You can use the space below to ask a vascular-disease related question. Once a week, a Vascular Center specialist responds to frequently asked questions and posts the answers here.
Please do not use this form to ask for a patient-specific diagnosis or medical advice. We're unable to respond individually to medical questions, concerns or comments. If you have an urgent concern, call your physician. If you are having chest pains or feel like you are having symptoms of a heart attack, call 911 or go to the nearest emergency room.
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Aortic Aneurysm
How does one know whether to choose an interventional vascular radiologist, or a vascular surgeon, for an AAA stent?
How long do abdominal aortic stents last?
What sort of delay is acceptable from diagnosis to treatment of an aortic aneurysm?
Do AAA stents last as long as a full, open repair?
Is the heart stopped in an open repair of AAA?
How do the legs get any circulation during an open repair of an AAA, while the aorta is clamped?
What is....?
What is peripheral artery disease?
What is an aortic aneurysm?
What is a bochdalek hernia?
What is atherosclerosis?
How are abdominal aortic aneurysms treated?
What is calcified atherosclerotic disease of the abdominal aorta?
What is a poorly calcified abdominal aortic aneurysm?
What is compression of the inferior vena cava?
What is thoracic outlet syndrome?
What is extensive calcification?
What is vascular insufficiency of the lower extremity?
What is vascular calcification in the pelvis?
What is vascular calcification in the foot?
What is vascular flutter ?
What is reflux in my femoral vein?
What are phleboliths and a bone island?
What are aortoiliac atherosclerotic vascular calcifications?
ABI Test
How accurate is an ABI test?
Why do an ABI before a vascular ultrasound?
Calcification
Can you prevent or stop the calcification process?
What causes calcification of lymph nodes?
What is calcification of the arteries? Is it treatable?
How serious is carotid vascular calcification?
What is splenetic artery calcification?
Why did "heavy calcification" in the aorta not appear on my x-ray?
How do you verify a patient has calciphylaxis and how do you treat it?
Carotid Artery
What causes an intermittent fluttering feeling near the carotid artery?
Should I have surgery for carotid artery blockage?
If the carotid artery is calcified, can there be an adverse effect during face lift surgery?
Veins
Is it normal for veins to suddenly stick out from your arms?
Should I be concerned about swollen veins on the side of my forehead?
What causes a swollen blood vessel on the forehead?
What causes leaky veins in the legs?
Can massaging the legs cause damage to valves in the veins?
How do you treat "leaky veins"?
How could damage to heart valves lead to a backup of blood in my venous circulation?
Why do some people get large red veins on the front of their thighs?
I have a large dark area on the side of my leg and was told my veins are breaking down. Can anything be done about this?
What method of treatment is best for spider veins?
Who would be the better choice to treat venous stasis ulcers on the lower extremity?
Deep Vein Thrombosis (DVT)
What procedures can be done to damaged veins caused by DVT?
I can't wear regular socks after DVT. Is this normal?
Is there any correlation between a diagnosis of DVT and phelboliths?
Miscellaneous
Why do legs ache?
What can cause a foot to remain purple after a sprained ankle?
What are the benefits and risks to be weighed in deciding whether to have a portacath inserted in the arm or chest?
What can be done to increase blood flow if you have small leg arteries?
Can a hemosiderin deposit on my leg be removed somehow?
Should I be concerned about pain and a hardened mass on the side of my head?
Why is the blood in an artery brighter red than the blood in a vein?
Why do arteries lack valves yet they are present in veins?
Is there any treatment for pain in the toes and feet from compromised circulation?
Why might my foot and toes turn purple after an injury to my leg?
How much should patients walk if they have a blood clot in the leg?
Could there be a connection between thoracic outlet syndrome, carotidynia and supraclinoid ICA aneurysms?
Question: I had an abdominal aortic stent placed for a narrowing in the aorta approximately seven years ago. Prior to this I had severe claudication. How long do these stents last? I was told I would not have to be on any blood thinners due to the velocity of blood flow through the aorta.
Answer: Aortic stents can last for a very long time for the reason you stated - the very high blood flow. The stent should be monitored with ultrasound to make sure that it is not becoming narrowed. Early narrowing can be treated with a balloon angioplasty to reopen it and will help prolong the life of the stent.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: Can you prevent or stop the calcification process?
