Conditions We Treat - Vascular Surgery - Staten Island University Hospital (2023)

The abdominal aorta is a large blood vessel that supplies blood to the abdomen, pelvis and legs. When the wall of the aorta becomes weak and diseased, it can enlarge and bulge. This is called abdominal aortic aneurysm and sometimes referred to as triple A. If the aneurysm is not treated, it can rupture and cause severe bleeding.

Causes of Abdominal Aortic Aneurysm:

• emphysema
• genetic factors
• high blood pressure (high blood pressure)
• obesity
• Rauch

Rupture symptoms include:

• moist skin
• nausea and vomiting
• throbbing in the abdomen
• fast heart rate
• Schock
• Sudden abdominal or back pain

The diagnosis is confirmed with an ultrasound or a CT scan. Once you've been diagnosed with an aneurysm, your doctor will decide whether it can be easily visualized (such as an ultrasound every six months) or whether surgery is needed.

There are two surgical approaches: Open surgery, in which an incision is made in the abdomen and the aneurysm is excised and replaced with a Dacron or PTFE tube graft (similar to plastic tubing).

The other is minimally invasive repair (also known as endovascular aneurysm repair, or EVAR). This procedure is performed with two small incisions in the thigh that expose the groin arteries. The doctor then places a stent in the aorta to rule out the aneurysm. The patient usually goes home the next day and resumes normal activities.

The carotid arteries are the main arteries located on either side of the neck. They supply blood to most of the brain. Over time, plaque can build up on the walls of these arteries, causing them to harden and narrow - this is known as carotid artery disease. Plaque can completely block the artery, or pieces of plaque can break off and lodge in the brain. Both situations can cause a stroke, in which blood flow to a part of the brain is cut off, depriving it of the oxygen it needs to function.

Risk factors include:

• Diabetes
• family history
• heart disease
• High pressure
• High cholesterol
• obesity
• Rauch

Carotid artery disease must not cause any symptoms. Unfortunately, the first sign of carotid artery disease can be a stroke or mini-stroke (also known as a transient ischemic attack, or TIA).

Symptoms of a TIA usually last a few minutes to an hour and include:

• confusion
• Inability to control movement of an arm or leg
• inability to speak clearly
• Loss of vision in one eye (many people describe this feeling as falling blind)
• Numbness or tingling on one side of the body
• Sudden drooping on one side of the face
• sudden memory loss
• weakness

Carotid artery disease is often detected during a routine exam when a hiss can be heard through a stethoscope around the neck. If your doctor suspects carotid artery disease, they will usually order a noninvasive test called a duplex carotid artery ultrasound. Additional tests to confirm the diagnosis include CT scan, magnetic resonance angiography (MRA), or cerebral angiography.

To prevent carotid disease from progressing, doctors recommend a healthy diet, regular exercise, and lifestyle changes, including:

• control diabetes
• hypertension control
• Limiting alcohol consumption
• stop smoking
• Regular check-ups

Mild blockages in the arteries are usually treated with medication. A severe blockage is usually treated with surgery or a minimally invasive procedure known as angioplasty and stenting.

Treatments include:

Carotid endarterectomy (CEA):The patient is put under general anesthesia. A 3- to 4-inch incision is made at the neck. The artery is isolated and the plaque removed. The artery is stitched back together to allow better blood flow to the brain.

The risks and benefits depend on many factors such as age and any medical conditions. Typically, the patient spends the night in the ICU and is discharged the next day.

Carotid Artery Stent (CAS):A small puncture is made in the groin. A specially designed wire and stent is inserted into the diseased carotid artery. Once in place, the stent is expanded to keep the artery open. The patient feels unwell and is usually sent home the next day. This procedure is less invasive than open carotid surgery.

The venous system is a large network of vessels throughout the body that carry blood back to the heart. These veins have small one-way valves that prevent blood from pooling in the legs and arms. Over time, the valves can become weak and blood pools in the legs. This is called chronic venous insufficiency. The accumulation of blood causes increased pressure in the legs and inflammation.

Symptoms include:

• ankle and leg swelling
• Bluish discoloration of the lower legs
• Dry and itchy skin
• ulcers around the ankles

Risk factors include:

• Alter
• family history
• History of deep vein thrombosis (DVT)
• standing for a long time

A physical examination and medical history are usually sufficient to make a diagnosis. An ultrasound can also be used.

