Conditions Treated

Peripheral arterial disease (PAD) is a very common condition, with more than 3 million new diagnoses each year. Adults over 40 are most often affected, as are patients with diabetes or kidney disease. It is considered a type of peripheral vascular disease.

In people with PAD, blood flow to the limbs is restricted due to narrowed passageways within arteries – usually due to atherosclerosis, the buildup of plaque in blood vessels.

PAD causes symptoms such as pain or muscle cramps when walking or exercising that goes away with rest. These symptoms occur because leg muscles are receiving insufficient oxygenated blood in order to carry out the movements being performed. Additional symptoms include nonhealing wounds on the legs or the skin of the leg being cool to the touch.

Treatment of PAD may include a traditional bypass surgery or newer, minimally invasive endovascular options that use small incisions and a catheter threaded through the arteries until it reaches the site of damage. Tiny instruments are manipulated via the catheter to remove plaque buildup inside artery walls and restore proper blood flow. Examples of these minimally invasive endovascular treatments include:

• Angioplasty – inflating a small balloon inside the blood vessel to widen it
• Stent – often used in conjunction with an angioplasty, a stent is a tiny tube left within the artery to help keep the passageway open
• Atherectomy – using a device to cut or sand away plaque buildup on blood vessel walls

Peripheral vascular disease (PVD) refers to the wide range of circulatory issues that can affect the arteries and veins of the limbs. Arteries are the blood vessels that carry oxygen-rich blood from the heart to the extremities. Veins carry oxygen-poor blood back to the heart.

Examples of PVDs include deep vein thrombosis, varicose veins, and chronic venous insufficiency.

Peripheral arterial disease (PAD), which affects the arteries of the legs, is considered a type of PVD.

When the walls of the arteries develop a buildup of fatty deposits and calcium (plaque), the condition is called atherosclerosis. As the condition worsens, the plaque hardens and can restrict blood flow, leading to a number of serious and life-threatening cardiovascular problems, such as coronary artery disease and heart attack.

Atherosclerosis is a common cause of peripheral arterial disease or PAD.

An aneurysm is an abnormal distension of an artery wall. The bulge occurs because the area of the artery is weakened and the pressure of blood traveling through the artery causes it to balloon outward. Artery walls most often weaken due to the buildup of plaque (atherosclerosis).

When an aneurysm occurs outside the aorta (the largest artery in the body, going from the heart to the abdomen and groin), it is called a peripheral aneurysm.

Peripheral aneurysms tend to develop in the leg, just above the knee, or in the neck. Even so, peripheral aneurysms are quite rare, and they tend to occur in men more often than women.

Peripheral aneurysms rarely cause symptoms, although they can lead to blood clots and obstructed blood flow – and you may experience pain, numbness, or tingling in your leg or foot as a result of these complications. Because of this, it is often recommended that peripheral aneurysms, once discovered, be treated. This is typically done via bypass surgery.

Vascular trauma is another way of saying that a blood vessel is damaged, either by blunt force or penetrating injury. Blunt force injuries involve crushing, stretching, or otherwise damaging the blood vessel. A penetrating injury indicates the blood vessel has been punctured or torn.

Falls, auto accidents, IV needle placement, and accidental or intentional pinching or compression can all result in vascular trauma, which in turn can result in bruising, swelling, tenderness, blood clots, or internal bleeding.

The aorta is the largest artery of the body, carrying oxygen-rich blood from the heart’s left ventricle down through the abdomen and into the groin. Along the way, it connects to peripheral arteries that supply the extremities with blood and oxygen.

When the walls of this artery weaken and bulge outward, it’s known as an aortic aneurysm. And when the aneurysm develops within the abdomen, it is called an abdominal aortic aneurysm(AAA), the most common type of aneurysm. Atherosclerosis is a common cause of an AAA.

Without treatment, abdominal aortic aneurysms are at risk of rupturing, which results in death 80% of the time. Because aneuryms usually don’t cause symptoms until they rupture, they are known as a “silent killer.” The most common symptom of a rupture is sudden and severe abdominal pain and the feeling of a pulse or heartbeat in the abdomen.

Imaging tests are used to diagnose an AAA. Aneurysms are often discovered when a test is performed for another reason. Depending on the size and location of the AAA, surgery (traditional open or minimally invasive endovascular surgery) may be necessary to prevent the artery from rupturing.

