Vascular Conditions

Vascular Care and Vascular Surgery



Abdominal Aortic Aneurysm (AAA)

Aneurysms often affect the aorta, the body’s largest artery. The aorta carries blood away from the heart through the chest and abdomen. The normal diameter of the aorta in the abdomen is about 2 centimeters, which is a little less than 1 inch. An aneurysm is considered to have formed if the aorta grows to more than 1½ to 2 times its normal diameter.

Aortic aneurysms are potentially serious health problems since a burst aorta results in massive internal bleeding that can be fatal unless treated rapidly by an experienced emergency medical team.

Symptoms

  • No symptoms – in some cases, no symptoms will be present
  • Nausea
  • Pulsating sensation near navel
  • Pain in your back, belly or side

Treatment

In most cases, an aneurysm must be treated rapidly by an experienced emergency medical team. Surgical repair includes stent and endovascular repair options. In mild cases, your physician may recommend no treatment and will monitor your aneurysm for any changes.

Buerger’s Disease

Inflammation of your small to medium sized blood vessels. Usually in your legs, it can lead to gangrene.

Symptoms

  • Pain in your extremities
  • Pale skin color of your fingers and toes in cold temperatures (Kayhaud’s Phenomenon)

Treatment

Stopping smoking (for smokers), medication, surgery, compression therapy and amputation in the case of infection or gangrene are all treatments used with Buerger’s disease.

Cardiovascular Disease

A group of heart conditions that includes genetic/structural problems of the heart, blood clots and diseased vessels. Examples include stroke, high blood pressure, heart murmur and more.

Carotid Artery Disease

A buildup of plaque in your carotid artery.

Symptoms

  • Transient ischemic attack (mini-stroke)
  • Stroke

Treatment

Generally treated by lifestyle changes such as healthy eating, not smoking and increasing your physical activity; surgical interventions are also used. Possible procedures to clear the plaque include stenting procedures, revascularization of subclavian and innominate vessels in preparation for thoracic aneurysm endografting and other bypass procedures.

Coarctation of the Aorta

A narrowing of the aorta, it slows or blocks blood flow from the heart to the body. Coarctation of the Aorta is often associated with other heart defects.

Symptoms

  • No symptoms – in some cases, no symptoms will be present until middle age
  • Difficulty breathing
  • Enlarged heart
  • Poor appetite

Treatment

No treatment and monitoring is the most common recommendation for mild cases. Surgery can be used to correct defects, especially in more severe cases.

Coronary Artery Disease

Damage or disease in the heart’s major blood vessels, coronary artery disease (CAD) is the most common form of heart disease in the U.S., affecting more than 17 million people each year. It accounts for more deaths than any other major cause of death in the U.S. and claims more lives than cancer, chronic lower respiratory diseases and accidents combined. (American Heart Association Heart Disease & Stroke Statistics. 2010)

Symptoms

  • No symptoms – in some cases, no symptoms will be present
  • Chest pain
  • Heart attack

Treatment

Diet and or lifestyle changes, medications and angioplasty or other surgery may be used to treat coronary artery disease. Common surgical treatment is minimally invasive treatment with percutaneous coronary intervention (PCI) such as balloon angioplasty or stenting. Less common is a coronary artery bypass graft (CABG).

Coronary Thrombosis

A blood clot in a blood vessel inside your heart, a coronary thrombosis restricts blood flow. There is an increased risk if you are a smoker, and can also be a complication of drug-eluting stents.

Symptoms

  • Pain on exertion

Treatment

Surgery to remove blockage.

Deep Vein Thrombosis (DVT)

A blood clot in a deep vein can be a serious condition that needs expert treatment. Deep vein thrombosis, or DVT, can be treated in a number of ways.

Symptoms

  • No symptoms – in some cases, no symptoms will be present
  • Pain in your calf, foot and/or leg
  • Tenderness and warm skin
  • Swelling in your extremities

Treatment

Deep vein thrombolysis is an endovascular procedure designed to rapidly break up a blood clot and restore blood flow. It may also preserve valve function in blood vessels. If the vein appears narrowed, the radiologist may also perform a balloon angioplasty or stent placement to widen the vessel and help prevent future blockages. Other treatments include placement of a vena cava filter and a procedure called a venous thrombectomy.

Dialysis

Dialysis access

  • Access creation
  • Access maintenance
  • Thrombectomies of the occluded access

Familial Hypercholesterolemia

Genetic disorder that causes increased levels of LDL, the bad cholesterol. It is caused by a defect on chromosome 19.

