Vascular Care

Peripheral vascular disease (PVD) refers to blockages of the arteries outside of the heart composed of cholesterol plaques. As the condition progresses, patients frequently experience intolerance to walking because of discomfort or weakness in the legs. Worsening of the disease may result in pain at rest or sores in the legs. Ultimately, a person might require amputation of the affected limb.

PVD is more common with increasing age, in smokers, and in diabetic patients. Simple, painless and inexpensive non-invasive tests can be performed in the office to detect the condition. Further evaluation may require advanced (CT or MRA) imaging. Catheter-based angiography may also be necessary to define the extent and severity of the disease.

PVD is typically first treated with risk factor modification: smoking cessation, cholesterol lowering therapy, aspirin and possible other medications. A search for other organs affected by cholesterol plaques may be indicated. Rehabilitation is recommended for PVD patients, and may be the only form of treatment needed.

Medications may help alleviate symptoms related to PVD. Patients who have inadequate relief with conservative management or who are at risk for sores or limb loss are frequently evaluated with the goal of aggressively improving blood flow.

Surgery was once the only therapy available to achieve this goal. Now, minimally invasive therapy, including balloon angioplasty and stent implantation, has great success for many patients. This is typically an outpatient procedure that offers immediate relief for many patients.

Stroke is the third-leading cause of death and the leading cause of disability in the U.S. A stroke is an obstruction of blood flow to a part of the brain that results in that part of the brain dying. Symptoms of a stroke include weakness, loss of control, or numbness in an extremity, visual disturbances, or difficultly with speech. Stroke symptoms that resolve within one day are called "transient ischemic attacks," or TIAs (frequently also referred to as "mini-strokes").

Following a TIA, there is a very high risk of a completed stroke within the next year. Strokes most frequently, however, occur suddenly with no warning symptoms.

About one in four strokes are the result of significant cholesterol plaque buildup (atherosclerosis) in the carotid arteries. Patients with other atherosclerotic disease are frequently screened for carotid artery disease.

Often, physical examination findings suggest the presence of carotid artery disease. Screening for carotid artery disease is quite simple and painless. An ultrasound examination of the carotid arteries takes about 20 minutes and can usually be completed at the time of an office visit.

Treatment of carotid artery disease begins with risk factor management including smoking cessation, blood pressure control, treatment of diabetes, and cholesterol lowering. Medical therapy most often involves blood thinners.

Carotid surgery may be performed to remove the cholesterol plaque. More recently, a less invasive option has become available in the form of carotid stents. This procedure has been shown to have similar results to surgery in selected patients.