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Peripheral Vascular Disease

Treatments for peripheral vascular disease  include heart-healthy lifestyle changes, medicines, and surgery or procedures.

Heart Healthy Lifestyle Changes

Treatment often includes making life-long heart-healthy lifestyle changes such as:

  • Physical activity
  • Quitting smoking
  • Heart-healthy eating

Surgery or Procedures

Bypass Grafting

Your doctor may recommend bypass grafting surgery if blood flow in your limb is blocked or nearly blocked. For this surgery, your doctor uses a blood vessel from another part of your body or a synthetic tube to make a graft.

This graft bypasses (that is, goes around) the blocked part of the artery. The bypass allows blood to flow around the blockage. This surgery doesn’t cure the disease,  but it may increase blood flow to the affected limb.

Angioplasty and Stent Placement

Your doctor may recommend angioplasty to restore blood flow through a narrowed or blocked artery.

During this procedure, a catheter (thin tube) with a balloon at the tip is inserted into a blocked artery. The balloon is then inflated, which pushes plaque outward against the artery wall. This widens the artery and restores blood flow.

A stent (a small mesh tube) may be placed in the artery during angioplasty. A stent helps keep the artery open after angioplasty is done. Some stents are coated with medicine to help prevent blockages in the artery.

Atherectomy

Atherectomy is a procedure that removes plaque buildup from an artery. During the procedure, a catheter is used to insert a small cutting device into the blocked artery. The device is used to shave or cut off plaque.

The bits of plaque are removed from the body through the catheter or washed away in the bloodstream (if they’re small enough).

Doctors also can perform atherectomy using a special laser that dissolves the blockage.

 

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Venous Disease

Sclerotherapy

Sclerotherapy is used to treat veins just below the skin’s surface that are either invisible or difficult to see with the naked eye. In this procedure, small needles provide access to the vein so a medicine called a sclerosing agent can be injected into the vein’s interior wall.

Light-assisted sclerotherapy is used to treat veins below the skin’s surface that are difficult to see. These reticular veins are responsible for feeding the veins that are visible on the surface of the skin. During light-assisted sclerotherapy, a small, hand-held light illuminates the veins and tissue directly below the patient’s skin.

Ultrasound-guided sclerotherapy is performed under the guidance of ultrasound. It is reserved for leaking veins that are not visible, and cannot be seen with transcutaneous illumination (hand-held light used to view veins near the surface]). This procedure is often used to treat perforator veins, or veins that connect the superficial system (above the muscles in your leg) to the deep system (veins under and between the muscles of the leg).

Ambulatory Phlebectomy
Ambulatory phlebectomy is a minimally invasive out-patient procedure used to treat varicose veins that are too large to be effectively treated with sclerotherapy. Ambulatory phlebectomy involves removing the vein through micro punctures in the skin. The defective vein is pulled to the surface of the skin and out of the leg through these small openings. Blood is diverted to the many other healthy veins in the leg; there is no ill effect from the loss of the vein.

Endovenous Vein Treatments
Endovenous laser ablation (EVLA), also called endovenous laser therapy (EVLT™) or radio frequency ablation (RFA), is a minimally invasive treatment used to address specific large varicose veins in the legs. It is considered the gold standard in treatment of venous symptoms, and has largely replaced previous, more invasive standards of care, such as vein stripping.

Conservative Therapy

Compression Therapy
The recommended form of compression therapy is the use of graduated compression stockings. Compression stockings can offer an alternative to the above procedures in treating varicose veins. They can be effective in relieving symptoms of venous disease, stopping its progression, and decreasing the likelihood of a clot. They also provide an alternative for patients who prefer not to opt for other treatments.  The drawback to compression therapy is that stockings must be worn daily.

Elevation
In some cases, elevation of the legs can alleviate the pain or swelling that is the result of early stage venous disease. Elevation of the legs above the heart for a period of three minutes, usually in the morning and several times throughout the course of the day, can encourage blood flow from the legs and decrease the pooling of blood.