Answer: The calcification process is a result of deposition of cholesterol (and plaque) into the blood wall. The best way to prevent this is to lower your cholesterol. This can be effectively done through diet and exercise as well as smoking cessation. Certain people, however, are more prone to developing plaque including diabetics and patients with a family history of vascular or cardiac disease. In these cases or where diet and exercise are not enough, lipid lowering medications can be helpful and have been shown to lower the risk of heart attack and other problems that plaque causes.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: What is splenetic artery calcification?
Answer: Splenic artery calcification are calcium deposits along the splenic artery. These usually occur with age and are often found incidentally on xrays. They generally are of no consequence, but can be a marker for atherosclerosis (plaque) in other arteries in the body.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: What is vascular insufficiency of the lower extremity?
Answer: Vascular insufficiency of the lower extremity usually refers to blockages in the arteries of the legs. The source of the blockage is plaque that develops from cholesterol deposits. While everyone accumulates some plaque as they age, people with elevated cholesterol, smokers and diabetics are likely to generate more of it. The blockage becomes significant when it limits the flow of blood into the legs. At rest, the legs do not require much oxygen and so the flow of blood is fairly low and so there are no symptoms (unless there is severe blockage). When a person starts to walk, the legs ask for more oxygen and blood flow increases. If there is a blockage limiting that flow, the legs do not get enough oxygen and they start to cramp. Typically, people describe cramping in the calf or thigh after walking a few blocks. Once a person stops to rest, the cramping subsides as the legs do not need the extra blood. A decision on whether to treat blockages in the legs, either with stents or surgery, depends on the severity of symptoms and is best discussed with a vascular surgeon.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: What causes a swollen blood vessel on the forehead?
Answer: The visible vessels on the forehead are usually veins. They can become distended whenever the flow out of it is reduced, such as with grimacing (the muscles of the face tense up, limiting blood flow) or straining (holding your breath limits the blood flow back into the chest). It is not dangerous and will not cause any harm.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: What can cause a foot to remain purple after a sprained ankle?
Answer: If there are any (small) broken blood vessels that occured during the injury then this may be just pooled blood. Like a bruise, it will be absorbed eventually, but may take a while.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: How could damage to heart valves lead to a backup of blood in my venous circulation?
Answer: Generally if a heart valve "leaks " or has severe stenosis or " blockage," blood will go where it should not. What happens when a valve is not working is that blood will pool or migrate to the low pressure venous system, where it will stay and back up. This can cause shortness of breath or leg swelling, among a long list of other symptoms that venous congestion can cause.
Dr. Jeff Gress, Interventional Cardiologist, Everett
Question: What are the benefits and risks to be weighed in deciding whether to have a portacath inserted in the arm or chest?
Answer: Arm ports tend to be a little more comfortable and the incision is a little smaller. There is a higher risk of blood clot in the vein since the vein is longer and thinner. This type of blood clot could cause arm swelling and would be treated with blood thinners. Chest ports require a slightly larger incision and are more prone to be irritated by bra straps and shoulder seatbelts. A variety of chest ports are power injectable and can be used to inject CT scan IV contrast whigh might allow you to avoid getting an IV catheter if you need a CT scan. Chest ports are a short distance below your collarbone and are generally not very visible. Both types will result in a small 'lump' while in place. We had been placing mostly arm ports in interventional radiology primarily historically. In the balance between patient comfort and safety, the preference is shifting gradually to using power injectable chest ports.
Dr. Oliver Ochs, Interventional Radiologist, Radia Center for Vascular Disease
Question: Why do legs ache?
Answer: The cause of leg pain can be due to a variety of reasons: orthopedic, neurologic, arterial, venous. From a vascular standpoint, if there is blockage in the arteries to the legs, people describe a cramping sensation when they walk as the arteries are not delivering enough blood to the legs when the muscles are working. People do not usually have pains when they are at rest. Alternatively, people with venous problems complain of aching in their legs with prolonged standing, often associated with swelling. Of course, there are many other causes of leg pain and your doctor can help you find the cause or refer you to the appropriate specialist.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: What is thoracic outlet syndrome?
Answer: Thoracic outlet syndrome is compression of the vessels in the thoracic outlet which is a narrow space between the clavicle and the first rib. The subclavian artery, subclavian vein and brachial plexus nerves run through this area. Compression of these structures can cause symptoms such as weakness of the arm or swelling.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: Is there any correlation between a diagnosis of DVT and phelboliths?
