L. Halbreich, M.D; Harold L. Kulman, M.D F.A.C.S; Steven H. Silverman,
M.D F.A.C.S; Jonathan P. Yunis, M.D F.A.C.S; Douglas A. Dorsay, M.D
F.A.C.S and Ralph T. DeCapua, P.A (Not shown above)
|Carotid Artery Stenosis|
What is carotid artery stenosis or carotid artery disease?
artery stenosis is the narrowing of the carotid arteries. These are the
main arteries in the neck that supply blood to the brain. Carotid
artery stenosis, also called carotid artery disease, is a major risk
factor for ischemic stroke. (This is the most common form of stroke and
is usually caused by a blood clot plugging an artery.)
narrowing is usually caused by plaque in a blood vessel. Plaque forms
when cholesterol, fat and other substances build up in the inner lining
of an artery. This process is called atherosclerosis.
How is carotid artery stenosis diagnosed?
artery stenosis may or may not cause symptoms. A doctor may hear an
abnormal sound called a bruit when listening to the artery with a
stethoscope. The stenosis can be easily detected with an ultrasound
probe placed on the side of the neck near the carotid arteries. This is
called carotid ultrasonography.
How is carotid artery stenosis treated?
on the degree of stenosis and the patient's overall condition, carotid
artery stenosis can usually be treated with surgery. The procedure is
called carotid endarterectomy. It removes the plaque that caused the
carotid artery to narrow. Carotid endarterectomy has proven to benefit
patients with arteries stenosed (narrowed) by 70 percent or more. For
people with arteries narrowed less than 50 percent, anti-clotting
medicine is usually prescribed to reduce the risk of ischemic stroke.
Examples of these drugs are antiplatelet agents and anticoagulants.
Carotid angioplasty may be another treatment option. It uses balloons and/or stents to open a narrowed artery.
|Abdominal Aortic Aneurysm|
What is an aortic aneurysm?
aneurysm is a bulge in a blood vessel, much like a bulge on an
over-inflated inner tube. Aneurysms are dangerous because they may
burst. The aorta, the main artery leading away from the heart, can
sometimes develop an aneurysm. Aortic aneurysms usually occur in the
abdomen below the kidneys (abdominal aneurysm), but may occur in the
chest cavity (This can happen if the wall of the aorta becomes weakened
by build ups of fatty deposits called plaque). This is called
atherosclerosis. Aneurysms may also be due to an inherited disease such
as the Marfan syndrome.
How is an aneurysm detected?
can be detected by X-ray or by imaging techniques such as
echocardiography , an MRI (magnetic resonance imaging) or a computed
tomography (CT) scan. A small aneurysm may not cause symptoms. Then a
patient's doctor will want to check it regularly to see if it's
enlarging. Pain in the area of an aneurysm is a common symptom. The
larger an aneurysm becomes, the more likely it is to burst.
How is an aneurysm treated?
Aneurysms are treated surgically. A patch or artificial piece of blood vessel is sewn where the aneurysm was.
|Peripheral Vascular Disease|
Peripheral Vascular Disease
What is peripheral vascular disease?
refers to diseases of blood vessels outside the heart and brain. It's
often a narrowing of vessels that carry blood to the legs, arms,
stomach or kidneys. There are two types of these circulation disorders:
peripheral vascular diseases don't have an organic cause. They don't
involve defects in blood vessels' structure. They're usually short-term
effects related to "spasm" that may come and go. Raynaud's disease is
an example. It can be triggered by cold temperatures, emotional stress,
working with vibrating machinery or smoking.
peripheral vascular diseases are caused by structural changes in the
blood vessels, such as inflammation and tissue damage. Peripheral
artery disease is an example. It's caused by fatty buildups in arteries
that block normal blood flow.
What is peripheral artery disease?
artery disease (PAD) is a condition similar to coronary artery disease
and carotid artery disease. In PAD, fatty deposits build up in the
inner linings of the artery walls. These blockages restrict blood
circulation, mainly in arteries leading to the kidneys, stomach, arms,
legs and feet. In its early stages a common symptom is cramping or
fatigue in the legs and buttocks during activity. Such cramping
subsides when the person stands still. This is called "intermittent
claudication." People with PAD often have fatty buildup in the arteries
of the heart and brain. Because of this association, most people with
PAD have a higher risk of death from heart attack and stroke.
How is peripheral artery disease diagnosed and treated?
used to diagnose PAD include a medical history, physical exam,
ultrasound, X-ray angiography and magnetic resonance imaging
Most people with PAD can be treated with lifestyle changes, medications or both. Lifestyle changes to lower your risk include:
Stop smoking (smokers have a particularly strong risk of PAD).
Control blood pressure.
Be physically active (including a supervised exercise program).
Eat a low-saturated-fat, low-cholesterol diet.
PAD may require drug treatment, too. Drugs include:
medicines to help improve walking distance (cilostazol and pentoxifylline).
cholesterol-lowering agents (statins)
a minority of patients, lifestyle modifications alone aren't
sufficient. In these cases, angioplasty or surgery may be necessary.
is a non-surgical procedure that can be used to dilate (widen) narrowed
or blocked peripheral arteries. A thin tube called a catheter with a
deflated balloon on its tip is passed into the narrowed artery segment.
Then the balloon is deflated and the catheter is withdrawn.
a stent, a cylindrical, wire mesh tube is placed in the narrowed
artery with a catheter. There the stent expands and locks open. It
stays in that spot, keeping the diseased artery open.
narrowing involves a long portion of an artery, surgery may be
necessary. A vein from another part of the body or a synthetic blood
vessel is used. It's attached above and below the blocked area to
detour blood around the blocked spot.