Treatment for CVI focuses on reducing pressure in the legs and improving blood flow. Includes leg raises, exercises and use of compression stockings. If an ulcer is present, the goal is to prevent it from growing and becoming infected. Local wound care with special gels can be sufficient. Sometimes antibiotics and surgery are needed to heal a wound.

Deep vein thrombosis (DVT) is a condition in which a blood clot forms in a deep vein in the body, usually in the legs. This is a serious condition due to the risk of pulmonary embolism, where a piece of the clot can break loose and travel to the lungs, causing difficulty breathing and even sudden death.

Risks for DVT include:

• smoke a cigarette
• family history
• Long journey by plane or car
• obesity
• Oral contraceptives (birth control pills)
• pregnancy
• Longer rest in bed
• Recent surgery (brain, hip, or knee)

Symptoms include:

• Pain or pain in your leg or arm
• changes in skin color
• Sudden swelling of the arm or leg

Deep vein thrombosis is usually diagnosed with an ultrasound test. This test takes about 15 minutes and is usually performed in a doctor's office or vascular laboratory.

Treatment for deep vein thrombosis involves thinning the blood with drugs such as heparin and coumadin. These drugs stop the clot from growing and breaking up. Your doctor will decide the dose and how long you will take the medicine for. Usually, patients have to take these drugs for several months.

If the patient cannot take blood-thinning medication or the medication is not working, a filter may be placed in the large vein that carries blood to the heart to catch any pieces of the clot that might dislodge before it reaches the lungs. . .

In rare cases, a patient may require minimally invasive thrombectomy or thrombolysis. Thrombectomy is the surgical removal of the clot. In thrombolysis, a catheter placed in the vein is used to dissolve the clot by applying medication directly or using a wire, similar to a machine used to clear blocked tubes.

Peripheral artery disease (PAD), also known as peripheral vascular disease (PVD), results from the accumulation of fatty deposits and plaque in the lining of blood vessels. This process is known as arteriosclerosis. As plaque builds up, the vessels become hard and narrow, leading to poor blood flow. Left untreated, it can lead to painful foot ulcers and infections that may require amputation. It can also lead to an increased risk of heart attack and stroke.

Risk factors for PAD include:

• Advanced age
• Diabetes
• Family history of atherosclerosis
• High pressure
• High cholesterol
• Rauch

People with PAD may have pain in their hips, thighs, or calves when they walk or run. The pain usually goes away when the exercise stops. Other symptoms may include hair loss on the legs, slow-healing wounds on the legs, skin changes on the legs and feet, impotence, pain in the toes when lying down, pale legs when lying up and redness. bluish discoloration of the extremities. PAD usually goes undiagnosed, so it's important to let your doctor know if you have symptoms.

If your doctor suspects you have PAD, he or she may order additional tests, including:

• Ankle-Arm Index (ABI):This test compares the pressure in the legs and arms. It's quick and painless and can be performed in the doctor's office.
• Double ultrasound:This test is performed in the doctor's office and provides up-to-the-second images of the blood vessels and blood flow in the vessels.
• Computed tomography or MRI:They are also non-invasive and painless tests that provide the doctor with images of the blood vessels that give more details about the location and severity of the disease.

The treatment includes:

Lifestyle changes and medications:Mild symptoms can be managed with lifestyle changes, such as: B. Smoking cessation, diabetes management and daily exercise. Medications that improve blood flow may also be beneficial. If the disease is severe, procedures to restore more blood flow may be needed.

Stent-Angioplasty:Under X-ray guidance, a small balloon attached to a flexible catheter is inserted into a blood vessel and guided to the site of the blocked artery. The balloon inflates and opens the vessel. If the vessel doesn't stay open, a stent (a tubular metal frame) may be placed to keep the artery open. The patient is usually sent home the same day.

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

The kidneys, located on either side of the abdomen, cleanse the body by producing urine. Renal arteries carry blood to the kidneys. With age and lifestyle, arteries can harden and narrow, reducing the blood flow needed by the kidneys. Reduced blood flow can seriously damage the kidneys and cause complications such as high blood pressure and kidney failure.

