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The carotid arteries lie on the side of the neck and carry oxygen-rich blood to the front of the brain, where thinking, speech, personality and sensory and motor functions reside. When atherosclerosis develops within these vessels with narrowing and obstruction, individuals are at an increased risk of stroke. Strokes develop when particles of plaque break loose from this obstructive process and shower into the brain leading to brain damage.

Many patients have carotid artery disease that has not yet become symptomatic. A transient ischemic attack (TIA or mini-stroke), on the other hand, is an important warning sign of a developing stroke. These are temporary and may last only a few minutes or hours. These include the following symptoms:

• sudden loss of vision or blurred vision in one eye
• weakness and/or numbness on one side of the face, or in one arm or leg, or one side of the body
• slurred speech, difficulty talking or understanding what others are saying
• loss of coordination
• dizziness or confusion
• difficulty swallowing

TIA’s are medical emergencies and immediate medical attention is important.

Screening for carotid artery disease can be performed with the use of duplex ultrasound. This is indicated when a “bruit”or whistling sound is heard with a stethoscope over the carotid arteries in the neck, or in a patient with a history of carotid artery disease. Additional testing with MRI or CT angiography may be helpful in some cases.
Risk factors for the development of carotid artery disease include age, cigarette use, personal or family history of PAD or heart disease, hypertension, diabetes, obesity and sedentary lifestyle.

Treatments include:

• Carotid Endarterectomy
• Carotid Stenting

For a patient with renal failure, their dialysis fistula is their lifeline.  Creating and maintaining a safe and effective access is vital to a dialysis patient’s health and quality of life. 

Treatments include:

• Placement of a catheter into the heart for immediate initiation of hemodialysis
• Creation of a hemodialysis arteriovenous fistula or graft for long term treatment
• Maintenance of functioning fistula with fistuloplasty and/or stenting

Arteries are elastic and allow blood to be carried under high pressure throughout the body. When the wall of the artery becomes weakened and distended like a balloon, this is called an aneurysm. Aneurysms can occur anywhere in the vascular tree but are most commonly found in the abdominal and thoracic aorta followed by the popliteal, renal and visceral arteries. Aneurysms usually are discovered before they produce symptoms, such as back pain, but may rupture if they become too large. Since a ruptured aneurysm is dangerous and can cause life-threatening bleeding, aneurysms are best corrected by an operation before this happens. Occasionally, clot that forms within the aneurysm “sac” can detach from the wall and shower into the tissue downstream. These are called “emboli” and they also can lead to problems that require intervention.

Risk factors for the development of aneurysmal disease include cigarette use, age, family history of aneurysmal disease, hypertension, concurrent peripheral arterial disease, congenital diseases such as inherited weakness of the blood vessel wall; i.e. Marfan’s syndrome and Ehlers-Danlos Syndrome, trauma and infection.

Screening for aneurysmal disease with the use of duplex ultrasound can be important in making the diagnosis since the disease often goes undetected deep within the body. Currently, Medicare is offering a one-time, abdominal aortic aneurysm (AAA) screening test to qualified seniors as part of its “Welcome to Medicare” physical. This must be conducted within the first 12 months of enrollment in Medicare. Men who have smoked at least 100 cigarettes during their lifetime and men and women with family history of AAA, qualify for this screening. Coverage for AAA screening may differ depending on insurance policies.

Treatments include:

• Aneurysm Surgery ➜ Traditional Open Surgery
• Aneurysm Surgery ➜ Endovascular Aneurysm Repair (EVAR)

Peripheral Arterial Disease (PAD), also known as peripheral vascular disease, atherosclerosis or hardening of the arteries, is a disorder that occurs in the arteries of the circulatory system. Arteries carry oxygen-rich blood from the heart to all areas of the body.

In PAD, arteries become narrowed or blocked when plaque forms inside the artery walls. This plaque or “atherosclerosis” is composed of cholesterol-rich material and calcium. When this develops, blood cannot get through to nourish organs. This can cause damage and eventually tissue death.

Symptoms of PAD may progress slowly over a lifetime or develop rapidly within hours. The first noticeable symptoms may be intermittent claudication – leg discomfort, pain or cramping that develops with activity and is relieved with rest. The pain is typically in the calf, but may also be felt in the buttocks or thigh depending on the location of the obstructive process. The pain can be severe enough to interfere with normal walking. This may progress to rest pain – burning or aching pain in toes or heels without activity often relieved with dependent positioning, and ulceration or gangrene, when tissue begins to die from critically poor blood flow and compromised oxygen delivery.

Risk factors for the development of PAD include diabetes, cigarette use, age greater than 50, hypertension and high cholesterol. Individuals with heart disease often suffer from PAD in other areas of the body.

Treatments include:

• Angioplasty/Stenting for PAD
• Bypass Surgery for PAD
• Changes to diet and exercise
• Medication
• Smoking cessation