Sarasota Memorial’s vascular specialists offer patients experienced care for any vascular disease, with advanced and minimally invasive treatments for aortic aneurysm, complex aortic repair including reconstructive surgery of the chest and abdominal areas, carotid artery disease, vascular access for kidney failure, and arterial reconstruction of the legs.
Common Vascular Conditions and Diagnostic Tests
Abdominal Aortic Aneurysm: Abdominal aortic aneurysms are most commonly detected by abdominal ultrasound studies (duplex scanning). These images can pinpoint the aneurysm location as well as allow for estimation of its size. CT scanning may also reveal specific information about AAA (abdominal aortic aneurysm) as well as MRA or magnetic resonance angiography. All of the aforementioned are noninvasive studies. An aortogram, an x-ray study utilizing the injection of a dye via a major peripheral vessel, is sometimes necessary to ascertain more information regarding an abdominal aortic aneurysm.
Carotid Artery Disease: The carotid arteries, the major suppliers of blood to the brain, may develop plaque or atherosclerosis along the vessel walls impairing blood flow. A carotid duplex scan, an ultrasound study, is often ordered to assess for potential obstruction within the carotid arteries. Magnetic resonance angiography (MRA) is another noninvasive study used to visualize these arteries and assess blood flow. Arteriography, in which dye is injected via a major peripheral vessel, may be required to assess the extent of obstruction and determine the best treatment recommendation.
Peripheral Arterial Disease: Peripheral Arterial Disease (PAD) refers to blockages in the circulation of the extremities caused by atherosclerosis (plaque accumulation) or other processes resulting in obstruction of blood flow. Arterial blood pressures may be assessed using a Doppler, or ultrasound stethoscope, that determines blood pressure measurements in the arms and legs. This can provide a general indication of the presence of blood flow obstruction. Duplex scanning utilizes ultrasound waves to assess for the presence of blockages in the peripheral arterial circulation. It may also determine the size of an artery. Magnetic Resonance Angiography (MRA) can be used to produce detailed images of the arterial circulation. This technology takes advantage of the energy produced when radio waves are introduced into a strong magnetic field and produces the resulting computer-generated two or three-dimensional pictures. Angiograms can provide the most definitive assessment of the blood circulation through the arteries. Dye is injected directly into the vessels and x-ray images are taken to determine the location and extent of arterial blockage. Results may indicate the best treatment intervention.
Venous Disease: Venous disease assessment may include determination of the nature and direction of blood flow, the presence of clot formation, and the quality of venous valve function within the venous system. A venous duplex scan, utilizing ultrasound waves, can provide images of blood flow and its direction as well as identification and location of existing clots. The quality of valve function within the veins can also be determined by a venous duplex scan. Sometimes a venogram is performed to provide more information regarding circulatory flow through the venous system. This study utilizes the injection of a special dye and x-ray pictures to identify the presence of venous disease.
Vascular Disease – Non-Surgical Procedures
Developments in treatment options for vascular disease now include what is referred to as minimally invasive endovascular approaches. These procedures are accomplished through small peripheral incisions rather than the traditional open surgical approaches.
Balloon Angioplasty: Balloon angioplasty with stent placement is now sometimes an option for alleviation of blockages in arteries and veins. A balloon catheter is directed to the area of obstruction and inflated to disrupt accumulated plaque and reestablish adequate blood flow. Placement of a stent, or wire-mesh tube, acts as a scaffold to prevent reoccurrence of the blockage at the angioplasty site. Because only a small incision is required to accomplish this technique, patients generally recover more quickly with decreased post-procedural discomfort.
Balloon angioplasty and stent placement for treatment of carotid artery disease remains in an investigational phase. Not yet approved by the Food and Drug Administration, this technique may be used to disrupt plaque formation or atherosclerosis within the carotid arteries thus ensuring adequate blood flow to the brain. Studies of its effectiveness versus the open surgical approach of carotid endarterectomy are ongoing.
Endovascular Stent Grafting of Abdominal Aortic Aneurysm: Endovascular stent grafting provides another option for treatment of an abdominal aortic aneurysm. This condition, sometimes referred to as “triple A,” is a bulging or ballooning of the wall of the abdominal aorta. Stent grafting offers a repair option for patients whose general health condition may place them at significant risk with the traditional open surgical procedure. A special catheter is used to place a stent graft at the site of the aneurysm, redirecting blood flow through the stent graft, or fabric tube, thus reducing the pressure of blood flow at the aneurysm site. This procedure is performed with mild sedation and local anesthesia. Endovascular stent grafting is not suited for repair of all abdominal aortic aneurysms. Vessel size, the location and nature of the aneurysm, and the patient’s other health conditions are taken into consideration.
Vascular Disease – Surgical Procedures
Peripheral Vascular Bypass: Used to address blockages in the peripheral vascular system, a bypass surgical technique may be used to reroute blood flow around an obstruction utilizing the patient’s own veins or an artificial graft as an alternative. Used to address blockages in the peripheral vascular system, the bypass surgical technique reroutes blood flow around an obstruction utilizing the patient’s own veins or an artificial graft as an alternative.
Carotid Endarterectomy: Carotid endarterectomy is a common surgical procedure to remove plaque from the carotid arteries, re-establish blood flow and help prevent stroke. Not all patients with carotid artery blockages are candidates for carotid endarterectomy. Factors that influence treatment include the estimated percentage of blockage, symptoms experienced by the patient and the health status of the patient. Carotid endarterectomy is considered a major surgical procedure.
Abdominal Aortic Aneurysm (AAA): Open surgical removal of AAA is a major surgery and is recommended based on the size of the aneurysm and the patient’s general health condition. Generally, an abdominal aneurysm greater than 5 cm in diameter is recommended for surgical intervention. A long incision allows access and resection of the aneurysm. A synthetic graft is then placed at the site of the removal.