Answer: DVT and phleboliths are probably not related. Phleboliths are calcifications in small veins that have been closed of for a long time. They are typically present low in the pelvis. They are a frequent normal finding in X-rays that include the pelvic region and really pose no threat. DVT in one of the main veins does have a risk of pulmonary embolus and needs to be treated with blood thinners.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: If the arteries in one leg to the foot are small, what can be done to increase the blood flow to the limb?
Answer: If the arteries in the foot are truly small, then there is not much that can be done to make them bigger. For arteries that are blocked, there are options including bypass or stents, but this is usually in the arteries higher up in the leg. Unfortunately, small distal arteries are often seen in patients with renal failure or diabetes and there are limited treatment options.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: Why is the blood in an artery brighter red than the blood in a vein?
Answer: The color of blood has to do with the amount of oxygen in the blood. Oxygen binds to hemoglobin in the red blood cells making the blood appear red. Hemoglobin without oxygen has a more blue color. Arteries carry oxygenated blood from the heart to the extremities and so the arteries appear red. Oxygen is taken out of the blood in the extremities and the veins then carry the blood without oxygen back to the heart, which explains why they appear blue.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: Can a hemosiderin deposit on my leg be removed somehow?
Answer: Unfortunately, there is not a good way to remove hemosiderin from the leg. It is the result of deposition of hemoglobin in the skin and the skin is now permanently stained.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: Could there be a connection between thoracic outlet syndrome, carotidynia and supraclinoid ICA aneurysms?
Answer: I do not know of any connection between thoracic outlet syndrome and supraclinoid ICA aneurysms. These are two different pathologies. In thoracic outlet syndrome, there is narrowing of the thoracic outlet by an accessory rib, excess ligamentous or muscular tissue or an enlarged first rib that narrows the space. Supraclinoid aneurysms are due to weakening of the arterial wall, usually due to hemodynamic shear injury. If a patient had enlarged arteries then I suppose there could be an increased risk of both thoracic aneurysms and supraclinoid ica aneurysms, but I can find no case reports of thoracic outlet syndrome with ICA aneurysms.
There may be a connection between carotidynia and supraclinoid aneurysms as carotid aneurysms in the neck can cause pain. A patient with a connective tissue disorder or fibromuscular dysplasia may have both carotid aneurysms in the neck as well as supraclinoid aneurysms.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: My husband used to massage my legs because the muscle would knot up. This has caused me to have valve problems and swollen feet. Will I have to wear support hose or will the veins and valves correct themselves?
Answer: Massage of the legs should not cause damage to the valves as the veins are fairly well protected. Reasons for the valves in your legs to fail include genetics (mother or sister with varicose veins), pregnancy, prolonged standing or strenuous lifting. If the valves in the legs have failed, then leg swelling and discomfort can occur. The degree of symptoms and treatment depends on which set of veins has been affected. The deep veins lay within the muscles themselves and damage to valves here can cause leg swelling that is not correctable by surgery. If the superficial vein valves have failed, such as in the saphenous vein, then ablation of the veins can help alleviate pain and swelling. A vascular surgeon would be the best person to evaluate and treat this condition.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: What is vascular flutter ?
Answer: In a person with advanced arteriosclerosis, the Bernoulli effect produces a symptom called vascular flutter. In this situation, the artery is constricted as a result of accumulated plaque on its inner walls. To maintain a constant flow rate, the blood must travel faster than normal through the constriction. If the blood speed is sufficiently high in the constricted region, the artery may collapse under external pressure, causing a momentary interruption in blood flow. At this moment, there is no Bernoulli effect, and the vessel reopens under arterial pressure. As the blood rushes through the constricted artery, the internal pressure drops and again the artery closes. Such variations can be heard with a stethoscope and are an indication of advance atherosclerotic disease.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: I recently had a x ray done on my leg and I was told that I had multiple pelvic phleboliths and a cortical bone island. What are these?
Answer: A bone island, also known as an enostosis, is a focus of compact bone located in cancellous bone. This is a benign entity that is usually found incidentally on imaging studies; rarely, however, the bone island may mimic a more sinister process, such as a metastic cancer, such as prostate cancer.
