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Vascular Disease

About Vascular Disease

 
Our Vascular Experts

Kent Hospital treats an array of conditions that affect the vascular system, or arteries and veins.

Vascular experts Guy Lancellotti, MD, chief of surgery at Kent Hospital, and Garima Dosi, MD, vascular surgeon at Kent Hospital, and affiliated with Brigham and Women’s Hospital manage each patient’s condition through individualized care plans that involve behavior change, medication management, and/or surgical procedures.

Our vascular services include, Aneurysms, Carotid Artery Disease, Deep Vein Thrombosis, Peripheral Arterial Disease, Varicose Veins, and Dialysis Access.

Aneurysms

 

Aneurysms occur when a weak or thin artery expands, filling with blood. Eventually the artery expands beyond its limit and ruptures or bursts, causing serious health problems such as a stroke, hemorrhage, brain damage, or death.
Treatment

Aneurysms can occur throughout the body including the aorta, extremity blood vessels, the stomach, abdomen, kidneys, or spleen. Once an aneurysm is detected, its size and potential risk are monitored through regular ultrasounds.

The treatment goal is to avoid an aneurysm rupture by directly repairing the weakened artery or placing a stent, allowing blood flow to bypass the aneurysm and avoiding further expansion of the bulging artery.

Symptoms and Risk Factors

There are no symptoms associated with most aneurysms until they have reached a size that is a serious risk for rupture. Some patients do report pain in the stomach area or back. Risk factors include smoking, high blood pressure, family history of aneurysm, and a previous aneurysm rupture or, in the case of brain aneurysm, a “sentinel bleed” or headache that results in an aneurysm slowly leaking.

Carotid Artery Disease

 


The carotid arteries are located in the neck and provide the brain with most of its blood supply. Carotid artery disease develops when these arteries become narrow due to the buildup of a fatty substance called plaque.

Blood continually flows past the plaque to reach the brain. When a piece of plaque breaks off and travels to the brain a person may have a stroke. A stroke is caused by a stoppage of blood flow the brain and requires immediate treatment to avoid permanent brain injury.

Stroke is the third highest cause of death and the leading cause of disability in the U.S., and carotid artery disease causes more than one-third of all strokes in the U.S

Treatment

In the case of carotid artery disease, it is critical that the plaque is removed to prevent the occurrence of a stroke. The most common procedure is a carotid endarterectomy. This outpatient surgical procedure involves opening and cleaning the plaque from the carotid artery. Once removed, patients will receive an annual ultrasound to ensure the plaque does not rebuild.

Symptoms and Risk Factors

Approximately 80 percent of patients treated for carotid artery disease experience no symptoms. Unfortunately, the other 20 percent often are diagnosed with carotid artery disease after experiencing a stroke.

The goal of treatment is prevention, and procedures are done to greatly minimize the patient’s chance of a stroke. Risk factors of developing carotid artery disease include: high blood pressure, tobacco use, diabetes, age, obesity, and sleep apnea.

Deep Vein Thrombosis (DVT)

 

Deep Vein Thrombosis (DVT) is a vascular condition where a vein becomes inflamed and a blood clot is formed. DVT almost always develops within the veins of the legs, but can also occur in the arms.

A pulmonary embolism is a potentially fatal complication of DVT and occurs when a blood clot breaks off from the vein, travels through the heart and into the lungs through the pulmonary arteries. The blood clot then cuts off the lung’s blood supply causing shortness of breath, chest pain, and sometimes death.

Treatment

Ultrasounds are used to determine if a patient has DVT. If detected, DVT treatment can include prescribing a blood thinner or placing a medication directly into the veins to disassemble the clot.

Symptoms and Risk Factors

Symptoms of DVT include: leg swelling, discoloration in the skin on the legs or arms, pain in the legs, and shortness of breath. Those who have been on prolonged bed rest, have cancer, underwent a recent major surgery, or have a family history of blood clots are at a higher risk of developing DVT.

Peripheral Arterial Disease

 

Peripheral Arterial Disease (PAD) is a common circulatory problem that develops when plaque builds within the arteries and reduces blood flow to the arms and legs.
Treatment

PAD is most often diagnosed with the ankle-brachial index (ABI). ABI is non-invasive, painless test that compares the blood pressure in the ankle with the blood pressure in the arm and provides insight on how well blood is flowing to the limbs and if artery blockages are present.

Once diagnosed, PAD is treated by removing the plaque in the veins through a surgical bypass or stent, also known as an angioplasty procedure.

Before an operation takes place, the patient will undergo some diagnostic studies. First, an ultrasound will take place to determine the speed of blood flow through the arteries and the amount of plaque within the arteries. Second, an arteriogram is performed during which dye is injected into the blood vessels using a catheter. X-rays are then taken to identify the exact location and the severity of the blocked arteries.

Symptoms and Risk Factors

While not everyone with PAD experiences symptoms, some signs of PAD can include: pain when walking; cramping in hips, thighs, or calf muscles; leg numbness; sores on the toes or feet that will not heal; or leg numbness.

Smoking cigarettes, diabetes, high blood pressure, high cholesterol, obesity, and limited physical activity are all risk factors that contribute to the development of PAD, as well aging and a family history of cardiovascular disease or stroke. Those with PAD are at a higher risk for having a heart attack or stroke.

Varicose Veins

 

Varicose veins are dark, bulging veins that usually appear on the back of the calf, on the inside of the leg, or in the groin. Varicose veins occur when the veins that keep blood moving upward through the legs toward the heart deteriorate.

The deterioration causes the blood to leak or flow backward towards the feet. To ensure the blood reaches the heart the pressure in the vein increases, stretching the vein and resulting in a varicose vein. The backwards flow of blood can cause blood clots or DVT. 

Treatment

The treatment of varicose veins has greatly evolved and in most cases their appearance and symptoms can be reduced through use of a laser to seal a vein closed. Other techniques include compression stockings or a phlebectomy, which seals smaller veins increasing the larger veins’ ability to move blood against gravity towards the heart.

Symptoms and Risk Factors

Varicose veins occur more frequently in women than in men. People who are overweight, who spend much of their day standing, and women who are pregnant are more likely to develop varicose veins. Age and family history are also risk factors.

Dialysis Access

 

Dialysis is the most common treatment for patients who have acute or chronic kidney (renal) failure. Dialysis uses a machine to send the patient’s blood through a filter, called a dialyzer, which is located outside the body. Dialysis access is a surgery that creates the artery and vein used to remove and return blood to the body during dialysis.
Treatment

Depending on the patient’s individualized condition and need, vascular surgeons will perform an AV fistula or graft. Both options are outpatient, minimally invasive surgical procedures.

Reducing your risk of developing vascular disease

There are many lifestyle changes that can be made to lower your risk of developing vascular disease while also improving your overall health. Behavior modifications are nearly always a part of our vascular team’s recommendations and include: limit your intake of foods high in fat, cholesterol, and sodium; regular physical activity; smoking cessation; and diabetes management.