A vascular surgeon is a surgeon who has undergone extensive training and specialization in the field of vascular medicine, a field focused on the health of the veins, arteries, blood vessels and circulatory system. Our team of vascular surgeons have years of experience diagnosing and treating vascular conditions, diseases and disorders.
These include PAD, carotid artery stenosis, aneurysms, renal artery stenosis and more. To learn more about the disorders we treat view our services page or for in-depth information view our learning center.
Most vascular disease is caused by atherosclerosis, a disease of the walls of the vessels, often called “hardening of the arteries.” This may cause plaque build-up to block the circulation, or weakening of the wall, which produces aneurysms that are prone to rupture. Vascular disease afflicts millions of Americans and is one of the most frequent causes of death and disability among older Americans.
Coronary artery disease is the most common type of heart disease. It is caused by atherosclerosis, “hardening of the arteries” that is limited to the vessels supplying circulation to the heart muscle itself. Vascular disease outside the heart can affect the rest of the circulation to the body, including the blood supply to the arms, the legs, the brain, the kidneys, and the gut — even the fingers and toes may be affected.
Vascular screening provides early detection of the major vascular problems, such as peripheral arterial disease, which can cause serious circulation problems in the legs; abdominal aortic aneurysms, which can rupture and cause death; and carotid artery disease that causes strokes. The non-invasive tests used in screening safely and effectively detect these diseases and, if necessary, provide patients and their physicians with information to help them make decisions about the most appropriate treatment.
Individuals who are over 55 years old, have smoked during their life, have high blood pressure, high cholesterol, or who are diabetic should consider being screened. Those with heart disease or other cardiovascular problems, and anyone with a family history of aneurysms should also be tested.
Early detection of critical vascular problems can definitely prevent stroke and death. However, most people affected will be found to have mild to moderate problems, and in these cases, effective medical treatments are available to prevent the problem from getting worse. Like cancers whose outcome may be fatal when diagnosis is delayed, there is the possibility of limiting the progression of vascular diseases with early detection and proper medial treatment, and avoiding the necessity of surgery or angioplasty down the line.
Veins and arteries, while both part of the circulatory system, function quite differently from each other. “Poor circulation” is a nonspecific term that often refers to arterial blockages. Arteries bring oxygen-rich blood from the heart to the extremities and can be thought of like a tube or hose. Veins, unlike arteries, have one-way valves and channel oxygen-depleted blood back toward the heart. If the valves of the veins don’t function well, blood doesn’t flow efficiently. The veins become enlarged because they are congested with blood. These enlarged veins are commonly called spider veins or varicose veins. Spider veins are small red, blue or purple veins on the surface of the skin. Varicose veins are larger distended veins that are located somewhat deeper than spider veins. For symptoms, causes and treatment options – VNUS® Closure® procedure, click here.
Most insurance plans cover the procedure in full if conservative treatments fail to relieve the symptoms. To learn more click here.
Patients report feeling little, if any pain. To learn more click here.
Typically, an abdominal aortic aneurysm does not produce any symptoms. However, when symptoms do arise, sharp pains in the abdomen or back are common. This pain is sometimes accompanied by abnormal pulsations in the abdomen. A careful palpation, or feeling of the abdomen, can be done by a physician to detect an AAA, but an abdominal ultrasound or CT scan is most reliable in detecting the condition.
There are two methods commonly used to repair an AAA – open surgery or endovascular aneurysm repair (EVAR). Your physician will help you decide which treatment option is best for you to repair your aneurysm. Factors that influence the method of repair include your age, health and the anatomy of the aneurysm.
Depending on the size and rate at which the aortic aneurysm is growing, treatment may vary from watchful waiting to emergency surgery. Once an abdominal aortic aneurysm is found, doctors will closely monitor it so that a procedure can be planned if it is necessary. An elective procedure for aneurysm repair may be likely Carotid Endarterectomy.
Carotid artery disease may be asymptomatic (without symptoms) or symptomatic (with symptoms). For a full list of details and treatment, click here.
When the blood vessels in the legs, abdomen, pelvis and neck are narrowed by the buildup of plaque, or fatty deposits, it’s a condition known as peripheral vascular disease (PVD). This buildup can lead to blockages that restrict blood circulation. It’s a condition you want to get under control because most people with PVD have a higher risk of death from heart attack and stroke, according to the American Heart Association.
A telltale sign of PVD is discomfort and fatigue in the legs when walking, which is relieved when you stop and rest. People with PVD of the neck arteries may experience transient ischemic attacks or TIAs, which are warning signs of stroke.
