VASCULAR SURGERY

An integral part of diagnosing vascular disease, such as peripheral vascular disease (PVD) and carotid artery stenosis is using vascular diagnostic tests that are performed on our ultrasound and physiologic arterial testing machines. There are several tests that In Office Studywe can perform on site at our Fort Myers and Cape Coral offices including:

  • Venous Duplex Scan
  • Arterial duplex scan of the extremities
  • Carotid duplex scan
  • Abdominal aortic ultrasound
  • Ankle/brachial index measurements (ABI)
  • Vein mapping
  • Graft scan

Our most common vascular ailments are abdominal aortic aneurysm, peripheral vascular disease, and carotid artery stenosis.

Abdominal Aortic Aneurysm (AAA)
An abdominal aortic aneurysm is a balloon-like bulge in the aorta, the blood vessel that supplies blood from the heart to the organs. The bulge forms in the vessel wall, and if left untreated can rupture, which can be life threatening.

Symptoms and Risk Factors: Usually there are no symptoms and an aneurysm is often found during a routine exam for an unrelated problem. Anyone is at risk to develop an abdominal aortic aneurysm, however, individuals that smoke, have high blood pressure, are over 55(men) or 65(women), or have a close relative with an AAA is at greater risk.

Diagnosis: Routine examinations, ultrasounds of the abdomen, and an abdominal CT scan can help diagnosis an abdominal aortic aneurysm.

Treatments: Small aneurysms can be safely observed. Larger aneurysms may require open or endovascular surgery, depending on the size and shape of an individual’s blood vessels.

Open Surgery: An incision is made in the abdomen. An artificial graft is inserted inside the damaged artery. Recovery time is longer (5-8 days in the hospital) than endovascular repairs, but for many patients it is the only option to treat an AAA.

Endovascular Surgery: Two small incisions are made in the groin and the artificial graft is inserted into the artery. This procedure is less invasive than open surgery and recovery time is shorter with patients usually going home 1-2 days after surgery.

Peripheral Vascular Disease (PVD)
PVD occurs when your arteries can not bring enough blood to you leg and foot muscles. Plaque build up in the arteries causes them to narrow and therefore less blood flows through to the leg. This causes pain and muscle cramping in the lower extremities after walking. In severe cases the loss of blood flow can result in gangrene and limb loss.

Symptoms and Risk Factors: Claudication (cramping pain in the buttocks, thigh, or calf when exercising and relieved when resting), rest pain (constant pain in the foot due to restriction of blood flow), nonhealing ulcers on the foot or toes, and gangrene are all symptoms of PVD. Risk factors include smoking, hypertension, diabetes mellitus and family history of PVD

Diagnosis: Peripheral Vascular Disease can be diagnosed using several different tests, including the ultrasound Doppler test, ankle brachial index (ABI), and angiograms.

Treatments: Reduce your risk factors. This will help decrease your chance of developing PVD. In some cases medication can be taken to reduce claudication, under the supervision of your doctor. Bypass surgery is often the only treatment for advanced PVD. There are two types: femoral popliteal and distal bypass.

Femoral Popliteal: The blocked artery is bypassed via the popliteal artery in the upper part of the leg using either an artificial graft or you own vein.

Distal: The blocked artery is bypassed via the distal artery in the lower leg using either an artificial graft or your own vein.

Endovascular: This is a less invasive procedure using balloons and stents that does not require anesthesia. It aids in wound healing and pain with claudication.

Carotid Artery Stenosis
Carotid artery stenosis is one of the leading causes of TIA and strokes. TIA is a transient ischemic attack, which has similar symptoms as a stroke but go away after a few minutes or hours and there is no brain damage. The carotid artery supplies blood to the brain and like other arteries has the ability to collect plaque, which can cause stenosis, or narrowing of the arteries, therefore allowing less blood flow to the brain.

Diagnosis: Carotid bruits are sounds that are heard by using a stethoscope on the neck that can indicate a build up of plaque in the artery. A carotid duplex scan can detect the degree of stenosis. An MRA is often used to confirm the diagnosis. It is a non invasive test that uses magnetic resonance imagining. In addition a contrast angiogram is used as a diagnostic procedure and prior to carotid angioplasty and stenting. It requires a catheter in the groin to inject dye into the artery. Then x-rays are obtained to identify where and to what degree the artery is blocked by plaque.

Treatments: Two ways to treat carotid artery stenosis is by carotid endarterectomy or by carotid artery angioplasty and stenting.

Endarterectomy: This is an open surgery used to remove plaque from the artery. It is very effective and most patients return home within 24 hours of the operation.

Angioplasty and Stenting: This less invasive procedure is used to improve the blood flow through the carotid artery. A balloon is used to expand the narrowed artery and then a stent is placed in the artery. The stent is left in place to hold the artery open, and therefore allow normal blood flow to the carotid artery.