What Are Hernias?
hernia is an opening or weakness in the wall of a muscle, tissue, or
membrane that normally holds an organ in place. If the opening or
weakness is large enough, a portion of the organ may be able to poke
through the hole. Imagine an inner tube poking through a hole in an old
tire - that's what a hernia is like.
Hernias happen more
frequently in certain parts of the body, like the abdomen, groin and
upper thigh area, and belly button area. They also can happen in any
place where you may have had an incision from surgery.
How Do People Get Hernias?
might take a long time for a hernia to develop or it might develop
suddenly. Hernias are caused by a combination of muscle weakness and
strain, although the cause of the weakness and the type of strain may
vary. Hernias are actually more common in babies and toddlers. And most
teens who are diagnosed with a hernia actually have had a weakness of
the muscles or other abdominal tissues from birth (called a congenital
defect). In these cases, straining your muscles doesn't cause the
hernia; it only makes the hernia more apparent (and painful!).
Here are some types of strain on the body that may induce hernias:
obesity or sudden weight gain
lifting heavy objects
diarrhea or constipation
persistent coughing or sneezing
types of strain on their own probably won't give you a hernia. But when
they team up with a weak muscle, a hernia is more likely to result.
hernias are discovered during routine physical exams. If you're a guy,
you may have had a physical exam where your doctor gave you a
testicular exam and checked your testicles for a hernia. By placing a
finger at the top of your scrotum and asking you to cough, the doctor
can feel if you have a hernia.
It's good for girls to know
about hernias, too, because they can affect you, especially if you've
been pregnant or are obese. A doctor can check for any possible hernias
in girls by gently pressing on the organs or looking for possible signs
during an examination.
Types of Hernias
(pronounced: in-gwuh-nul) hernias are more likely to occur in guys than
girls. More than 70% of all hernias that occur are inguinal hernias,
which means that a part of the intestines protrudes through an opening
in the lower part of the abdomen, near the groin, called the inguinal
canal. In guys, the inguinal canal is a passageway between the abdomen
and the scrotum through which a cord called the spermatic cord passes
(the testicles hang from the spermatic cord). In girls, the inguinal
canal is the passageway for a ligament that holds the uterus in place.
Nearly all cases of inguinal hernias in teens are due to a congenital
defect of the inguinal canal. Instead of closing tightly, the canal
leaves a space for the intestines to slide into.
If you have
an inguinal hernia, you might be able to see a bulge where your thigh
and your groin meet. In guys, the protruding piece of intestine may
enter the scrotum, which can cause swelling and pain. Other symptoms of
an inguinal hernia might include pain when you cough, lift something
heavy, or bend over. These types of hernias require surgery to repair;
in fact, inguinal hernia operations are the most common type of surgery
performed on kids and teens.
hernias are common in newborns and infants younger than 6 months. They
occur when part of the intestines bulge through the abdominal wall next
to the belly button. In babies with umbilical hernias, parents may see
bulging around the belly button area when the baby cries. Unlike other
types of hernias, umbilical hernias may heal on their own, usually by
the time a baby is 1 year old. If not, surgery can repair the hernia.
an epigastric (pronounced: eh-pih-gas-trik) hernia, which is also
called a ventral hernia, part of the intestines protrude through the
abdominal muscles located between the belly button and the chest. It's
mostly guys who have to worry about this type of hernia - about 75% of
epigastric hernias occur in males. People with this type of hernia may
notice a lump. Surgery is a common way to fix this problem.
you've had surgery in your abdominal area, you might experience this
type of hernia. In incisional hernias, part of the intestines bulge
through the abdomen around a surgical incision. In this case, surgery
actually weakened the muscle tissue in the abdomen. This type of hernia
requires another surgery to repair it.
type of hernia occurs at the opening of the diaphragm where the
esophagus (the pipe that food travels down) joins the stomach. If the
muscle around the opening to the diaphragm becomes weak, the uppermost
part of a person's stomach can bulge through the diaphragm. Hiatal
(pronounced: high-a-tul) hernias are common, although small ones don't
usually cause any symptoms. Unlike the other types of hernia, you won't
be able to see a bulge on the outside of your body, but you might feel
heartburn, indigestion, and chest pain. Hiatal hernias can be treated
with medication and diet changes, but they do sometimes require surgery.
What Do Doctors Do?
you notice a bulge or swelling in your groin, abdomen, scrotum, or
thigh, you should talk to your doctor. Sometimes a hernia may also
cause sharp or dull pain and the pain may worsen when you are standing.
most types of hernias, including inguinal, umbilical, epigastric, and
incisional, your doctor will be able to see and feel the bulge and
diagnose you with a hernia.
Except for umbilical hernias in
babies, hernias don't just go away on their own - you must talk to your
doctor and receive treatment. Over time, your hernia may become larger
and more painful, and in some cases of hiatal hernia, a piece of the
intestine could become trapped (this is known as incarceration). In a
true surgical emergency, the blood supply could be cut off to the
incarcerated intestine (this is known as strangulation). This situation
is painful and dangerous because it can cause infection and may cause
the strangulated tissue to die, so it's important to call your doctor.
you've had a hernia operation and you notice redness or discomfort
around your incision (the area where the cut was made to perform the
operation), be sure to let your doctor know. It could be a sign of
infection that will require further treatment.