Vascular Disease Diagnostics
Abdominal Aortic Aneurysm
Diagnostic Testing
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
Diagnostic Testing
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
Diagnostic Testing
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
Diagnostic Testing
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 invasive study
utilizes the injection of a special dye and x-ray pictures to identify
the presence of venous disease.
Vascular Disease NonSurgical 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 postprocedural 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 is a relatively recent technology development
that 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. The aorta is
the body’s largest blood vessel and carries the oxygenated blood
away from the heart to the body. Stent grafting offers a repair option
for patients whose general health condition may place them at significant
risk with the traditional open surgical procedure.
Endovascular stent grafting is accomplished from two small incisions
made at the top of each groin. A special catheter under x-ray guidance
is used to place a stent graft at the site of the aneurysm. Blood flow
now occurs 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. In comparison
to the open surgical repair, patients who undergo endovascular stent
grafting can expect a much shorter hospital stay, less discomfort, and
a shorter recovery time.
However, 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 will be considered
in deciding which approach is best for each individual. Because this
is a recent technology, long-term results are not known and studies of
patients who have undergone the procedure are continuing.
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. An example of this would be a femoral-popliteal bypass.
The femoral arteries carry blood supply from the aorta to the lower extremities.
Beginning in the groin area, the femoral arteries traverse the thighs
and pass behind the knees where they are known as the popliteal arteries.
The femoral and popliteal arteries are common sites of plaque accumulation.
This obstruction will often result in claudication or a cramping discomfort
in the legs experienced during activity. This is due to a decreased amount
of oxygen-enriched blood reaching the leg muscles. When medical management
does not result in successful improvement of this condition, then a femoral-popliteal
bypass may be a treatment approach. In this technique, a bypass is created
by utilizing the patient’s own veins to reroute the circulatory
flow around blockages in the femoral artery directly to the popliteal
artery located behind the knee. If necessary, a plastic tube may be used
instead to create a route for alternative blood flow.
This procedure is a major surgery and will require a three-to-five day
hospital stay and
approximately four to six weeks for a recovery period. A lifestyle
management plan to minimize the reoccurrence and development of further
peripheral vascular disease will be of primary importance.
Carotid Endarterectomy
Carotid endarterectomy is the most common surgical procedure performed
for the prevention of stroke. The carotid arteries located on either
side of the neck are the principal supplier of blood flow to the brain.
Plaque accumulation in the carotid arteries can significantly increase
the risk for stroke occurrence.
Carotid endarterectomy is the general surgical procedure performed to
remove the plaque
obstructing blood circulation in the carotid arteries. The surgeon
will perform an open incision in the neck area at the site of the plaque.
A shunt may be used temporarily to reestablish blood flow through the
vessel. The plaque is then removed from the site of the blockage.
Not all carotid artery blockages are candidates for carotid endarterectomy.
Each patient’s presentation is considered on an individualized
basis including the estimated percentage of the existing blockage, the
symptoms experienced by the patient, and the health status of the patient.
Carotid endarterectomy is considered a major surgical procedure. Patients
are observed closely in the immediate postoperative period. With a stable
immediate recovery, patients are often discharged home the next day after
surgery.
Abdominal Aortic Aneurysm (AAA)
A surgical treatment approach for abdominal aortic aneurysm will be
decided 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.
Open surgical removal of AAA is a major surgery and can result in complications
related to the major organ systems. Uncomplicated postoperative recovery
generally involves a hospital stay of from five-to-seven days and a six-to-eight
week recuperative period.
|