Symptoms

  • Fatty skin deposits (xanthomas)
  • Cholesterol deposits in your eyelids (xanthelasmas)
  • Chest pain
  • Coronary Artery Disease at a young age
  • Sores and wounds on your feet that do not heal
  • Sudden stroke-like symptoms

Treatment

Lifestyle changes and medications are the normal course of treatment.

Hyperlipidemia

Increased levels of lipids, or fat particles, in your blood. It is diagnosed with blood tests.

Symptoms

  • No symptoms – in some cases, no symptoms will be present

Treatment

Medication and lifestyle changes, such as a healthy diet and increased physical activity.

Hypertension

Commonly called high blood pressure, hypertension can cause other health conditions. High blood pressure can be made worse by a lack of physical activity, smoking and an unhealthy diet full of salt and processed fatty foods.

Symptoms

  • No symptoms – in some cases, no symptoms will be present
  • Headaches
  • Nosebleeds
  • Dizziness
  • Nausea

Treatment

Diet and/or lifestyle changes, medications and increased exercise are all treatments for hypertension.

Inflammatory Vasculitis

An inflammation, or swelling, of your blood vessels that includes arteries, veins and/or capillaries. It causes blood vessels to weaken and/or narrow, often leading to a blockage. Inflammatory vasculitis can be caused by multiple factors, including autoimmune diseases, as well as a side effect of some medications.

Symptoms

  • Fever
  • Weight loss
  • Dark or purple colored spots on your skin
  • Arthritis
  • Headache
  • Stroke
  • Hypertension
  • Abdominal pain
  • Bloody cough
  • Gangrene

Treatment

Corticosteroids, immunosuppression therapy and antibiotics are all common treatments. If any organs are damaged as a result of the vasculitis, they may require additional treatment.

Kawasaki Disease

A short term disease, Kawasaki disease causes inflammation in the walls of your blood vessels.

Symptoms

  • Rash
  • Fever
  • Peeling skin
  • Joint pain
  • Diarrhea
  • Vomiting

Treatment

Aspirin is commonly used as an initial treatment. Other treatments include immunoglobulin therapy or other medications.

Lymphedema

Swelling in your extremities, such as your arms and legs, that is caused by a blockage in your lymphatic system.

Symptoms

  • Swelling of arms and/or legs
  • Pain and/or discomfort, especially in arms and/or legs

Treatment

Exercise, massage and the use of compression stockings and/or wraps are the most common treatment.

May-Thurner Disease

Also known as iliac vein compression syndrome, it is a rare condition that causes blood clots and deep vein thrombosis (DVT).

Symptoms

  • Pain in legs
  • Swelling of legs

Treatment

Your treatment will vary depending on the underlying cause of the disease. It is recommended that you receive evaluation by a vascular specialist, in order to best treat your specific symptoms.

Mesenteric Ischemia

Also known as mesenteric vascular disease, mesenteric ischemia is an injury of the small intestine due to a lack of blood supply. It can be sudden or gradual, developing over time into one of the three stages: hyperactive, paralytic and shock.

Symptoms

  • Abdominal pain
  • Abdominal bloating
  • Bloody stools
  • Systemic shock (dehydration, decreased blood pressure, rapid heart rate, confusion)

Treatment

Treatment usually includes anticoagulation medications to prevent clots that would block blood flow to the small intestine. In some cases, surgery is required to remove a blockage.

Paget-Schroetter Disease

Paget-Schrötter syndrome is a type of deep vein thrombosis (DVT) that involves blood clots forming in the arms. These clots usually form in two specific veins, known as your axillary and subclavian veins. It is important to treat the blood clots, as they can break free and move from your arm to other locations in your body, possibly causing life-threatening issues, such as a pulmonary embolism. The disease is more common in younger males.

Symptoms

  • Pain
  • Warmth
  • Redness/blueness of the skin
  • Swelling in your arms

Treatment

Treatment is the same as deep vein thrombosis (DVT) treatment. Anticoagulation medications are a common approach, followed by surgery, when necessary, to clear the blockage.

Peripheral Aneurysm

A peripheral aneurysm is a swelling or abnormality of a blood vessel that is not your aorta.

Symptoms

  • Pulsating lump
  • Pain, especially with exercise
  • Painful sores or ulcers on your toes and/or fingers
  • Gangrene

Treatment

Lifestyle changes, medications and surgery to reinforce vessel walls may all be used.