An aortic dissection is a tear of the aorta (the body’s largest artery running down the center of the body from heart to groin). It is considered a medical emergency, requiring immediate surgery or stenting.

With a dissection, the aorta’s innermost layer tears, resulting in blood traveling between the inner and middle layers of the aortic wall, which causes the layers to separate.

Aortic dissection occurs where the aortic walls have weakened. Such weakening can be the result of a congenital condition or as the result of atherosclerosis. High blood pressure and smoking increase the risks of weakening blood vessel walls, making the area more susceptible to aneurysm (bulging) or dissection (tears).

Aortoiliac occlusive disease is the blockage of blood flow that affects the aorta, the body’s largest artery running down the center of the body, as it divides into the iliac arteries at the lower abdomen in order to supply oxygen-rich blood to the lower half of the body.

A blood vessel blockage in this area is also sometimes referred to as aortoiliac disease or Leriche syndrome. Body tissue located beneath the blockage will not receive adequate blood or oxygen and will eventually die.

Symptoms of aortoiliac occlusive disease include pain in the buttocks, thighs, or calves when in motion. The most common cause of aortoiliac occlusive disease is atherosclerosis (plaque buildup in the arteries).

Treatment will depend on the exact size and location of the artery blockage. A surgical bypass may be recommended in some cases. The most common minimally invasive endoscopic procedure for aortoiliac disease is balloon angioplasty and stenting.

Considered a type of peripheral artery disease (PAD), arm artery disease involves restricted blood flow through the arteries of the arms. Atherosclerosis is a common cause.

Arm artery disease is much less common than PAD that occurs in the legs. People who have artery disease may experience pain and weakness in the arm and hands, especially when in use.

The carotid arteries are located on both sides of the neck and carry oxygenated blood from the heart to the brain, neck, and face. When blood flow through these arteries becomes blocked, it can result in a stroke or heart attack.

Typically, carotid artery disease is the result of hardening of the arteries (atherosclerosis). Imaging tests can confirm a diagnosis of carotid artery disease.

Treatment may include carotid endarterectomy or balloon angioplasty and stenting of the carotid artery that is blocked.

Persistent, recurring problems with inadequate blood flow through the veins – the blood vessels that carry oxygen-depleted blood back to the heart – is called chronic venous insufficiency.

It typically occurs in the legs, when the valves on veins don’t work properly and blood pools in the legs, rather than being able to travel upward toward the heart.

Chronic venous insufficiency is the cause of varicose veins and spider veins.

There are hundreds of disorders that can affect connective tissue – the various tissues throughout the body that provide a supportive framework for organs and other tissues, including bones and muscles.

Connective tissue disorders (CTD) can affect any part of the body, including the circulatory system. CTDs can weaken blood vessels, and the aorta in particular, leading to complications such as aneurysms, dissections, and ruptured arteries.

When a blood clot develops in the large veins deep within the legs, pelvis, or arms, it is called deep vein thrombosis (DVT). It most often occurs in the legs. You may experience no symptoms, or you may experience pain and swelling in the legs.

Anything that interferes with normal blood flow can cause a clot, such as prolonged periods of limited movement, side effects of certain medications, and vascular trauma.

If the blood clot breaks free and travels to the lungs, it can become a life-threatening pulmonary embolism.

Blood thinners (anticoagulants) are used to help prevent the occurrence of blood clots in people who are susceptible to developing them.

Endoleaks sometimes occur following an endovascular aneurysm repair (EVAR) procedure. It means that blood has leaked back into an area of the artery wall that formerly had an aneurysm.

An aneurysm is when an artery bulges abnormally outward (due to a combination of a weakened artery wall and the pressure of blood traveling through the blood vessels). Surgery to repair the aneurysm and prevent a life-threatening rupture involves inserting a stent and tissue graft to strengthen the area and reduce the distension of the aneurysm.