Phleboliths are calcifications in small veins that have been closed of for a long time. They are typically present low in the pelvis. They are a frequent normal finding in X-rays that include the pelvic region. They are not related to trauma, back injuries or otherwise.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: What causes leaky veins in the legs?
Answer: "Leaky veins" in the legs refers to the state of the valves in the veins. These valves keep blood from rushing down to the feet when you stand. Damage to these valves can result in blood traveling backwards and pooling in the legs, causing swelling and varicose veins. The damage can be due to several reasons including genetics (if your parents have varicose veins, you are at risk), pregnancy, prolonged standing or trauma to the legs. The valves are fragile and cannot be repaired surgically and don't regenerate.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: What is a bochdalek hernia?
Answer: A bochdalek hernia is a hernia in the diaphragm. It is congenital and is often diagnosed shortly after birth as the abdominal organs are herniated into the chest. This causes malformation of the lung, usually left side and often causes respiratory failure in the infant. A bochdalek hernia in an adult is extremely rare but can occur and often necessitates repair.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: What is reflux in my femoral vein?
Answer: Reflux in the femoral vein means that the valves are not functioning correctly. This can lead to swelling in the leg. Damage to the valves can be caused by trauma, such as a broken leg, or from a prior deep vein clot. Unfortunately, for deep veins, the treatment is primarily limited to compression stockings as the valves cannot be repaired.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: I have a large dark area on the side of my leg and was told my veins are breaking down. Can anything be done about this?
Answer: This sounds like venous disease and it can be treated. The dark spot on your leg is possibly due to the deposition of red blood cells in the soft tissues that have accumulated because the veins are not draining effectively. The hemoglobin in the cells breaks down and stains the skin. While there is a large range of venous disease from spider veins to ulcers, hemosiderin deposits, like what you are describing, usually indicates more advanced venous disease and should be addressed by a vascular surgeon.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: What sort of delay is acceptable from diagnosis to treatment of an aortic aneurysm?
Answer: Treatment of an abdominal aneurysm is really dependant on size and symptoms. Arteries are considered aneurismal when they are twice their normal size. In the abdominal aorta, this is about 3 cm, depending on the surrounding arteries. The risk of rupture of an aneurysm increases with size as the wall of the aneurysm becomes thinner. Many aneurysms do not grow and can be stable for years. These need to be followed with ultrasound or CT. When an aneurysm is larger than 5 cm, the risk of rupture begins to increase significantly and this is the size at which we consider intervention. We would also consider intervention if the aneurysm is causing symptoms of back pain or abdominal pain as this can be a sign of pending rupture.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: Why did "heavy calcification" in the aorta appear in a CT scan but not on my x-ray?
Answer: Sometimes the calcification in the aorta may be difficult to see on a plain x-ray. The "shadow" of the aorta may lie over the spine, making it difficult to visualize as the spine will appear much brighter. The CT scan is much better at differentiating aneurysms.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: How serious is carotid vascular calcification?
Answer: Carotid calcification is also termed carotid stenosis. There is a risk of stroke associated with carotid stenosis that increases with the degree of blockage. In general, blockage less than 50% is pretty low risk for a stroke. The risk of stroke increases significantly when the blockage is greater than 70%. Because of this, blockages over 50% need to be followed closely with ultrasound at least every year. Once blockage becomes greater than 80%, surgery to clean out the artery is often recommended to prevent a stroke. One other note about carotid stenosis is that it is a marker for cholesterol deposits in the body in general. Patients with carotid stenosis often have coronary artery disease in their hearts as well as blockages in their legs. These patients need to be agressively treated with low cholesterol diet, smoking cessation and even cholesterol lowering medications to reduce the risk of further plaque build up.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: How much should patients walk if they have a blood clot in the leg?
Answer: We used to think that when a patient was diagnosed with a deep vein thrombosis (DVT), they needed to be on strict bedrest. There actually was never any evidence to prove this was beneficial, it just seemed like a good idea. There recently has been several studies that show no difference between patients placed at bedrest to those allowed to ambulate early. In fact, there is evidence that early ambulation may reduce some of the pain and swelling associated with DVT.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: Who would be the better choice to evaluate or treat venous stasis ulcers on the lower extremity and why? A dermatologist, plastic surgeon or vascular surgeon?