Exercises
Exercising the feet, toes, and ankles is recommended to help reduce symptoms and prevent the onset of venous disease and its progression. Tapping the toes and flexing the feet several times a day, for example, can help blood move up into the legs.  This is particularly recommended for those who sit and stand for long periods.

Medication
Medication may be an option for those with venous symptoms. Ibuprofen, creams, and other non-steroidal, anti-inflammatory medications may be recommended; other medications may be prescribed depending on the severity of the symptoms. A specialist can guide you on proper use of medications.

Prevention
Because venous disease has a strong genetic component, prevention can help those with a family history to avoid clots and ward off symptoms. Maintaining a healthy weight and exercising regularly is an important part of maintaining vein health. Because smoking hinders circulation, quitting is an important part of prevention as well. Regular movement to prevent long periods of sitting or stagnancy is also recommended. At

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Hyperhidrosis

When medical treatments have failed to offer adequate control of hyperhidrosis, your physician may recommend surgery. Surgery may be recommended for severe cases of palmar or axillary hyperhidrosis that have not responded to medical therapy. Your physician will determine if surgery is the appropriate treatment for you.

If surgery is needed, a minimally invasive procedure called video-assisted thoracic sympathectomy (or thoracoscopic sympathectomy) may be used. This involves interrupting a specific portion of the main sympathetic nerve, which is a part of the autonomic nervous system. The sympathetic nerve "chain" is made up of a network of nerves that branch off from the spine and form next to the ribs in the chest.

Each sympathetic nerve branch originates from a bundle of cells called a "ganglion." Through two small incisions under the armpit, a specific ganglion that causes sweating is located and removed. Then the signal which tells the body to sweat in a specific region is ‘turned off’, reducing localized hyperhidrosis. The exact ganglion that is removed depends on the area of excessive sweating that is being treated.

The patient is under general anesthesia during the video-assisted thoracic sympathectomy procedure. By inserting a small camera, called a thoracoscope, the surgeon is guided to the appropriate ganglion. Once the nerve is detected, it is interrupted. After completing the procedure on one side of the body, the surgeon then performs the same procedure on the opposite side. This procedure is usually completed within two hours, and most patients go home the day of surgery.

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Swollen Legs

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Varicose Veins

Endovenous Laser Treatment (EVLT)

In endovenous laser treatment, a thin fiber is inserted into the damaged vein through a very small entry point in the skin. A laser light is emitted through the fiber, as the fiber is pulled back through the vein, it delivers just the right amount of energy. The targeted tissue reacts with the light energy, causing the vein to close and seal shut. The veins that are closed are superficial veins that handle less than five percent of the body's blood flow. The blood is automatically routed to other, healthy veins.

The procedure is minimally invasive and requires no general anesthesia. Only local anesthetic is used to numb the area where the physician is working. Patients are encouraged to walk immediately after the procedure and can resume normal activities the same day.

Sclerotherapy

This simple procedure involves a series of injections of medication into the veins.  The injections cause a shrinking and eventual closing of the vein.  Schlerotherapy gives more predictable results, is less painful and less expensive than laser treatments.  Scleroetherapy is an in-office procedure and usually requires several treatments.

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Carotid Artery Disease

Heart-Healthy Lifestyle Changes

Your doctor may recommend heart-healthy lifestyle changes if you have carotid artery disease. Heart-healthy lifestyle changes include:

  • Heart-healthy eating
  • Aiming for a healthy weight
  • Managing stress
  • Physical activity
  • Quitting smoking

Medical Procedures

You may need a medical procedure if you have symptoms caused by the narrowing of the carotid artery. Doctors use one of two methods to open narrowed or blocked carotid arteries: carotid endarterectomy and carotid artery angioplasty and stenting.

Carotid Endarterectomy

Carotid endarterectomy is mainly for people whose carotid arteries are blocked 50 percent or more.

For the procedure, a surgeon will make a cut in your neck to reach the narrowed or blocked carotid artery. Next, he or she will make a cut in the blocked part of the artery and remove the artery’s inner lining that is blocking the blood flow.

