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501 Seaview Avenue, Suite 302
Staten Island, New York 10305

Abdominal aortic aneurysm

The abdominal aorta is a large blood vessel that supplies blood to the abdomen, pelvis, and legs. When the wall of the aorta becomes weak and diseased, it may become larger and balloon outward. This is called an abdominal aortic aneurysm and is also sometimes known as a "triple A.” If the aneurysm is not treated, it may burst, leading to severe hemorrhage.

Causes

There are a number of different causes of abdominal aortic aneurysm, including:

  • Hypertension (high blood pressure)
  • Smoking
  • Obesity
  • Emphysema
  • Genetic factors

Symptoms

The symptoms of rupture include:

  • Sudden pain in the abdomen or back
  • Pulsation in the abdomen
  • Clammy skin
  • Nausea and vomiting
  • Rapid heart rate
  • Shock

Diagnosis

If your doctor believes you may have an aneurysm, they will confirm the diagnosis with either an ultrasound or a CT scan.  Once you have been diagnosed with an aneurysm your doctor will decide if it can simply be observed with imaging (for example, an ultrasound every six months) or if surgery is needed.

Surgery

There are two approaches to surgery:

Open surgery
An incision is made into the abdomen. The aneurysm is cut out and replaced with a tube graft made of Dacron or PTFE (similar to a plastic tube).

Minimally invasive repair
Also known as an endovascular aneurysm repair (EVAR), this procedure is performed with two small incisions in the thigh that expose the groin arteries. The doctor then places a stent graft into the aorta to exclude the aneurysm. The patient typically goes home the next day and resumes normal activity.

Carotid artery disease

Carotid arteries are the major arteries located in both sides of the neck. They supply blood to most of the brain. Over time, plaque can build up in the walls of these arteries causing them to harden and become narrow. This is known as carotid artery disease. The plaque may completely close off the artery, or pieces of the plaque may break off and lodge in the brain. Either process can cause a serious condition known as a stroke, where blood flow is cut off to a part of the brain, depriving it of the oxygen it needs to function.

Risk factors

Some of the risk factors for carotid artery disease are:

  • Family history
  • High blood pressure
  • High cholesterol
  • Heart disease
  • Diabetes
  • Smoking
  • Obesity

Symptoms

Carotid artery disease may not cause symptoms. Unfortunately, the first sign of carotid artery disease could be a stroke or a mini-stroke (also known as a transient ischemic attack or TIA). Symptoms of a TIA usually last a few minutes to one hour and include:

  • Feeling weak
  • Numbness, or a tingling sensation on one side of the body
  • Confusion
  • Being unable to control the movement of an arm or a leg
  • Losing vision in one eye (many people describe this sensation as a window shade coming down) 
  • Sudden drooping of one side of the face
  • Being unable to speak clearly
  • Sudden memory loss

Diagnosis and tests

Disease of the carotid arteries is often discovered during a routine examination when a swishing sound is heard through a stethoscope placed on the neck.  If your doctor suspects carotid artery disease, they will generally order a non-invasive examination called a carotid artery duplex ultrasound.  Additional tests your doctor may order to confirm the diagnosis include CT scan, magnetic resonance angiogram (MRA) or cerebral angiogram.

Prevention

To keep carotid artery disease from progressing, doctors recommend eating a healthy diet, regular exercise and lifestyle modifications including:

  • Quitting smoking
  • Regular check-ups
  • Controlling high blood pressure
  • Controlling diabetes
  • Limiting alcohol intake

Treatment

Mild blockage of the arteries is usually treated with medications. Severe blockage is usually treated with surgery or a minimally invasive procedure known as an angioplasty and stent.

Carotid endarterectomy (CEA): The patient is placed under general anesthesia. A three to four-inch incision is made in the neck. The artery is isolated and the plaque is removed. The artery is sewn back together to allow improved blood flow to the brain. 

The risks and benefits depend on many factors like age and other medical conditions of the patient. Typically, the patient stays overnight in the intensive care unit and is discharged the next day. 
 
Carotid artery stenting (CAS): A small puncture is made in the groin. A specially designed wire and stent are placed in the diseased carotid artery. Once in place, the stent is expanded to hold the artery open. The patient feels a little discomfort and is usually sent home the next day. This procedure is less invasive than open carotid surgery.

Chronic venous insufficiency (CVI) and venous ulcers

The venous system is composed of a large network of vessels throughout the body that carry blood back to the heart. Inside these veins are tiny one-way valves that prevent blood from pooling in the legs and arms. Over time, the valves may become weak and, in turn, blood pools in the legs. This is known as chronic venous insufficiency. The pooling of blood causes increased pressure in the legs and inflammation. 

Symptoms

  • Bluish discoloration of the lower legs
  • Ankle and leg swelling
  • Dry itchy skin
  • Ulcers around the ankle

Risk factors

  • Age
  • Family history
  • Standing for prolonged periods of time
  • History of deep venous thrombosis (DVT)

Diagnosis

Usually, a physical exam and history are sufficient to make a diagnosis. An ultrasound may also be used.

