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Vascular Disease

Vascular issues in the veins and arteries can build up over time — similarly to heart disease. If left untreated, they can result in pain, limited mobility, ulcers, damage to organs, amputation and life-threatening conditions such as infection, gangrene and stroke.


WakeMed Heart & Vascular — Vascular & Peripheral Vascular

WakeMed Heart & Vascular — Vascular & Peripheral Vascular is the perfect place for all of your vascular disease treatments and surgeries. Whether you have varicose veins, carotid disease or an abdominal aneurysm, you’ll find specialized care in a comfortable setting.

The goal of our vascular experts is to alleviate pain, improve quality of life, detect vascular disease and treat it before a serious problem occurs. More often than not, we can successfully treat vascular conditions — often with minimally invasive procedures that make it possible for the patient to go home the same day.

Our physicians offer patients the most advanced tools and technologies — backed by the latest research — to address any conditions affecting their arteries and veins. We work with each patient to develop a course of treatment that allows them to live a more healthy and active lifestyle.


Symptoms of and Risk Factors for Vascular Disease

Symptoms of vascular disease can include:

  • Pain, cramping or fatigue in one or both calves, thighs, hips or ankles, especially during exercise, walking or climbing
  • A dull, heavy ache in the legs
  • Tiredness in the legs, even at rest
  • Changes in the skin color on the legs, often a bluish or dark-red discoloration
  • Ulcers on the legs
  • A feeling of cold in the legs

If you are experiencing any of these symptoms, please schedule an appointment today with a vascular specialist.

Risk factors for vascular disease include:

  • Increasing age (normally occurs after age 60)
  • Diabetes or a family history of diabetes
  • Smoking
  • Overweight
  • Family history of cardiovascular disease, high blood pressure and/or high cholesterol
  • Sedentary lifestyle
  • Personal history of high blood pressure and high cholesterol

Vascular Conditions of the Legs

Vascular conditions that can affect the legs include:

Peripheral artery disease: Peripheral artery disease (PAD) is the narrowing of arteries in the body. Also known as peripheral vascular disease, PAD is most commonly caused by atherosclerosis, the buildup of fat and cholesterol that turns into plaque on the inside of arteries.

Peripheral aneurysm: An aneurysm is a bulging of an artery at a weak spot. A peripheral aneurysm (PA) is one that occurs in an artery other than the aorta. Peripheral aneurysms in the legs are most common in the popliteal artery, which runs down the back of the lower thigh to the knee, but can also occur in the femoral artery, which is in the groin area.

Varicose veins: Varicose veins occur when the valves in the veins of the legs become weak or damaged and do not work properly. As a result, blood pools in the veins, creating lumpy, twisted, swollen veins. Family history, pregnancy, injury and obesity are common causes of varicose veins. Intervention may become necessary if pain, blood clots or skin ulcers are present — although many people choose to have their varicose veins treated simply due to their appearance.

Blood clot (thrombus): Blood clots form in the veins when blood flow is compromised. They usually develop due to factors that include:

  • Prolonged bed rest or lack of movement
  • Injury or infection
  • Damaged valves in veins
  • Pregnancy
  • Surgery
  • Genetic disorders (deficiency of natural anticoagulant proteins)

Both deep vein thrombosis (DVT), a blood clot in a deep leg vein, and pulmonary embolism, a blood clot that breaks free and travels to the lungs, are life-threatening and can cause serious complications.

Carotid artery disease: Carotid artery disease is when one or both of the carotid arteries — the two large blood vessels on either side of the neck — are narrow or obstructed. This serious condition can lead to a blockage of blood flow to the brain and cause a stroke.

Abdominal aortic aneurysm: The aorta is the large blood vessel that supplies blood to the legs and abdomen. An abdominal aortic aneurysm (AAA) is when a bulge develops in a section of the aorta.


