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Venous insufficiency refers to a defect, or ‘insufficiency’, of the venous system in the lower extremities causing swelling, pain, varicose veins (which can cause pain), and changes to the skin including red or brown pigmentation (known as stasis dermatitis), dry scaling, ulcers, and infection. The abnormality is usually a failure of the veins to properly return blood upward to the heart.
This causes a ‘back-up’ of blood in the leg veins that raises the venous pressure, which in turn forces the fluid within blood to leak out into the tissues causing swelling. The elevated pressure also forces blood back into the smaller veins in the subcutaneous tissue under the skin causing varicose veins, which can cause pain and if located under ulcers or wounds, can prevent healing. Diagnosis of venous insufficiency and their associated complications requires a thorough history and physical exam by a vascular surgeon.
A specific type of ultrasound of the venous system in the legs is required, called as venous duplex study. Treatment of primary/deep and lymphatic insufficiency requires compression therapy with prescription-strength compression stockings. If ulcerations or wounds developed, then alternative methods of compression may be required, which incorporate wound care techniques. For severe cases or for those who are not candidates for traditional compression therapy, a compression pump may be required.
Treatment of superficial venous insufficiency (including varicose veins) often requires a catheter procedure, which we perform in our hospital, to close the abnormal veins. This procedure called Laser ablation or Radiofrequency ablation of Varicose veins may often be combined with microphlebectomy (removal of veins through tiny incisions) and/or sclerotherapy (injection of veins with a sclerosing agent). Patient may be treated on a day-care basis
Peripheral arterial disease (PAD, or PVD for peripheral vascular disease) refers to the build-up of atherosclerotic (cholesterol) plaque within the peripheral arteries such that symptoms occur from lack of blood flow. The arteries in the legs are most commonly affected. The symptoms can include claudication (pain with walking), pain at rest in the feet or toes, and tissue loss, which includes ulcers, wounds, gangrene, and infection.
Complications from PAD include acute thrombosis (occlusion from blood clot formation) and embolism, which is when thrombus (blood clot) or plaque from higher up in an artery or the heart breaks loose and lodges itself into an artery further downstream. These complications can cause sudden severe pain, limb-threatening ischemia, and gangrene and/or infection.
This can result in loss of toes or limbs. Diagnosis and management of PAD requires a thorough history and physical exam by a vascular surgeon. Occasionally, a computed tomography (CT) scan, magnetic resonance imaging (MRI) study, or arteriogram (injection of contrast dye into the arteries) is required. Treatment of symptomatic PAD may involve medical therapy along with an exercise regimen, minimally invasive (endovascular) treatment with balloon angioplasty and/or stenting, or open surgical reconstruction with a graft.
Aneurysms represent a dilation (ballooning) of the artery caused by weakening of the walls of the artery. They can occur almost anywhere in the body but most commonly occur in the abdominal aorta (known as AAA for abdominal aortic aneurysm), thoracic aorta (TAA), peripheral arteries (iliac, femoral, popliteal, subclavian), carotid arteries, and visceral arteries (splenic, renal, celiac, and hepatic).
Complications from aneurysms include rupture, which can cause life-threatening bleeding, and embolization (movement to a location further down the artery) of thrombus from within the aneurysm, which can cause limb-threatening ischemia, stroke, TIA, or endorgan injury. Management of aneurysms often requires complete evaluation of arterial system by Vascular Surgeon.
Occasionally, a computed tomography (CT) scan is required. Treatment of large or symptomatic aneurysms involves exclusion of the aneurysm by either minimally invasive (endovascular) stent graft placement, also known as EVAR for endovascular aneurysm repair, or open surgical reconstruction with a graft.
Carotid artery disease includes stenosis (narrowing), occlusion, or dissection of the carotid arteries, which can cause stroke or mini-stroke (known as TIA for transient ischemic attack). Stroke or TIA occurs from stenosis when a piece of the atherosclerotic (cholesterol) plaque that causes the stenosis breaks off (now called an embolus) and travels up to the brain where is occludes an artery that supplies a particular part of the brain.
The resulting symptoms depend on the size of the embolus that travelled up, or ‘embolized’, and the location within the brain that was affected. The embolus can also travel to the artery that supplies the eye, rather than the brain, and cause visual defects. Treatment of symptomatic or severe asymptomatic carotid stenosis requires a procedure in the form of either carotid endarterectomy (This procedure involves surgically removing the plaque from within the artery to prevent future stroke or TIA) or Carotid angioplasty & stenting.
Once kidney function goes below 10 to 15 percent of normal, dialysis treatments or a kidney transplant are necessary to sustain life. Dialysis cleans blood by removing it from the body and passing it through a dialyzer, or artificial kidney. In order to undergo dialysis, a dialysis access is required.
An AV fistula is a type of dialysis access where, a connection is created by a vascular surgeon, between an artery and a vein. Arteries carry blood from the heart to the body, while veins carry blood from the body back to the heart. Vascular surgeons specialize in blood vessel surgery. The surgeon usually places an AV fistula in the forearm or upper arm. An AV fistula causes extra pressure and extra blood to flow into the vein, making it grow large and strong. The larger vein provides easy, reliable access to blood vessels. Without this kind of access, regular hemodialysis sessions would not be possible. Untreated veins cannot withstand repeated needle insertions.
Foot problems in people with diabetes are usually treated by keeping blood sugar levels in a target blood sugar range and by using medicine, surgery, and other types of treatment.
When foot problems develop, those problems need prompt treatment so that serious complications don't develop. Even problems that seem minor - like calluses, blisters, cracked or peeling skin, and athlete's foot - need to be evaluated by a specialist. These problems frequently occur as a result of reduced sensitivity in the feet and may precede more serious infections or foot ulcers if the cause (poorly fitted shoes, excessive weight-bearing, or dry skin) isn't identified and corrected.
After a foot ulcer has formed, it will not heal as long as weight-bearing on the area continues. Unless your foot ulcer is infected, your doctor may put a cast on your leg to help the ulcer heal. Keeping your weight off your injured foot is very important. Even when you are at home, be careful to stay off that foot. Cushioned shoes, orthotic inserts, support with a cane or crutches, and - in extreme cases - a wheelchair and bed rest may be used to reduce weight and pressure on the feet. Foot infections need to be treated with antibiotics.