I am often asked, "What is a peripheral vascular surgeon?" I am a surgeon who treats blood vessel disease outside of the heart and brain. This includes both artery and veins problems in the arms, legs, neck and abdomen.
Veins are blood vessels which carry blood back to the heart. The commonest vein problem is the development of varicose veins in the legs. Most varicose veins are caused by "leaky valves." Veins are designed to carry blood only in one direction - when valves leak, pressure is transmitted to surface veins, causing them to enlarge. Varicose veins can cause leg pain, leg swelling, bleeding, leg ulcers and even blood clots with inflammation (phlebitis). Having these symptoms is usually an indication to treat varicose veins. Since the leaky valves cannot really be repaired, the treatment of varicose veins is destruction of the varicose veins. Treatment of varicose veins has greatly improved in the past few years, with almost all surgical procedures being done in the office, and associated with a quick recovery.
Although venous disease is more common, the arterial disease treated by a peripheral vascular surgeon can cause more serious health problems. The two most common artery diseases are narrowing from atherosclerosis (hardening of the arteries) and aneurysms (enlargement of the arteries). The major risk factors for development of atherosclerosis include hypertension, high cholesterol, diabetes, smoking and a family history of blood vessel problems. The commonest blood vessels affected by atherosclerosis are the carotid arteries in the neck, which carry blood to the brain, and the arteries of the legs. The commonest blood vessel to develop an aneurysm is within the abdomen (abdominal aortic aneurysms).
Abdominal aortic aneurysms are the 15th leading cause of death in United States. A very large aneurysm (over 5.5 cm) is associated with significant stretching of the blood vessel wall, making it so weak that the chance of rupture becomes significant. Rupture of an abdominal aortic aneurysm causes rapid blood loss, quickly leading to the development of shock. Although surgery can be performed for ruptured aortic aneurysms, this surgery is not always successful. It is far better to repair large abdominal aortic aneurysms before they rupture. An abdominal aortic aneurysm is sometimes discovered by chance when imaging is done of the patient's abdomen for other reasons. An important advancement for discovering abdominal aortic aneurysms is an ultrasound screening of patients at high risk for having an abdominal aortic aneurysm. Repair of abdominal aortic aneurysms has also advanced in recent years, with many aneurysms now being repaired by a stent graft technique rather than requiring major open surgery.
Stroke is the third most common cause of death in the United States, and carotid stenosis is one of the leading causes of stroke. Carotid stenosis is typically caused by atherosclerotic plaque. Plaque has potential to break off and travel to the brain, causing a stroke or a mini stroke. The typical symptoms caused by carotid plaque are having difficulty with speech, weakness or drooping of the face, temporary loss of vision in one eye, or numbness and weakness in one arm or one leg. These are the symptoms of stroke for which patients should seek immediate evaluation. Severe carotid stenosis is usually treated with either surgery (carotid endarterectomy) or stenting. This is another disease for which a vascular screening service has become an important diagnostic modality.
Most artery blockage in the legs is also caused from atherosclerosis. This is one arterial problem which will usually cause symptoms before serious problems develop. The earliest symptoms associated with narrowing of the leg arteries is pain during walking, which is called claudication. When the narrowing in the arteries becomes more severe, ulcers or gangrene can occur, sometimes leading to leg amputation. Fortunately, surgery and stenting can be performed to prevent leg amputation. Detection of arterial disease at an early stage is very important, so that the risk factors leading to the arterial disease can be aggressively treated.
In summary, a vascular surgeon treats blood vessels outside of the heart and brain, with the commonest problems requiring treatment being varicose veins, carotid stenosis, abdominal aortic aneurysms, and lower extremity peripheral arterial disease. Any patient over the age of 60, and especially with a history of the risk factors for atherosclerosis discussed above, should consider being assessed by a vascular surgery screening service, such as that offered by Trinity Health Partners at Trinity Regional Medical Center.
Michael J. Willerth, M.D., is affiliated with Trimark Surgery and Trinity Regional Medical Center.