The main symptom associated with narrowing of the renal arteries is high blood pressure, which is difficult to control with medication.

Untreated high blood pressure can lead to:

• heart failure
• Kidney failure requiring dialysis
• ringing in the ears
• strong headache
• AVK

Causes include:

• Accumulation of cholesterol and plaque, also known as atherosclerosis
• Congenital narrowing of the arteries that occurs during fetal development
• Fibromuscular dysplasia (also called FMD), an overgrowth of tissue within the renal artery that usually affects women between the ages of 20 and 40

The first diagnostic test is usually a duplex ultrasound, which examines the renal arteries and blood flow in the arteries. This test is performed in the doctor's office or vascular laboratory and takes about 20 minutes.

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

• Angiogramm
• Computed Tomography
• MRA (Magnetresonanzangiographie)

Early cases of renal artery narrowing can be treated with lifestyle changes, such as:

• Dealing with diabetes and high blood pressure
• regular training
• stop smoking

In certain cases, a procedure to improve blood flow may be necessary. These procedures include:

Stent-Angioplasty:A balloon is inserted into the artery and expanded to open the artery. Occasionally, a stent is used when the balloon cannot keep the artery open. The patient usually goes home a few hours after the procedure.

Operation:Surgery may be required in cases that cannot be treated with angioplasty and stenting. Surgery consists of removing the disease causing the narrowing or bypassing it with an artificial graft or vein from the patient's own leg.

When a clot forms in a deep vein, it is called deep vein thrombosis (DVT). When a clot is in a superficial vein, it is called superficial thrombophlebitis.

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

This condition is treated with leg elevation, medications like Motrin, and warm compresses on the affected area. For severe symptoms, the doctor may also prescribe blood-thinning medications, such as heparin or coumadin.

The aorta is the largest artery in the body and supplies oxygen-rich blood from the heart to the rest of the body. It is connected to the heart and travels through the chest to the abdomen. When the wall of the aorta becomes weak and diseased, it can enlarge and bulge. This is called an aortic aneurysm. When it occurs in the chest, it's called a thoracic aortic aneurysm (TAA).

If an aneurysm is left untreated, it can rupture and cause severe bleeding. Although thoracic aneurysms are not as common as abdominal aneurysms, they can be more dangerous because mortality is extremely high if they rupture.

Causes include:

• emphysema
• genetic factors
• high blood pressure (high blood pressure)
• obesity
• Rauch

Symptoms include:

• moist skin
• nausea and vomiting
• fast heart rate
• Schock
• Sudden severe back pain

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

Once you've been diagnosed with an aneurysm, your doctor will decide if it needs to be repaired surgically or if it can be monitored through close monitoring and imaging.

Treatments include:

Minimally invasive correction:Many thoracic aneurysms can now be treated with an endoprosthetic device, which is a hollow tube surrounding a stent. Small incisions are made in the groin using various wires and catheters. The stent is placed in the aorta to repair the aneurysm. The patient usually goes home in a day or two. Minimally invasive repair now allows physicians to treat many patients who are at high risk for open surgery.

Open surgery:An incision is made on the left side of the chest, and the aneurysm and diseased material are removed. A PTFE or Dacron tube is then used to create a new aorta. The patient is usually sent to the intensive care unit for several days to recover.

The venous system is a large network of vessels throughout the body that carry blood back to the heart. There are small one-way valves in the veins that prevent blood from pooling in the legs and arms. Varicose veins are dilated veins that form when the small valves are destroyed. Failing valves cause blood to pool in the legs, causing blood to leak out of the vessels and into the surrounding tissues, including the skin. About 25% of the population suffer from this disease.

Varicose veins develop when the pressure in the legs increases. People who stand for long periods and people who are overweight are particularly at risk of developing varicose veins. Other risk factors include age, family history, and pregnancy.

Diagnosis of varicose veins is usually made through a physical examination and medical history. An ultrasound test is used to get more details about the anatomy and location of the veins.

Symptoms can include:

• Bluish discoloration of the surrounding skin
• Pain and swelling with fatigue and cramping
• Slight bumps on the legs, usually behind the calves or on the inner thighs

Varicose veins are initially treated by elevating the legs, exercising, and wearing elastic stockings. If these measures fail, varicose veins can be removed through small skin incisions or minimally invasively with a special laser.