Finally, your surgeon will close the artery with stitches and stop any bleeding. He or she will then close the cut in your neck.

Carotid Endarterectomy

The illustration shows the process of carotid endarterectomy. Figure A shows a carotid artery with plaque buildup. The inset image shows a cross-section of the narrowed carotid artery. Figure B shows how the carotid artery is cut and how the plaque is removed. Figure C shows the artery stitched up and normal blood flow restored. The inset image shows a cross-section of the artery with plaque removed and normal blood flow restored.
 

Carotid Artery Angioplasty and Stenting

Doctors use a procedure called angioplasty to widen the carotid arteries and restore blood flow to the brain.

A thin tube with a deflated balloon on the end is threaded through a blood vessel in your neck to the narrowed or blocked carotid artery. Once in place, the balloon is inflated to push the plaque outward against the wall of the artery.

A stent (a small mesh tube) is then put in the artery to support the inner artery wall. The stent also helps prevent the artery from becoming narrowed or blocked again.

Carotid Artery Stenting

 
 
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Lymphedme

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Spider Veins

Sclerotherapy

This simple procedure involves a series of injections of medication into the veins.  The injections cause a shrinking and eventual closing of the vein.  Schlerotherapy gives more predictable results, is less painful and less expensive than laser treatments.  Scleroetherapy is an in-office procedure and usually requires several treatments.

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Abdominal Aortic Aneurysm

Surgery

If you have an abdominal aortic aneurysm, surgery is generally recommended if your aneurysm is about 1.9 to 2.2 inches (about 5 to 5.5 centimeters) or larger. Doctors may also recommend surgery if the aneurysm is growing quickly. In addition, your doctor may recommend treatment if you're experiencing symptoms such as stomach pain or you have a leaking, tender or painful aneurysm.

Surgery options may include:

  • Open abdominal surgery. Open abdominal surgery to repair an abdominal aortic aneurysm involves removing the damaged section of the aorta and replacing it with a synthetic tube (graft), which is sewn into place.

    This procedure requires open abdominal surgery, and it will generally take you a month or more to fully recover.

  • Endovascular surgery. Endovascular surgery is a less invasive procedure used more frequently today to repair an aneurysm. Doctors attach a synthetic graft to the end of a thin tube (catheter) that's inserted through an artery in your leg and threaded up into your aorta.

    The graft — a woven tube covered by a metal mesh support — is placed at the site of the aneurysm and expanded. The graft is fastened in place with the metal mesh that frequently has small hooks or pins. The graft reinforces the weakened section of the aorta to prevent rupture of the aneurysm.

    Recovery time is generally much shorter with this procedure than with open abdominal surgery, but endovascular surgery can't be done in about 30 percent of people with an aneurysm. Discuss with your doctor whether you're a candidate for this procedure. After endovascular surgery, you'll need to have regular follow-up imaging tests to ensure that the graft isn't leaking. Long-term survival rates are similar for both endovascular surgery and open surgery.

The options for treatment of your aneurysm will depend on a variety of factors, including location and size of the aneurysm, your age, and other existing conditions that may increase your risk of surgery or endovascular repair. Your doctor will discuss with you the most appropriate treatment for you.

 
References
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Chronic Open Wounds

Chronic wounds should be treated systemically, as the patient’s overall health, nutrition, and underlying diseases must be managed to support the healing process. Vascular surgeons treat and dress wounds, often applying layers of medicated compression bandages, to improve circulation and nutrition to the wound, in a germ-free environment. Irrigation is also standard. Sophisticated analysis would lead them to determine if curettage is required to remove damaged tissue.
The San Diego Vascular Center is the premier vascular treatment center. Whether you are looking for spider vein removal, or need a reliable, highly-qualified staff to care for chronic wounds or vascular disease, our team of board-certified doctors is at your service.

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Chronic DVTs

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TOS (Thoracic Outlet Syndrome)