain in the feet and toes because of decreased blood circulation. The pain is more likely to occur during the night or other periods of inactivity. Lowering the legs may reduce the pain because gravity helps blood flow downward. Certain areas of the skin my change color or feel cool. If PAD continues to advance, blocked arteries prevent blood from carrying necessary nutrients, resulting in sores and gangrene on the legs and feet. Diagnosis: Diagnostic tests may include measuring the blood pressures in the ankle and arm for comparison (ankle-brachial index) using a blood pressure cup and Doppler ultrasound. This may be performed before and after exercising on a treadmill. Doppler may also be used to measure blood pressure at different points on the arm or leg. The heart's electrical impulses may be measured with electrode patches attached to the skin (electrocardiogram) during or after treadmill exercise. Magnetic resonance angiography (MRA) is a type of magnetic resonance imaging that may be used to evaluate the arteries. Additional diagnostics may involve a reactive hyperemia test, PVR waveform analysis or photoplethysmography. Treatments: Treatments, which depend on the extent of PAD and the patient's health, focus on improving symptoms and stopping the condition from getting worse. Exercise, medications, lifestyle changes, foot care or surgery may be recommended. Medications may help prevent blood clots and lower cholesterol and blood pressure levels. Angioplasty may be recommended to insert and briefly inflate a tiny balloon in the vein to improve blood flow. It is delivered by catheter (long, thin tube) inserted through a very small incision. The catheter may also deliver a clot-dissolving drug to the area or a mesh tube (stent) to be left in the artery to keep the artery open. For some patients, surgery may be necessary to perform a bypass graft of the artery's damaged section using a vein from another part of the body or a man-made fabric tube. In rare cases, amputation may be necessary. [ Visit our medical encyclopedia to learn more ] Carotid diseaseDefinition: Carotid disease is a hardening of the carotid arteries, typically occurring when cholesterol and plaque build up in the arteries in your neck that supply blood to your brain. Causes: A number of risk factors can contribute to your chance of developing carotid disease: A family history of heart disease, age, smoking, hypertension, diabetes and high cholesterol. Symptoms: While a person may not have any symptoms, if one of the carotid arteries becomes blocked, or if a piece of the plaque breaks off and blocks the flow of blood, the risk of a stroke increases dramatically. Warning signs that you are at risk for a stroke include blurred vision, weakness or numbness in your arms, legs or face, slurred speech, dizziness or trouble talking. If you experience any of these symptoms, call 911 immediately. Diagnosis: Carotid disease can be diagnosed by a physician listening to the arteries in your neck with a stethoscope. If a rushing sound is heard, you may have the disease. Build up and blockages can also be found through several diagnostic tests, including:
It is also important to let your physician know if you've experienced any of the stroke symptoms listed above. Treatments: The most common treatments for carotid disease include lifestyle modifications, medications or procedures such as:
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