Answer: Vascular surgeons are well trained in the treatment of venous stasis ulcers. The source of these ulcers is often due to a problem with the veins in the legs and there are several treatment options including new, minimally invasive treatments. Vascular surgeons are the only ones specifically trained to make the diagnosis and provide the full complement of treatments. This is evidenced by the fact that venous disease is part of the board certification for vascular surgery. Sores on the legs can also be caused by other reasons including arterial disease. Vascular surgeons can diagnose and treat this as well.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: What causes calcification of lymph nodes?
Answer: Calcification of lymph nodes is usually a sign of previous infection. Enlarged lymph nodes is a sign of lymph activity including infection, but also lymphoma or other cancers. For active infection in the leg, treatment is antibiotics depending on the cause of the infection. Without infection to explain the enlarged lymph nodes, follow up with your regular doctor is recommended to make sure there is no other reason for the enlargement.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: How do the legs get any circulation during an open repair of an AAA, while the aorta is clamped?
Answer: During aneurysm repair, clamps are placed on the iliac arteries which normally carry blood down to the legs. There is no temporary bypass and so the legs are without circulation for 30 to 60 minutes. The patient is given a large amount of blood thinner before the clamps are applied so the chance of blood clotting is very low. Before the repair is completed, the clamps are released to flush the blood back out of the legs to make sure. Then, once the repair is completed, we check the pulses in the feet to make sure circulation has been restored.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: If I've had a trauma injury to my leg, why might my foot and toes turn purple when the leg is vertical, then return to normal within minutes when horizontal within minutes? Could this be damage to a vein or artery?
Answer: This sounds like there may be some damage to the veins in the leg as well. Often when there is vein injury, the valves in the vein don't function well and when the leg is dependant, blood pools in the foot, causing discoloration and swelling. This is not often debilitating but if there is significant, prolonged swelling there can be a risk of venous ulcers. Treatment is usually compression stockings to keep the swelling reduced.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: What are aortoiliac atherosclerotic vascular calcifications?
Answer: Aortoiliac atherosclerotic vasular calcifications are calcium deposits in the wall of the arteries. This is a result of cholesterol and plaque. Plaque in the aorta may be benign or may cause blockage that limits blood flow to the legs. Symptoms would include pain in the legs/calves when you walk. Even without symptoms, calcified vessels are a sign of elevated cholesterol in your blood and means you could have blockage in other arteries including those in your heart and neck. You should have your cholesterol level measured and begin treatment with a low cholesterol diet, smoking cessation and cholesterol medications.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: How do you verify a patient has calciphylaxis and how do you treat it?
Answer: Calciphylaxis is a state of elevated calcium in the body. It is seen almost exclusively in patients with renal failure due to the elevated hormone PTH or parathyroid hormone. Calcification occurs in very small arteries, particularly in the skin. It manifests as a variety of lesions on the skin generally on the lower extremities. The lesions are exceedingly painful and lead to open wounds that often become dead tissue and infected. The condition is frequently fatal. Diagnosis is made by checking calcium and phosphate levels and biopsy of the skin lesions. Treatment is to reduce the calcium in the body as much as possible through medications and sometimes a procedure to remove the parathyroid glands. The skin wounds need to be treated with aggressive debridement and wound care to prevent serious infection.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: What is extensive calcification?
Answer: Extensive calcification is another term for plaque. Plaque results from the deposition of cholesterol in the blood vessels. The plaque then becomes calcified. It can occur in the carotid arteries in the neck, placing the patient at risk for stroke, in the arteries of the heart, placing the patient at risk for heart attack and in the legs, limiting the blood flow to the legs. Patients with extensive plaque need to be agressively managed to reduce their cholesterol and stop smoking to lower these risks.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: Is the heart stopped, like in heart bypass surgery, for an open repair of an AAA?
Answer: In open repair of AAA, the heart is not stopped. The blood pressure is tightly controlled by the anesthesiologist because the aorta in the abdomen does have to be clamped, but the heart is still beating.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: Two days ago, all of the veins on both of my arms are suddenly very large sticking way up from the back of my hands to just above the elbows. And when I put my arms up the all sink in, leaving an indentation where they were. What causes this and should I be concerned?
