06-22-2022 Primetime Livnig - Flipbook - Page 26
26 A Special Advertising Section of Baltimore Sun Media Group | Wednesday, June 22, 2022
Vascular disease, continued from page 8
clots and inflammation from forming and
enabling proper blood flow to limit the
incidence of stroke and death. American
Heart Association guidelines specify the
use of statins to lower cholesterol for
patients with vascular disease.
In some cases, surgical procedures
are indicated. Vascular surgeons treat
severe blockages by utilizing a stent,
which is implanted in the carotid artery
to prevent it from narrowing. The stent
is inserted at the femoral artery and run
through the groin. This avoids an incision
in the neck, but it also has been associated with a slightly increased risk of stroke
in large clinical trials.
An innovative technique is sometimes
utilized during stent placement. In this
case, the surgery is done while reversing blood flow as the stent is placed in
the carotid artery through a small incision above the collarbone. The procedure
decreases the risk of stroke by taking the
blood, cleaning it and removing debris
before returning it to the body through a
vein in the patient’s leg.
“When you insert a stent inside an
artery that’s already brittle or soft, flakes
can easily break off and travel to the
brain,” says Dr. Sarkar. “The insertion of
the stent definitely causes debris to be
released. We use filters and nets in an
effort to capture the debris, but some
can get through and cause a stroke. Flow
reversal was an innovative idea to not
only trap the debris but to clean the blood
before it is returned to the body, minimizing the incidence of stroke.”
The treatment option utilized with the
most data support is a carotid endarterectomy. Through an incision in the neck,
the vascular surgeon can physically clean
out the carotid artery, removing the plaque
that has built up over time and become a
potential cause for stroke. According to
Dr. Sarkar, this procedure is performed
in asymptomatic patients with a greater
than 80% blockage as well as those who
show symptoms of a mini stroke or brain
attack, or have had an actual stroke, with
50% blockage or greater. Following a
carotid endarterectomy, the survival rate
is greater than 78% after five years and
more than 45% after 10 years.
Abdominal Aortic Aneurysms
According to the Society for Vascular
Surgery, approximately 14,000 people in
the United States die each year from a
ruptured abdominal aortic aneurysm. An
aortic aneurysm is balloon-like swelling
in the aorta, the large artery that carries
blood from the heart through the chest
and trunk. Swelling occurs 80% to 90% of
the time in the abdomen, and if it ruptures,
the result is usually fatal.
There are no warning signs for an
abdominal aortic aneurysm, which often
go undetected until it ruptures. Medicare
has approved ultrasound screening for
male patients with no symptoms if they
have a history of cigarette use; smoking is associated with inflammation that
weakens artery walls. Screening is also
recommended for men over age 50 and
post-menopausal women with a family
history of aneurysm.
Nearly 200,000 people in the United
States are diagnosed annually with an
abdominal aortic aneurysm. In some
cases, the swelling is detected during
an examination for another condition, Dr.
Sarkar notes. If detected, aneurysms are
monitored by a vascular surgeon, and
often fail to grow large enough to cause
concern.
“The risk of rupture of an aneurysm
is very low,” Dr. Sarkar explains. “Even
though it’s a terrifying diagnosis, that
there is a weakness in your artery that
may rupture, the likelihood is under 2%
for patients with a 5-centimeter aneurysm.
The mathematics are favorable, but all
aneurysms should be monitored annually
by a vascular surgeon.”
National guidelines indicate that if the
swelling measures at least 5.5 centimeters in diameter, preventative surgical
repair is recommended. Most aneurysms
may be repaired minimally invasively with
an endovascular stent graft through the
groin. The graft directs blood flow through
a smaller channel, avoiding the swollen
artery. In the past, the condition warranted
open surgery and an extensive recovery.
Peripheral Artery Disease
Peripheral artery disease, also known
as atherosclerosis, is the medical term
associated with hardening of the arteries
and blockages that compromise circulation. Peripheral artery disease affects
between 8 million and 12 million people
in the U.S., according to the National
Institutes of Health. More vulnerable to
peripheral artery disease are diabetics,
smokers and those over age 50.
Peripheral artery disease occurs primarily in the legs, with blockages in the
arteries to the legs in its early stages.
Patients experience difficulty walking, particularly with calf pain. Anyone who experiences difficulty when walking or severe
calf pain should be evaluated for peripheral artery disease through an ultrasound
screening, Dr. Sarkar notes. Patients with
leg pain are medically referred to as having claudication, named for the Roman
Emperor Claudius, who was known for
having a limp due to a congenital birth
defect. Claudication is derived from the
Latin verb claudicare, which means “to
limp.”
The first line of treatment is a structured
exercise program with rigid control of risk
factors, including weight loss, smoking
cessation, and diabetes and hypertension
(high blood pressure). Like patients with
carotid artery disease, patients diagnosed
with peripheral artery disease should be
on medication including a statin and an
antiplatelet medication like aspirin. Most
patients, according to Dr. Sarkar, are not
in danger of losing their leg, as long as
they get their risk factors under control.
Patients with disabling leg pain, ulcers
or cuts that won’t heal, or even gangrene should consult a vascular surgeon
for treatment to improve blood flow. In
addition to risk factor management and
exercise, these patients could need interventional care. A stent may be inserted
to open the artery or bypass surgery may
be performed utilizing blood vessels from
another part of the body to bypass the
blockage.
Venous Diseases
Venous disease has two manifestations, deep vein thrombosis and venous
insufficiency.
Deep vein thrombosis (DVT), a blood
clot within the veins of the leg, occurs in 2
million Americans. DVT causes symptoms
in the leg and can deliver potentially fatal
complications by breaking off and traveling to the lungs.
Three main risk factors exist for DVT:
pregnancy, trauma to the legs or pelvis
and surgery, particularly to the abdomen,
pelvis or leg. If any of these risk factors
apply and there is unexplained pain or
swelling in the leg, the patient should have
a painless, noninvasive ultrasound to rule
out DVT. If DVT is diagnosed, immediate
treatment is necessitated. Patients will
be treated with anticoagulant medication or blood thinners to prevent the clot
from growing or breaking off to block the
lungs and cause a pulmonary embolism.
In most cases, the medication will allow
the body to dissolve the clot, if it is fresh
and soft.
Venous insufficiency or venous reflux
is the backward flow of blood in the
veins. Faulty valves in the veins prevent
the blood from flowing to the heart, and
instead the blood seeps back to the legs,
where it collects. Chronic venous insufficiency can be caused by aging, extended
sitting or standing, reduced mobility or a
blood clot deep in the leg veins, or it can
be inherited. With the collection of excess
Vascular disease,
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