Please use the space below to make a comment or ask a vascular-disease related question. Once a week, a Vascular Center specialist will respond to frequently asked questions and post them on this page. Please do not use this form to ask for a patient-specific diagnosis or medical advice. We cannot respond individually to medical questions, concerns or comments. If you have an urgent concern, you should contact your physician directly. If you are having chest pains or feel like you are having symptoms of a heart attack, you should call 911 or go to the nearest emergency room.
Search our Medications library for answers to basic questions about medications (dosage, precautions, side effects).
How does one know whether to choose an interventional vascular radiologist, or a vascular surgeon, for an AAA stent?
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?
How do you verify a patient has calciphylaxis and how do you treat it?
What is peripheral artery disease?
What is an aortic aneurysm?
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 vascular calcification?
What is vascular calcification in the pelvis?
What is vascular calcification in the foot?
How serious is vascular calcification of the aorta?
How accurate is an ABI test?
Why do an ABI before a vascular ultrasound?
What causes calcification of lymph nodes?
What is calcification of the arteries? Is it treatable?
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?
Why might my foot and toes turn purple after an injury to my leg?
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?
Should I be concerned about pain and a hardened mass on the side of my head?
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?
What procedures can be done to damaged veins caused by DVT?
I can't wear regular socks afer DVT. Is this normal?
How do you treat "leaky veins"?
Why do some people get large red veins on the front of their thighs?
What method of treatment is best for spider veins?
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: I have been told I have moderate extensive vascular calcification of the aorta. How serious is this?
Answer: Extensive calcification of the aorta is a marker for overall cholesterol deposition. It is generally not symptomatic unless there is enough plaque to limit blood flow through the aorta. This would be manifested by symptoms of leg cramping during exercise. Without symptoms such as these, there is no treatment specific to the aorta. Treatment should be targeted however at lowering your risk factors for depositing cholesterol, including smoking cessation, low fat diet and lipid lowering medications to bring your cholesterol down. You should discuss this with your regular doctor.
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 vascular calcification?
Answer: Vascular calcification occurs in atherosclerotic plaque in the arteries. The process of plaque formation is a complex one with deposition of cholesterol filled and other cells. One of the materials deposited is calcium. This is seen in older patients frequently but also in patients with diabetes and kidney disease. It is really a marker of artery blockage in general.
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 intervenional 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 any artery occurs as a result of atherosclerotic plaque. This is a marker for atherosclerosis in all arteries in the body, not just in the abdominal aorta. The plaque in the aorta does not cause any immediate damage, unless it is associated with narrowing of the aorta or aneurysm of the aorta. Persons having arterial calcifications should optimize their cholesterol and other blood lipids, high blood pressure and diabetes. Smokers should make every effort to stop completely. These measures may decrease the liklihood of heart attack, stroke and other vascular problems.
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
|