Answer: Distended veins can come from several sources. It is normal for veins to distend somewhat when the arms are down as blood pools due to gravity. When the arms are elevated, blood returns to the heart and the veins decompress. Veins that stay persistently distended, particularly on both sides, can be due to some source of increased venous pressure, either by compression on the veins within the chest or perhaps due to the heart not functioning well, causing a backup of blood. In your case, it sounds as if this was transient with relief by elevating your arms, so it is probably normal. If it persists or gets worse, you should discuss it with your physician.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: Do AAA stents last as long as a full, open repair?
Answer: "AAA Stents" or endovascular repair of an abdominal aortic aneurysm has been proven to be effective in long term follow-up out to about 8 years. The difference is that patients who receive an endograft must be followed with ultrasound or CT scan forever as there is a small chance the device could move and a leak develop. In general, an open repair is higher risk initially, but has proven to last a long time without any particular follow-up. I recommend open repair in younger, healthier patients who can tolerate it but this of course has to be individualized to each patient.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: How does one know whether to choose an interventional vascular radiologist, or a vascular surgeon, for an AAA stent?
Answer: You should choose your doctor based on their experience as well as they're expertise. Vascular surgeons have extensive training in open repair and natural history of aneurysms while interventional radiologists are adept with wires and catheters needed to place stents for aneurysms. The best choice is either someone who is trained in both vascular surgery and interventional radiology or a group that operates as a team where both an interventional radiologist and vascular surgeon participate in the operation.
Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease
Question: What causes an intermittent fluttering feeling near the carotid artery?
Answer: Arteries are rarely the source of sensations such as fluttering or pain. A fluttering feeling in the neck seems most likely due to a muscle fasciculation or spasm.
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question: Why do arteries lack valves yet they are present in veins?
Answer: Veins have one-way valves to assist the return of blood from the legs back to the heart. When humans are standing or sitting, blood has to travel upward, against the force of gravity, from the legs to the heart. These valves prevent gravity from pushing the blood back down the leg. The calf muscles are the "pumps" which propel the blood upward.
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question: In 2006 I had bilateral pulmonary emboli/DVT. Still today I cannot wear "regular socks" as it cuts into my affected leg and causes severe indentation/swelling. Is this normal?
Answer: Wearing graduated compression stockings after an episode of DVT will diminish leg swelling and help minimize symptoms of postphlebitic syndrome and lower the risk of venous ulceration. These prescription stockings come in various lengths and compression strengths. They should be as tight as possible, since more compression is better; however, if the compression is excessive, then compliance with their regular use is decreased. Start out with 20-30 mmHg compression.
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question: Why do some people get large red veins on the front of their thighs?
Answer: The cause of visible leg veins seems to be a combination of genetic factors, age and childbearing. The appearance can usually be improved with minimally invasive procedures such as injection sclerotherapy or, in more advanced cases, laser ablation of the saphenous vein and phlebectomy of the larger varicose veins.
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question: What is vascular calcification in the foot?
Answer: Vascular calcification in the foot is seen most often in patients with diabetes or renal insufficiency. It usually indicates advanced atherosclerosis
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question: I have been told that I have vascular calcification in my pelvis. What is this?
Answer: Vascular calcification in the pelvis is due to either calcium in the walls of arteries (usually the iliac arteries) or phleboliths, which are small non-dangerous blood clots in the veins of the pelvis. Phleboliths are extremely common, and have no clinical importance. Arterial calcifications indicate at least a moderate amount of atherosclerotic disease.
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question: What procedures can be done to damaged veins caused by DVT?
Answer: DVT (deep vein thrombosis) refers to blood clots in the deep veins of the legs; the arteries are not affected. There is currently no good way to repair the damage done to the veins after an episode of DVT. The damage may be limited by maintaining adequate blood thinning for 6 months and wearing graduated elastic support stockings. There is some data to suggest that using medicine to dissolve the clots when they are first discovered may further limit vein damage; however, this thrombolytic therapy has some risk of fatal bleeding, so it is not commonly used at this time.
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question: How do you treat "leaky veins"?
Answer: I think by "leaky veins" you are referring to incompetence of venous valves, which may be the source of varicose veins. If varicose veins are associated with valvular incompetence in the greater and/or lesser saphenous trunks, then successful treatment involves eradication of the saphenous veins and removal of the varicose branches. Until a few years ago the saphenous veins were removed by surgical stripping, which usually requires general or regional anesthesia in an outpatient surgery center or hospital. Currently, most incompetent saphenous veins are treated with endovascular laser ablation, which is done in the office with only local anesthesia. This minimally invasive procedure allows patients to resume full activity much more quickly than after conventional surgery.
