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Vascular Disease in Orange County

 

What is peripheral arterial disease (PAD)?

Your arteries deliver oxygen-rich blood from your heart to other parts of your body.  Your peripheral arteries carry blood away from the heart to your arms and legs.  The peripheral arteries in your legs are extensions of the largest artery in your body, the aorta.  The aorta travels down through your abdominal region and branches off into the iliac arteries of each leg.  The iliac arteries further divide into smaller arteries and deliver blood down your legs to your toes.

Healthy peripheral arteries are smooth and unobstructed, allowing blood to flow freely to the legs and provide oxygen, glucose, and other nutrients that your legs need.  Typically with age, the peripheral arteries build up plaque, a sticky substance made up mostly of fat and cholesterol.  Plaque narrows the passageway within the arteries and causes them to become stiff.  Peripheral arterial disease results when the peripheral arteries become too narrow or obstructed and limit the blood flow to the legs.  If left untreated, peripheral arterial disease can cause pain or aching in the legs, difficulty with walking, resting pain in the foot at night in bed, non-healing sores or infections in the toes or feet, and can lead to limb loss in its most severe form.  In addition, it can be associated with other serious arterial conditions leading to heart attacks and stroke.

At the most severe end of the PAD spectrum, amputation leading to limb loss can occur. Non-healing or slow-healing ulcers are indications of such threat. By working closely and collaborating with our allied medical colleagues in the community, our vascular surgeons see themselves as “leg savers.” We are committed to offer all that’s possible with state-of-the-art technology, to bring more blood flow to the affected extremity and prevent amputations. This ranges from risk factor modification and education, to diagnostic tests, and to a full continuum of endovascular and open treatments to help you keep on walking.

Causes and risk factors

  • Age
  • Gender - males are more prone to the condition than females
  • Hypertension (high blood pressure)
  • Diabetes
  • Smoking
  • High cholesterol
  • Obesity
  • Lack of exercise
  • Family history of vascular problems
  • Symptoms

There may be no symptoms in the early stages of peripheral arterial disease.  Developing symptoms may include discomfort or pain in your legs when walking but no pain when you rest.

Diagnosis

The diagnosis of peripheral arterial disease can be established, and its severity confirmed, by a simple noninvasive Doppler examination.

If you experience symptoms of peripheral arterial disease in your legs, see a vascular surgeon.  They are the only physicians treating peripheral vascular disease today who can perform all the treatment options available , including medical management, minimally invasive endovascular angioplasty and stent procedures, and open bypass surgery.  Only when you see a vascular surgeon who offers all treatment modalities will you be assured of receiving the care that is most appropriate to your condition.

Treatment

Depending on the severity of your condition, treatment options may include lifestyle changes, medications, minimally invasive angioplasty/stenting, or open bypass surgery.

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What is abdominal aortic aneurysm (AAA)?

Your arteries deliver oxygen-rich blood from your heart to other parts of your body.  The aorta, the largest artery in your body, runs from your heart, down through your chest, and into your abdomen (called the abdominal region).  The abdominal region of the aorta is responsible for delivering blood to your legs, GI tract, and kidneys.  An abdominal aortic aneurysm (AAA) occurs when the wall of the aorta progressively weakens and begins to bulge.  An AAA may continue to enlarge and eventually rupture if left untreated, causing severe internal bleeding and possibly death.

In addition to concerns about rupture, clots or debris may also develop within an AAA.  These substances can be carried to other areas in the body and block circulation, causing severe pain or possibly limb loss if blood flow is cut off for too long.

AAA can safely be treated with early diagnosis.  Nearly 200,000 people in the United States are diagnosed with AAA annually; approximately 15,000 die each year from a ruptured AAA.

Causes and risk factors

Most aortic aneurysms are caused by a breakdown in the proteins that provide structural strength to the wall of the aorta.  Some risk factors that contribute to this structural breakdown include:

  • Age - individuals over 60 years are most likely to develop the condition.
  • Gender -males are more prone to the condition than females
  • History of atherosclerosis (hardening of the arteries)
  • Family history of AAA
  • Smoking
  • High blood pressure
  • Chronic lung disease
  • Symptoms

Most people feel no symptoms, and an AAA is often detected when tests are conduction for other unrelated reasons.  Those with symptoms describe them as :

  • A pulsing feeling in their abdomen
  • Unexplained, severe pain in their abdomen or lower back
  • Pain, discoloration, or sores on their feet (this is a rare symptom)

Diagnosis

If you experience symptoms of AAA, or if unrelated tests reveal AAA may be present, see a vascular surgeon.  They are the only physicians treating vascular disease today who can perform all the treatment options available, including medical management, minimally invasive endovascular stent graft procedures, or open AAA repair.  Only when you see a vascular surgeon who can perform all potential treatments will you be assured of receiving the care that is most appropriate to your condition.

Medicare Screening Benefit

Medicare offers a free, one-time AAA ultrasound screening (beginning January1, 2007) for qualified seniors as part of their Welcome to Medicare physical.  Men who have smoked sometime during their life and men and women with a family history of AAA are eligible for this benefit.

Treatment

The most important factor determining the treatment of AAA is its size.  It may require lifestyle changes, such as quitting smoking, lowering blood pressure, and taking medication.  For large AAAs, or those that have been increasing in size over time, repair may be carried out either by placement of an endovascular stent graft or by open bypass grafting.  Your vascular surgeon will diagnose and prescribe the best treatment for your condition.

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