There are five types of endoleaks:

• Type I is when a gap develops between the tissue graft and artery wall and blood rushes in to fill the space. Type I endoleaks may be due to poor fit of EVAR materials or blood vessel dilation over time. This type of leak raises the risk of rupture and usually requires immediate medical attention.
• Type II is the most common type of endoleak, when blood from arteries that branch off the main aorta forces blood back to the repaired site of the aneurysm because it offers the least amount of resistance.
• Type III involves misalignment or tear of overlapping repair material at the aneurysm site, which allows blood to re-enter the aneurysm sac. Like Type I, the pressure it puts on the artery wall can lead to rupture.
• Type IV is a leak due to overly porous graft tissue that allows blood to pass through it into the area of the aneurysm sac.
• Type V is due to endotension – distention of the artery wall – but without visible leak or cause.

Endoleaks typically cause no symptoms and are discovered during a follow-up examination with your vascular surgeon after an EVAR. An EVAR is most often used to treat an abdominal aortic aneurysm(AAA).

Also sometimes called fibromuscular dysplasia, FMD is a disease in which muscle and fibrous tissues in your arteries thicken, which causes the arteries to narrow. This can prevent sufficient blood flow from getting to vital organs throughout the body and affect organ function. The arteries to the kidneys (renal arteries) and brain (carotid arteries) are most often affected.

FMD can increase blood pressure and lead to tears (dissection) of blood vessel tissue. Symptoms will depend on where the narrowing of blood vessels is occurring. There is a genetic component to FMD, making people with a family history of it more likely to develop the disease.

Imaging tests are used to confirm a diagnosis of FMD, while surgery and medications are used to treat the condition.

A blood vessel disease, giant cell arteritis (GCA) causes inflammation of the temporal arteries, which run along the side of your head at your temples, just in front of your ears. It may also be referred to as temporal arteritis, and it is the most common type of vasculitis. Symptoms include headaches, fever, scalp tenderness, jaw pain, and vision problems.

Biopsy of the artery is generally needed to confirm a diagnosis of GCA. Steroid medications and nonsteroidal anti-inflammatory drugs (NSAIDs) are the first line of treatment to bring swelling down and avoid complications such as vision loss.

Hyperlipidemia means having too many fats (lipids) in the bloodstream. These fats, like cholesterol and triglycerides, can clog the arteries, restrict blood flow, and lead to heart attack and stroke.

The most common type of hyperlipidemia, hypercholesterolemia, refers to high levels of LDL cholesterol — the “bad” type. Routine blood tests are used to identify hyperlipidemia. People with hyperlipidemia generally exhibit no symptoms. Medication and lifestyle changes are the usual treatments.

Lymphedema describes an obstruction within the lymphatic system that causes fluid buildup and inflammation (edema).

The lymphatic system includes an extensive network of vessels that transports a fluid called lymph throughout the body. Lymph plays a vital role in the body’s immune system response.

People with lymphedema may experience swelling in the arms or legs. It a common consequence of cancer treatment that damages or involves the removal of lymph nodes. Treatment typically revolves around controlling the inflammation.

A lack of blood to the small intestine can result in a condition called mesenteric ischemia. Also known as a bowel infarction, it may be caused by atherosclerosis or a blood clot.

Mesenteric ischemia can be chronic or acute. Symptoms of the chronic type include abdominal pain that worsens after eating but eventually goes away within a few hours. Symptoms of the acute form include sudden and severe abdominal pain as well as nausea and vomiting.

Chronic mesenteric ischemia may be treated by angioplasty and stenting to widen the narrowed part of the artery. If a blood clot causes acute mesenteric ischemia, you will likely require emergency surgery.

Portal hypertension is another name for high blood pressure within the portal venous system — the blood vessels that transport blood from the digestive tract to the liver, where it is filtered before traveling on toward the heart.

Blood pressure increases due to blocked blood flow through the liver. Veins in the esophagus or stomach area develop to bypass the blockage, then may weaken and bleed.

Symptoms of portal hypertension include blood in the stool, fluid in the abdomen, confusion and forgetfulness as a result of reduced liver function, and decreased white blood cell count.

Scar tissue due to cirrhosis of the liver is the most common cause of the blocked blood flow that causes portal hypertension. Blood clots in a portal vein may also cause it.

Treatment focuses on stopping the bleeding. Medications such as beta blockers can reduce blood pressure and the likelihood of rupture. Endoscopic procedures like banding (ligation) use rubber bands to block the blood supply to enlarged veins. Additional procedures may be recommended should these efforts not stop the bleeding.