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question: What is calcified atherosclerotic disease of the abdominal aorta?
Answer: Calcification of the aorta describes the calcium deposits in the wall of the arteries. These are the result of cholesterol and plaque in the wall of the artery that then becomes calcified. Plaque in the vessels may be benign or it may build up enough to cause blockage that limits blood flow to the legs. Symptoms would include pain in the buttock/legs/calves when you walk. If there are symptoms, referral to a vascular surgeon is warranted. Even without symptoms, calcified vessels are a sign of elevated cholesterol in your blood and means you could have blockage in other arteries including those in your heart and neck. You should have your cholesterol level measured and begin treatment with a low cholesterol diet, smoking cessation and cholesterol medications. These therapies will help to limit further cholesterol deposits, but will not remove the plaque that is already there.
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question: If someone is experiencing pain on one side of the head and a vein/artery/blood vessel throbs and then feels like its starting to harden, is that a major concern? And if there appears to be hardened nodes in certain parts of the body that feel like a hardened blood vessel, is there a way of knowing whether its a swollen blood vessel or a lymph node?
Answer: Temporal arteritis is a serious condition that may cause pain over the artery that can be felt in the temple region of the scalp. A patient should notify their primary care provider about this. There is often no way to tell the nature of a palpable mass without some imaging test (duplex scan, CT scan, etc).
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question: What is a poorly calcified abdominal aortic aneurysm?
Answer: It is an abdominal aortic aneurysm without much calcium in the wall as seen on imaging studies (CT, MRI, ultrasound). There is no clinical significance to the lack of calcium in the aneurysm wall.
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question: I have had extensive, unsightly spider veins accompanied by a few varicose veins on my thighs, calves, and ankles all of my adult life. I suspect the cause is both heredity and obesity. What method of treatment is most successful in the removal/treatment of this combination?
Answer: The best treatment depends upon the function of the valves in the greater and lesser saphenous veins, as well as any perforating veins of the legs. If the valves are "leaky", then often the saphenous veins require treatment with either surgical stripping or endovascular laser ablation, and the smaller branch veins can be treated with injection sclerotherapy and/or miniphlebectomy. If the valves in the saphenous veins are normal, then injection sclerotherapy alone works well.
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
for more information on veins go to www.radiaveincenter.com
Question: Is there any treatment for pain in the toes and feet from compromised circulation?
Answer: If pain in the feet and toes is determined to be caused by severe arterial insufficiency, then revascularization is indicated to relieve the pain as well as prevent tissue loss and possibly major amputation. Sometimes the leg can be successfully treated with percutaneous catheter-based devices; other times surgical bypass is necessary.
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question:I have several large swollen veins on the side of my forehead. They come and go, sometimes appearing on the opposite side. I can feel a pulse in them. Is this anything to be concerned about? They have no connection with headaches.
Answer: These "veins" are probably the superficial temporal arteries, since there is a pulse in them. As long as they are not painful, and there is no headache, they are of no concern.
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question: Why do an ABI before a vascular ultrasound?
Answer: The ABI (ankle - brachial index, or the ratio of the systolic BP at the ankle to the arm BP) answers the question: is there arterial insufficiency present at rest? If there is a post-exercise ABI, then this determines whether there is true claudication (ABI decrease of 0.15 or more, and associated exercise related leg symptoms).
The vascular ultrasound (duplex scan) only looks at arterial anatomy. It does not quantitate the severity of the arterial insufficiency, or determine whether the patient's leg symptoms are really due to arterial disease.
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question: If the carotid artery is calcified, can there be an adverse effect during face lift surgery?
Answer: If there are no symptoms of stroke associated with the carotid artery calcification, then there is unlikely to be any adverse event with face lift surgery.
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question: I have a 60% blockage in my left carotid artery. I have not had any symptoms; the blockage was found by a routine exam. My doctor suggest surgery, but I feel the risks are rather high for 60% blockage. Can you give me any insight to my problem?
Answer: Optimal treatment of patients with asymptomatic carotid disease remains somewhat controversial. The best scientific studies consistently show that carotid surgery definitely reduces the risk of stroke in patients with greater than 60% carotid stenosis (blockage); however, the size of the benefit appears relatively small. It seems that surgery may benefit men more than women. Although it seems logical that greater degrees of carotid blockage would benefit more from surgery, this has not been proven in several studies.