Treatment

Treatment of CVI focuses on reducing the pressure in the legs and improving the circulation. It includes elevation of the legs, exercise, and use of compression stockings. If an ulcer is present, the goal is to prevent it from getting larger and becoming infected. Local wound care with specialized gels may be sufficient. sometimes antibiotics and surgery may be required to heal a wound.

Deep venous thrombosis

Deep venous thrombosis (sometimes called DVT) is a condition in which a blood clot forms in a vein that is deep inside the body, typically in the legs. This is a serious condition because of the risk of a pulmonary embolus, where a piece of the clot can dislodge and travel to the lung causing difficulty in breathing and even sudden death.

Risks

Risks for DVT include:

  • Prolonged bed rest
  • Family history
  • Cigarette smoking
  • Pregnancy
  • Oral contraceptive medications (birth control pills)
  • Obesity
  • Recent surgery (brain, hip or knee surgery)
  • Long plane or car trip

Symptoms

  • Sudden swelling of the arm or leg
  • Pain or aching in the leg or arm
  • Skin color changes

Diagnosis

Deep venous thrombosis is usually diagnosed with an ultrasound test. This test takes about 15 minutes to perform and is typically done in the doctor's office or the vascular lab.

Treatment

Treatment for deep venous thrombosis involves "thinning the blood" with medications such as Heparin and Coumadin. These medications prevent the clot from getting larger and breaking off. Your doctor will decide on the dose and length of time you will stay on the medication. Typically, patients will have to continue these medications for several months.

If the patient is unable to take a blood thinning medication or the medication is not effectively working, a filter can be placed in the large vein that carries blood to the heart to catch any pieces of the clot that may break off before they reach the lungs.

Minimally invasive thrombectomy and thrombolysis
In rare cases, a patient may require one of these procedures.  A thrombectomy is the surgical removal of the clot. Thrombolysis uses a catheter placed in the vein to break down the clot by direct application of medication or by using a spinning wire, similar to a “Roto-rooter” machine that is used to clear clogged pipes.

Peripheral arterial disease

Peripheral arterial disease (PAD), also known as peripheral vascular disease (PVD), develops as a result of a build-up of fatty deposits and plaque in the lining of blood vessels. This process is known as atherosclerosis. When plaque builds up, the vessels become hard and narrow causing poor circulation. If left untreated it can cause painful foot ulcers and infections that may require amputation. It can also lead to increased risk for heart attack and stroke.

Risk factors

Risk factors for PAD include:

  • Family history of atherosclerosis
  • High blood pressure
  • Diabetes
  • High cholesterol
  • Advanced age
  • Smoking

Symptoms

People who have PAD may experience pain in their hips, thighs or calves when they walk or run. The pain often goes away when the exercise stops. Other symptoms can include hair loss on the legs, slow-healing sores on the legs, changes in the skin on the legs and feet, impotence, pain in the toes when lying flat, paleness of the legs when they are elevated, and reddish-blue discoloration of the extremities.

PAD often goes undiagnosed. It is important to inform your physician if you have symptoms.

Diagnosis and tests

Your doctor will ask you specific questions regarding your complaints; usually the history you provide will lead them to the diagnosis of PAD. If your doctor suspects your symptoms are caused by PAD they may order additional tests, including:

Ankle-brachial index (ABI)
This test compares the pressure in the legs and arms. The test is quick and painless and can be performed in the doctor's office.

Duplex ultrasound
Performed in the doctor’s office, this test gives second-to-second pictures of the blood vessels and the blood flow in the vessels.

CT scan or MRA
These are also non-invasive, painless tests that provide the doctor with pictures of the blood vessels, giving more details about the location and severity of the disease.

Treatment

Lifestyle changes and medications
Mild symptoms can be treated with lifestyle changes like quitting smoking, control of diabetes, and daily exercise. Medications that improve blood flow may also be beneficial. If the disease is severe, procedures may be needed to restore more blood flow.

Angioplasty and stent
With the use of X-ray guidance, a small balloon attached to a flexible catheter is inserted into a blood vessel and directed to the site of the blocked artery. The balloon inflates and opens the vessel. If the vessel does not stay open, a stent (tube-shaped metal scaffolding) may be inserted to keep the artery open. The patient is usually sent home the same day. 

Surgical revascularization
If the disease is advanced, balloon angioplasty and stent placement may not restore enough circulation. In that case, a surgical bypass may be needed. A surgeon makes two or three incisions in the leg, then uses either the patient’s own vein or a synthetic graft to bypass the diseased area.

Renal artery disease

The kidneys are organs located on either side of the abdomen. Their main function is to clear waste from the body through the production of urine. The renal arteries carry blood to the kidneys. With age and lifestyle, the arteries can become hard and narrowed, reducing the blood flow needed by the kidneys. Reduced blood flow can seriously damage the kidneys and cause complications like high blood pressure and renal failure.

Symptoms

The main symptom related to renal artery narrowing is high blood pressure that is difficult to control with medicine.