When a blood clot somewhere in the body travels to the lungs and stops blood flow there, it can be deadly. A pulmonary embolism (blood clot in the lungs) prevents oxygen from reaching the lungs and can result in chest pain, difficulty breathing, and sudden death.

Most often, the blood clot begins in the legs as deep vein thrombosis then breaks free and lodges in the lungs.

Medications to dissolve blood clots may be used to treat some cases of pulmonary embolism. Surgery to remove the clot can also be performed. Blood thinners can help prevent future clotting.

Renovascular conditions are those that restrict or block the flow of blood to and from the kidneys. They affect the renal arteries or renal veins and may cause kidney failure and high blood pressure.

Renovascular conditions include:

• Renal artery stenosis — when an artery leading to the kidneys becomes narrow due to plaque buildup on artery walls, a blood clot, or fibromuscular disease
• Renal vein thrombosis — when a blood clot forms in the vein that carries blood away from the kidneys
• Renal atheroembolism — when blood flow is blocked due to hardened plaque buildup that has dislodged from its original location and blocked the small arteries of the kidneys

An extremely common and debilitating vascular disease, a stroke occurs when blood flow to the brain is interrupted.

Blood clots, atherosclerosis, and aneurysms can all lead to stroke.

Depending on how long the brain is deprived of oxygen-rich blood, brain tissue can die and impair many different bodily functions, including movement, speech, vision, and more.

For the best chance of successful recovery from stroke, it is imperative that you receive immediate medical attention. The sooner you are treated, the greater the likelihood of your recovery.

When an aneurysm (an outward bulge of an artery) occurs in the aorta (the largest artery in the body running down the center of the body from heart to groin), it is called an aortic aneurysm.

When the aortic aneurysm occurs in the part of the aorta that passes through the chest, it is called a thoracic aortic aneurysm.

Like the more common abdominal aortic aneurysm, atherosclerosis (plaque buildup on artery walls) is a common cause, together with high blood pressure, and surgery may be necessary to prevent a rupture of the aneurysm.

Because of where the aneurysm occurs — in the chest — symptoms depend on what nearby structures the aneurysm may be affecting. Symptoms may include swallowing difficulties, hoarseness, chest pain, upper back pain, and a rapid heart rate.

Thoracic outlet syndrome involves the impingement of nerves and blood vessels in the thoracic outlet — the area between the collarbone and first rib. This can result in pain felt in the arm, neck, and shoulders. The fingers may also feel weak or be cold to the touch.

TOS is fairly rare and can be caused by trauma, repetitive use, or birth defects.

Treatment tends to focus on pain relief using nonsurgical methods such as physical therapy and nonsteroidal anti-inflammatory drugs (NSAIDs), although surgery may be required in some cases to relieve the compression of the nerves or blood vessels.

Noticeably enlarged veins — those that can be seen through the skin — are what is known as varicose veins.

Varicose veins typically appear on the legs because that is where blood tends to pool when gravity and faulty vein valves keep blood from making its way back to the heart.

The condition is easily treated, usually with a combination of procedures to close the enlarged vein, together with lifestyle modifications such as the use of compression stockings, exercise, or more.

A vascular infection means a blood or lymph vessel somewhere in your body has become infected by bacteria.

These types of infections typically occur after surgeries that include the use of graft material, which may introduce harmful substances directly into the bloodstream.

Vascular infections can quickly spread throughout the body and can lead to signs of infection like fever and chills. If not treated in time, infection can result in tissue loss and death.

Vasculitis is a group of disorders that causes inflammation of the blood vessels, which can block blood flow to organs and other body tissues. Inflamed arteries and veins can also weaken, leading to complications such as aneurysms, dissections, and ruptured arteries.

Vasculitis is often considered a connective tissue disorder because blood is a fluid connective tissue. It may be caused by infection, an immune system disorder, or unknown cause.

This type of aneurysm (outward bulge of weakened blood vessel walls) affects the arteries that supply blood to the liver, spleen, kidneys, or intestines.

Symptoms will depend on the affected artery. For example, an aneurysm affecting the renal artery can impair kidney functioning.

Depending on the size and location of the visceral artery aneurysm, surgery may be recommended to alleviate your symptoms and prevent rupture.