Diagnosing Vascular Disease

To diagnose vascular problems, we start with the basics — symptoms, family history, personal health, lifestyle and a physical exam. A cardiologist may perform a simple, painless ankle brachial index (ABI) screening to compare the blood pressure in the arms with the blood pressure in the legs. The blood pressure in the legs is typically higher than the blood pressure in the arms.

Additional non-invasive imaging tests can help the vascular specialist pinpoint the location and severity of a vascular issue — and determine the best way to treat it. Those tests may include:

  • Carotid ultrasound testing, which is a painless test that creates images of the insides of the arteries
  • Carotid duplex exam, which is an ultrasound test that shows how well the blood is flowing through the carotid arteries
  • Ultrasound imaging of the renal artery and/or abdominal aorta
  • ABI screening of the upper and lower extremities with/without exercise
  • Venous ultrasound imaging of the upper and lower extremities
  • Arterial ultrasound imaging of the upper and lower extremities


Determining Whether Vascular Disease Has Affected the Heart

If you suffer from vascular disease, your cardiologist might use cardiac imaging to see if it has affected your heart or coronary arteries. Imaging technologies that may be used include:

  • Echocardiogram ("echo") tests: Echocardiography is a type of cardiac imaging that uses sound waves to create moving pictures of the heart and its blood vessels at rest and during exercise. Echocardiogram images help cardiologists diagnose, evaluate and monitor many heart conditions. Types of echo tests include:

    • Transthoracic 2-D echocardiography (TTE): This common, non-invasive echo study is performed externally, outside of the chest. TTE can be performed using bubbles (to identify problems with cardiac blood flow) or DEFINITY® contrast (to further clarify imaging).
    • Transesophageal echocardiography (TEE): This minimally invasive study can help cardiologists get a closer look at cardiovascular structures if more information is needed after a TTE study.

  • Cardiac CT and MRI: Cardiac computed tomography (CT) and magnetic resonance imaging (MRI) are two advanced, non-invasive ways to look inside the heart and thoroughly assess the cardiovascular structures. These can be performed with or without calcium scoring.


Treating Vascular Disease

The goals of treating vascular disease are to restore quality of life and to prevent complications and related conditions. There are a number of options for treating vascular conditions.

Treatment begins with lifestyle changes, which include keeping blood pressure, cholesterol and diabetes under control; and improving diet, exercising and quitting smoking. Lifestyle changes alone often make a big difference in the fight against vascular disease.

A doctor also may prescribe medications such as blood thinners to help maintain blood flow.


Minimally Invasive and Surgical Treatments

A minimally invasive or surgical procedure can be necessary to treat vascular disease when the arteries become so clogged that blood flow is diminished to the point that oxygen is not reaching the leg muscles, which can cause serious problems such as ulcers, infection and gangrene. These treatments include:

  • Endovascular aneurysm repair (EVAR): Endovascular techniques to treat peripheral dissections (when the inner wall of an artery tears) and bypass techniques to perform arteriovenous graft surgery (connecting an artery to a vein)
  • Catheter-based procedures: Used to open — and keep open — clogged arteries. While the patient is under mild sedation, the physician inserts a thin flexible tube (catheter) into the blood vessel and threads it to the location of the blockage. A tiny camera helps the physician guide a wire past the blockage. The wire supports an uninflated balloon or plaque-removing device while the balloon is inflated to open the artery or the device is activated to remove plaque. The physician will then usually place a stent in the artery to keep it open.
  • Bypass surgery: Physicians make an incision near the affected area and attach a vein from another part of the body above and below the blockage, therefore bypassing the blockage or aneurysm and restoring blood flow.
  • Abdominal aortic aneurysm surgery: Depending on the condition, we can make an open repair or endoluminal repair to fix an aneurysm
  • Treatment for varicose veins: Including laser ablation, sclerotherapy and ambulatory phlebectomy


Make an Appointment

If you or someone you know has the signs or symptoms of vascular disease, please make an appointment today with one of WakeMed’s experienced vascular specialists.