Untreated high blood pressure may lead to:

  • Severe headaches
  • Ringing in the ears
  • Heart failure
  • Stroke
  • Kidney failure requiring dialysis

Causes

  • Cholesterol and plaque build-up, also known as arteriosclerosis 
  • Congenital narrowing of the arteries that occurs during fetal development
  • Fibromuscular dysplasia (also called FMD), an overgrowth of tissue inside the renal artery that usually affects women between 20 and 40 years old

Diagnosis

The initial test is usually a duplex ultrasound, which looks at the renal arteries and the flow of blood within the arteries. This test is performed in the doctor's office or the vascular laboratory and takes about 20 minutes to complete.

Your doctor may also order additional tests if more information is needed, including:

  • CT scan
  • MRA (Magnetic resonance angiography)
  • Angiogram

Treatment

Early cases of renal artery narrowing can be treated with lifestyle changes like:

  • Smoking cessation
  • Regular exercise
  • Controlling diabetes and high blood pressure

Certain cases may require a procedure to improve the blood flow. These procedures include:

Angioplasty and stent
A balloon is placed in the artery and expanded to open up the artery. Occasionally, a stent is used if the balloon fails to keep the artery open. The patient typically goes home several hours after the procedure.

Surgery
Surgery may be needed in cases that cannot be treated with an angioplasty and stent. The surgery consists of either removal of the disease that is causing the narrowing or a bypass using an artificial graft or a vein from the patient's own leg.

Superficial thrombophlebitis

When a clot forms in a deep vein it is known as a deep venous thrombosis (DVT). When a clot is located in a superficial vein it is known as superficial thrombophlebitis.

Symptoms

When thrombophlebitis occurs in a vein, a thick cord can be felt under the skin. Pain and swelling in the area might also occur.

Treatment

This condition is treated with the elevation of the leg, medications such as Motrin, and warm compresses to the involved area. If the symptoms are severe, the doctor may also prescribe blood-thinning medications like Heparin or Coumadin.

Thoracic aortic aneurysm

The aorta is the largest artery in the body. It delivers oxygenated blood from the heart to the rest of the body. It is attached to the heart and travels through the chest into the abdomen. When the wall of the aorta becomes weak and diseased it may become larger and balloon outward. This is known as an aortic aneurysm. When it occurs in the chest it is known as a thoracic aortic aneurysm, also called TAA.

If an aneurysm is not treated it may burst, leading to severe hemorrhage. Although thoracic aneurysms do not occur as often as abdominal aneurysms, they may be more dangerous, as mortality is extremely high when they rupture.

Causes

There are a number of different causes of thoracic aortic aneurysm, including:

  • Hypertension (high blood pressure)
  • Smoking
  • Obesity
  • Emphysema
  • Genetic factors

Symptoms

The symptoms of rupture include:

  • Sudden severe pain in the back
  • Clammy skin
  • Nausea and vomiting
  • Rapid heart rate
  • Shock

Diagnosis

If your doctor thinks you may have an aneurysm, they will confirm the diagnosis with either an ultrasound or a CT scan.

Treatment

Once you have been diagnosed with an aneurysm, your doctor will decide if it needs to be repaired with surgery or if it can be observed with close follow-up and imaging tests.

Minimally invasive repair
Many thoracic aneurysms can now be treated with an endograft device, which is a hollow tube surrounding a stent. Small incisions are made in the groin using multiple wires and catheters. The stent is placed in the aorta to repair the aneurysm. The patient typically goes home in one or two days. Minimally invasive repair now allows doctors to treat many patients who were considered too high risk for an open surgery.

Open Surgery
An incision is made in the left side of the chest. The aneurysm and diseased material are removed. A tube made of PTFE or Dacron is then used to create a new aorta. The patient is typically sent to the intensive care unit for several days for recovery.

Varicose veins

The venous system is composed of a large network of vessels throughout the body that carry blood back to the heart. Inside the veins are tiny one-way valves that prevent blood from pooling in the legs and arms.

Varicose veins are dilated veins that develop when the tiny valves are destroyed. The non-working valves allow the blood to pool in the legs causing the blood to leak out of the vessels and into the surrounding tissue, including the skin. Approximately 25 percent of the population suffers from this condition.

Cause

Varicose veins develop when the pressure in the legs is increased. People that stand on their feet for long periods of time and overweight people are especially at risk for developing varicose veins. Other risk factors include age, family history and pregnancy.

Diagnosis

The diagnosis of varicose veins is usually made by a physical exam and a history. An ultrasound test is used to give more detail about the anatomy and location of the veins.

Symptoms

Patients suffering from varicose veins may notice soft bulges in the legs, usually behind the calves or inner thighs. The surrounding skin may have a bluish discoloration. The legs often become painful and swollen with a tired, cramping feeling.

Treatment

Varicose veins are initially treated with leg elevation, exercise and use of support stockings. If these measure fail, the varicose veins can be removed by small incisions or by a minimally invasive approach using a special laser. 

501 Seaview Avenue , Suite 302
Staten Island, New York 10305
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