Peripheral Artery Disease/Peripheral Vascular Disease (PAD/PVD)

Peripheral artery disease (PAD), also known as peripheral vascular disease (PVD) is a slow and progressive circulation disorder. It may involve disease in any of the blood vessels outside of the heart and diseases of the lymph vessels - the arteries, veins, or lymphatic vessels. Arteries are the blood vessels that deliver oxygen-rich blood and nutrients from the heart to the tissues of your entire body. When you have PAD/PVD, neither the oxygen nor the nutrients can get to the legs, arms and organs.

Conditions associated with PAD/PVD may occur because the artery becomes blocked in some manner (oclusive) or the artery constricts due to a spasm or expands (functional). Examples of occlusive PAD/PVD include peripheral arterial occlusion and Buerger's disease (thromboangiitis obliterans). An example of functional PAD includes Raynaud's disease and phenomenon.

One in every 20 Americans over the age of 50 has PAD/PVD, a condition that develops when fatty deposits that limit blood flow to the legs and increase the risk for a heart attack or stroke. Men and women are equally affected by PAD/PVD, although African-Americans have an increased risk.

At Detroit Medical Center, interventional cardiologists and vascular surgeons are now using some of the latest imaging technology to get access to the arteries in order to treat PAD/PVD.

Symptoms

  • Leg pain with physical activity (goes away with rest)
  • Muscle loss (atrophy)
  • Hair loss on legs
  • Smooth, shiny skin on legs
  • Skin that is cool to the touch, especially when accompanied by pain while walking
  • Decreased or absent pulses in the feet
  • Non-healing ulcers or sores on the legs or feet
  • Cold or numb toes

If you are experiencing any of these symptoms, DO NOT WAIT. Talk to a doctor. If you do not have a doctor, call 888-DMC-2500, and the DMC Health Access Center can help you locate one, and schedule an appointment.

Treatment

There are options for treatment. Understanding and modifying your risk factors is an important part of treating PAD/PVD. A risk factor is anything that may increase your chance of developing a disease, and can be changeable or unchangeable. Changeable risk factors are things you can change, including your coronary artery disease, impaired glucose tolerance, dyslipidemia, hypertension, obesity, physical inactivity and smoking or use of tobacco products. In the case of PAD/PVD, unchangeable risk factors include your age, family or personal history of heart disease, male gender, type 1 diabetes (diabetes mellitus), postmenopausal women and a family history of dyslipidemia, hypertension or peripheral vascular disease.

Treatment can also involve a number of surgical options, including femoral popliteal bypass surgery, femoral popliteal stenting, femoral popliteal balloon angioplasty, thrombolytic therapy, minimally invasive atherectomy, or other vascular surgery.

Renal Artery Stenosis

Renal artery stenosis is the narrowing of kidney arteries. This condition causes high blood pressure and may eventually lead to kidney failure. Largest risk factor is uncontrolled high blood pressure.

Symptoms

  • No symptoms – in some cases, no symptoms will be present

Treatment

Medications are a common treatment. If necessary, surgery can be used to widen the arteries.

Renal Vein Thrombosis

Renal vein thrombosis is a blood clot blocking a vein in the kidney. Blood clots in renal veins are uncommon and rarely affect the kidney, but they can sometimes travel to and lodge in arteries supplying your lungs, causing a dangerous condition called a pulmonary embolism.

Symptoms

  • Pain in the sides of the abdomen, legs, or thighs
  • Blood in the urine
  • Protein in the urine
  • Enlarged kidney
  • Fever, nausea, or vomiting
  • High blood pressure
  • Sudden, severe leg swelling
  • Difficulty breathing

Treatment

Anticoagulant medications are the treatment of choice, but in some cases surgery may be necessary.

Syncope

Commonly called fainting, syncope is a temporary loss of consciousness and muscle tone caused by inadequate blood supply to the brain. The common reason behind each syncopal or fainting episode is a temporary lack of oxygen-rich (red) blood getting to the brain. However, many different problems can cause a decrease in blood flow to the brain.

Some causes of syncope include:

  • Vasovagal syncope. This is the most common type of syncope. A variety of situations stimulate the vagus nerve, which leads to a slowing of the heart rate and dilation of the body's blood vessels. With a slow heart rate and dilated blood vessels, less blood gets to the brain, and fainting occurs. Pain and emotional stress can trigger vasovagal syncope in susceptible people. This type of syncope can happen more often in some families.
  • Orthostatic hypotension. This is a drop in blood pressure that occurs when a person has been standing for a while, or changes from a sitting to a standing position. Blood pools in the legs, preventing a normal amount of blood from being pumped to the brain. This momentary drop in blood flow to the brain causes a person to faint.
  • Heart disease. Rarely, there are abnormalities of the heart that can cause syncopal episodes. Heart defects causing "outflow obstruction" may produce fainting because they restrict the blood flow to the body and brain.
  • Irregular or rapid heart rhythms can also trigger syncope. When the heart beats rapidly or irregularly, the ventricles have less time to fill with blood, and the body reacts to the diminished blood flow to the brain by fainting.
  • Myocarditis. Inflammation of the heart muscle, known as myocarditis, weakens the heart muscle so it is not able to pump as normal. The body again reacts to decreased blood flow to the brain by fainting.