PVD usually develops gradually. High blood pressure, high cholesterol, smoking and family history all contribute to PVD, as can diabetes, being overweight or simply being a man.
Surgical and minimally invasive techniques such as angioplasty and stents can be used to relieve blockages. But many people with PVD can be treated with healthy lifestyle modifications. Two of the most important things you can do are to quit smoking and to reduce your cholesterol levels through a healthy diet, exercise and, if needed, medications.
Per the National Pressure Ulcer Advisory Panel (www.npuap.org): a pressure ulcer is defined as: A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.
A good reference for this is npuap.org under prevention tips. If you are in a healthcare facility, a patient’s skin should always be assessed upon admission. Depending on your facility type (whether the patient has been admitted to the ICU in a hospital, or a long-term care facility) will depend upon how often the patient’s skin is reassessed after the first 24 hours. Also, the initial skin assessment may determine how often the patient’s skin is reassessed. For example, in the hospital setting, the patient’s skin may be reassessed every 24 hours. Initially in a long-term care facility, a patient’s skin may be reassessed every week. Pressure ulcer prevention tips include: moisturizing skin, good nutrition and looking at the patient’s support surfaces (in bed and in wheelchair).
The Braden Scale is a tool for predicting a patient’s risk for developing pressure ulcers. (For an example of this form, please see www.bradenscale.com)
A patient will not be able to heal their wounds without good nutrition. A blood test to check their prealbumin level is used to assess the patient’s current protein levels.
“Clean Technique” is the terminology used to describe a wound dressing change in any environment besides the surgical area. (During surgery, sterile technique is performed.)
There are several different types of dressings. Generally speaking, the dressing are categorized as follows: gauze, hydrogel, hydrocolloid, foam, transparent film, calcium alginates, chemical debriding agents, growth factors, compression dressings, and biological dressings.
Support surfaces, such as alternating air mattresses are used to reduce the pressure on an open wound. Per the NPUAP the definition of a support surface is as follows: “A specialized device for pressure redistribution designed for management of tissue loads, micro-climate, and/or other therapeutic functions (i.e. any mattresses, integrated bed system, mattress replacement, overlay, or seat cushion, or seat cushion overlay).” There are several different components of a support surface (such as air, foam, gel, water).
When assessing a patient’s lower extremity, the signs and symptoms of poor circulation include: dry, scaling skin; loss of hair, pale shiny skin, thickened fungal toenails, decreased pedal pulse, rubor dependency. A patient with poor peripheral circulation may complaint of pain at night (with their legs elevated in bed). They may describe having to “hang their leg off the bed, to get relief”. They also might describe getting up at night to walk around (“to get the blood flowing to my legs”.) The physician may order vascular studies to assess the patient’s circulatory status. The test ordered is typically an ABI or ankle/brachial index to assess arteriole status.
Typically, wounds are classified by their etiology: pressure, arterial insufficiency, venous insufficiency, diabetic ulcers, trauma (such as skin tears), surgical, and burns.
Peripheral neuropathy is the term for damage to nerves of the peripheral nervous system, which may be caused either by diseases of the nerve or from the side effects of systemic illness. Peripheral neuropathy often causes weakness, numbness and pain, usually in the hands and feet.
A diabetic ulcer is an open wound secondary to systemic changes due to longstanding effects of diabetes mellitus. These wounds are usually secondary to the effects of repetitive trauma on a nonsensate foot. Typically with longstanding diabetes, the patient will present with structural (both boney and muscular) changes in their feet and diminished sensation in their feet. With these changes, the patient will experience repetitive trauma to their feet (usually the plantar aspect of the forefoot) and not realize it.
Lymphedema is chronic edema (usually in the extremities, but not confined to) caused by damage to the lymphatic system. The lymphatic system is the bodies filtering system that aids in destroying pathogens, filtering wastes, removes excessive fluid, and assists the circulatory system to deliver nutrients, oxygen and hormones.
Physical therapists play an essential role as a member of a wound care team.

Therapists:

  • Have vital knowledge with regards to wound debridement (on a superficial level) and wound dressings
  • Use of modalities to increase circulation, reduce pain, reduce edema, and decrease wound bioburden
  • Positioning in the bed and wheelchair to offload the wound site
  • Add mobility services to improve the patient’s overall functional status
The physical therapist has many modalities to assist with wound healing. Your therapist may use the following:

Electrical stimulation
Traditional ultrasound (high frequency)
Low frequency ultrasound:
1. Contact US (Misonix, Soring, and Arobella)
2. Non-contact US (MIST therapy by Celleration)
3. Pulsed shortwave diathermy
4. Pulsed lavage with suction