For surgery to be of maximal benefit, complications must be kept to a minimum – less than 3% incidence of operative stroke or death. Many centers of excellence in the United States (including Providence Everett) have complication rates much less than this.
Studies are in progress to determine whether carotid angioplasty and stenting is beneficial in asymptomatic patients. No rigorous scientific studies have yet been published, although some centers claim good results.
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question: What is compression of the inferior vena cava? What test makes it possible to see the inferior vena cava.
Answer: The inferior vena cava (IVC) is the large vein that carries blood back to the heart from the legs, pelvis and abdomen. It lies just in front of the spine and behind the abdominal contents (intestines). It can be compressed or obstructed by various conditions. This usually results in leg swelling since blood cannot be emptied effectively from the legs. Depending upon the location of the obstruction the abdomen may also swell. Veins may become protuberant and visible in the legs or abdominal wall (varicose veins); these veins enlarge to attempt to carry blood around the site of the blockage in the IVC.
A duplex scan or vascular ultrasound will usually be the first test performed in this setting. However, it usually does not visualize the IVC completely, since the IVC is located deeply in the abdomen. A CT scan or MRI often detects the location and nature of the compression accurately. In some cases a venogram is required, which is a test where contrast dye is injected through a catheter placed in the IVC.
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question: What is calcifaction of the arteries? Is it treatable?
Answer: Calcification of the coronary arteries is a late effect of atherosclerosis. The quantity of calcium present (calcium score) is a fairly good measure of the amount of atherosclerosis present. Treatment (removing as many risk factors as possible) is indicated for the atherosclerosis. The calcium may decrease a little with good treatment. Heart attacks are thought to be caused by plaque disruption or rupture not by calcium build up.
Dr. David Stewart, Medical Director, Providence Everett Heart and Vascular Institute
Question: How accurate is an ABI test? Can it produce an abnormal reading due to tiny arteries?
Answer: The ABI (ankle-brachial index) is calculated by dividing the systolic blood pressure obtained in the tibial arteries at the ankle by the highest systolic pressure obtained in the arms. Normally the ratio is 0.9 or higher. In non-diabetic patients the test is highly specific to diagnose the presence of significant lower extremity atherosclerotic disease. The sensitivity of the test can be increased by calculating the ABI after exercise. In other words, some patients with significant arterial blockages in the legs may have a normal resting ABI, but an abnormal post-exercise ABI. Diabetic patients may have calcification in the walls of the tibial arteries in the lower leg and foot. These calcified arteries may not be compressible by the blood pressure cuff, which makes determination of the ankle blood pressure inaccurate or impossible. In these cases, it is often possible to determine the blood pressure in the toes where the arterial calcification is less.
Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease
Question: What is peripheral artery disease?
Answer: Peripheral artery disease blocks (PAD) circulation to vital structures, commonly the legs and feet. It can be associated with high blood pressure, heart disease and stroke. PAD can cause pain in the calves when walking, but in its more severe form cause leg ulcers, and even gangrene that can lead to amputation.
Dr. Phil Feliciano, Vascular Surgeon, Radia Center for Vascular Disease
Question: What is an aortic aneurysm?
Answer: The aorta is a large blood vessel that carries blood from the heart to all the vital organs. An abdominal aortic aneurysm (AAA) is caused by a progressive weakening of the vessel wall that causes the aorta to dilate or "balloon". The aneurysm will grow larger and even rupture causing death if not treated.
Dr. Phil Feliciano, Vascular Surgeon, Radia Center for Vascular Disease
Question: How are abdominal aortic aneurysms treated?
Answer: Surgical treatment of AAA has been done for many years and is a durable procedure. Today at Providence Everett Medical Center we commonly repair these aneurysms using surgery, but also we can repair these aneurysms using a less invasive technique which allow us to repair the aneurysm using a catheter-based method using small incisions in the groin. We have been performing the less invasive procedure since 1999, when it was approved by the FDA. This minimally invasive technique has allowed our patients to have a quicker recovery and decrease their hospital stay to only one or two days.
Dr. Phil Feliciano, Vascular Surgeon, Radia Center for Vascular Disease
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