Other situations or illnesses that can cause syncope include, but are not limited to, head injury, seizure, stroke, inner ear problems, dehydration, low blood sugar, breath holding episodes in young children, pregnancy and anemia.

Symptoms

  • Presyncope (feeling faint or dizzy)
  • Cold sweat
  • Clammy skin
  • Fainting

Treatment

Specific treatment will be determined by your health care provider based on your medical history and physical exam. Staying hydrated (taking in enough water and liquids) and maintaining a good diet can prevent future episodes. When you feel faint, try lying or sitting down with your head lower than your heart should be encouraged to increase blood flow to the brain and prevent fainting. If there is an underlying condition, such as heart disease, that is causing the syncope, you may be referred to a specialist, such as a cardiologist, for medication and further evaluation.

Thoracic Aortic Aneurysm

An aneurysm of your thoracic aorta, these are a serious condition that need prompt medical attention. Aneurysms often affect the aorta, the body’s largest artery. The aorta carries blood away from the heart through the chest and abdomen. As the blood vessel expands it can rupture or burst.

Symptoms

  • No symptoms – in some cases, no symptoms will be present
  • Pain in the jaw, neck, upper back or chest
  • Coughing or difficulty breathing

Treatment

Your physician may prescribe no treatment, instead monitoring the size of your aneurysm for any changes. Surgical repair is possible, preferably with a stent-graft.

Thoracic Outlet Syndrome

A group of disorders involving compression of blood vessels or nerves.

Symptoms

  • Pain in the shoulders and/or neck
  • Tingling or numbness in fingers

Treatment

Pain relief can come with physical therapy and over the counter medications, such as ibuprofen. Surgery is an option, though rarely needed in most cases.

Total Anomalous Pulmonary Venous Return (TAPVR)

A rare congenital defect, TAPVR causes the four pulmonary veins to connect and drain into the right atrium of the heart instead of the left atrium of the heart. It is most commonly diagnosed soon after birth, though in mild cases a child may show signs later in life.

Symptoms

  • Newborns with TAPVR are very ill from birth and may have blue skin (cyanosis).
  • Older children will show signs of a heart murmur.
  • Treatment

    Surgery is needed to correct the defect.

    Transposition of the Great Arteries

    A congenital heart defect, transposition of the great arteries changes how blood moves through your body by switching (transposing) the two main arteries that leave the heart.

    Symptoms

    • Blue tint to the skin (cyanosis)
    • Shortness of breath
    • Lack of appetite
    • Poor weight gain in infants

    Treatment

    Medication can be used to reduce symptoms until surgery can be performed to correct the defect.

    Truncus Arteriosus

    A defect in which the aorta and pulmonary artery do not form separately. Instead, a large artery, called the truncus, comes from the heart. As the truncus leaves the heart, it may branch into arteries that carry blood to the body and to the lungs.

    Symptoms

    • Blue tint to the skin (cyanosis)
    • Fatigue
    • Rapid breathing
    • Shortness of breath
    • Clubbed fingers/toes

    Treatment

    Surgery is required to correct the defect.

    Varicose Veins

    Enlarged, bumpy veins; usually in your legs and/or feet.

    Symptoms

    • No symptoms – in some cases, no symptoms will be present
    • Pain
    • Discomfort

    Treatment

    Compression stockings, exercise and surgical procedures are all used to treat varicose veins.

    Vascular Ring

    A congenital defect, a vascular ring causes normal vessels to appear in an abnormal location. It can compress or block your esophagus and/or airway.

    Symptoms

    • Noisy breathing
    • Difficulty breathing
    • Trouble swallowing

    Treatment

    Surgery is require to repair the defect.

    Venous Insufficiency

    More common in your legs and/or feet than in other parts of your body, venous insufficiency is the inability of your veins to circulate your blood efficiently.

    Symptoms

    • Aching and/or cramping in legs
    • Pain in your legs
    • Swelling in your legs
    • Varicose veins
    • Ulcers or slow healing wounds on your legs and/or ankles

    Treatment

    Compression stockings, exercise, maintaining a healthy weight, and surgical and other medical interventions can all be used to treat venous insufficiency. Surgical intervention may include ablation or angioplasty.