Back in Circulation: Treatments for Artery and Vein Diseases

Just like a plumber clears blockages and maintains the pipes in your house, vascular surgeons manage and repair the complex network of “pipes”—arteries and veins—that make up your circulatory system. These comprehensively trained surgeons specialize in a wide variety of conditions that affect the arteries and veins throughout most of the body.

At Overlake Medical Center, vascular care is part of the David and Shelley Hovind Heart & Vascular Center, where surgeons offer some of the region’s most advanced procedures and expertise. “We have an excellent core team of doctors and therapists that coordinates well with the hospital,” says Kathleen Gibson, MD, vascular surgeon at Lake Washington Vascular.

Vascular surgeons treat all of the body’s blood vessels except those in the heart and brain (because cardiologists, cardiothoracic surgeons, neurosurgeons and neurologists specialize in those organs), but they treat the same diagnosis: atherosclerosis—plaque buildup in the arteries as a result of risk factors such as aging, smoking, diabetes and genetics that lead to heart disease or stroke risk. Namely, they find and clear blood vessels blocked by clots or plaque buildup and repair damaged blood vessels. They also provide valuable emergency support and expertise.

"Our specialty gets involved if a patient suffers a ruptured abdominal aortic aneurysm, traumatic bleeding or if another surgeon encounters bleeding or other vascular problems in the operating room," explains Brian Ferris, MD, vascular surgeon at Lake Washington Vascular.

Vascular disease refers to any disorder that affects the arteries and veins. Methods of treatment include:

• Taking medications like aspirin to reduce clotting.
• Minimally invasive procedures using a catheter equipped with a tiny balloon that is inflated to open the arteries and is then removed. Sometimes small devices called stents are used to hold the artery open.
• Traditional open surgery to remove plaque from a blocked artery (an endarterectomy). Bypass surgery, in which a graft is placed to bypass a blockage, is another procedure vascular surgeons use to repair blocked arteries.

Healthy lifestyle choices directly reduce the impact of vascular disease. To reduce your risk of vascular disease:

• Quit smoking.
• Stay active and exercise daily.
• Eat a balanced diet and maintain a healthy weight.
• Work with your doctors to keep health problems, such as heart disease and diabetes, under control.

Arterial Conditions

The arteries carry oxygen-rich blood to all the tissues in the body, but over time, arteries can get blocked from a combination of cholesterol and calcium. Most people recognize this as coronary artery disease affecting the heart, or carotid artery stenosis affecting the brain. When it happens in other arteries throughout the body, however, it’s called peripheral artery disease (PAD) and can lead to claudication—reduced blood flow that causes pain, weakness and trouble walking—or can cut off circulation entirely, leading to constant pain, tissue loss, gangrene or potentially amputation if not treated properly.

As with heart disease, many people with PAD can be treated with medications and lifestyle changes such as quitting smoking, exercising and having a healthy diet.“We actively participate in clinical trials for new blood thinners to see how they may help with PAD and if they perform better than aspirin [the current, common treatment],” Dr. Ferris says.

There have been recent advancements in surgical treatments for patients who need more than medication to treat their PAD, or for those with aneurysms. Stents, coils and bypass surgery can help restore normal blood flow. "Arterial interventions used to be prolonged open procedures," Dr. Gibson says. "But now we can do minimally invasive procedures to shave plaque out of the arteries, place stents or treat aneurysms, and patients can go home the same or next day."

Atherosclerosis, or hardening of the arteries, occurs when plaque builds up in the arteries and reduces blood flow. The disease can occur practically anywhere in the body, but it most frequently affects the legs, abdomen and carotid arteries.

Common artery problems include:

• Peripheral artery disease (PAD), which restricts blood flow to the legs and feet and can cause chronic pain or discomfort.
• Carotid artery blockage, which reduces blood flow to the brain and can result in a stroke.
• Abdominal aortic aneurysm (AAA), which occurs when the walls in the abdominal aorta weaken, stretch too thin or rupture.

PAD alone affects approximately 8.5 million Americans each year. Some risk factors for vascular disease include smoking, a high-fat diet, stress, obesity and diabetes.

Venous Disorders

While arteries deliver oxygen-rich blood to the body’s tissues, the veins take the deoxygenated blood from the tissues back to the heart and lungs to expel carbon dioxide and load it back up with new oxygen. Just as a clot from an artery can lodge in the brain and cause a stroke, clots can happen in the veins as well and can cause potentially deadly conditions if they reach a vital organ, such as the lungs. A severe form of this is pulmonary embolism (PE), which occurs when a clot from the deep veins in the legs (deep vein thrombosis, or DVT) breaks off and travels to the lungs.

The Centers for Disease Control and Prevention estimates that some 900,000 people are affected by DVT every year, and of those who get PE, one-quarter die instantly, which is why prevention is one of the vascular surgeon’s best tools. Historically, procedures for veins have seen less innovation than their counterparts in the arteries.“Vascular surgeons had to adapt stents made for arteries or for the bronchi in the lungs,” Dr. Gibson says. “However, we’re currently doing active clinical trials on dedicated stents for veins and for deep venous reconstruction.”

Varicose veins are another common concern, and they can be a bigger problem than many people realize. These clusters of twisted veins are often visible at the surface of the skin. “A lot of people think it’s just a cosmetic issue,” Dr. Gibson says. “But in some cases, varicose veins can cause significant pain, as well as ulceration and chronic wounds if they’re not treated.”

Varicose veins occur when the valves in the veins weaken, allowing blood to pool and stretch the vein walls. This usually happens in the legs, where the veins must pump blood upward, against gravity. But they can happen elsewhere, including the pelvis, especially in pregnant women. Fortunately, there are several noninvasive procedures to treat varicose veins. “We have laser treatments, catheters with radiofrequency waves, specialized adhesive to glue them shut and injected medications,” Dr. Gibson says. “They are all simple, in-office procedures.”