Vascular Medicine

Atherosclerosis is a disease of the peripheral blood vessels that is causes narrowing and hardening of the arteries that supply blood flow to the legs and feet. This narrowing is due to a buildup of plaque on the artery walls, causing a decrease in blood flow. The inner lining of the arteries can be damaged from smoking, high cholesterol, high blood pressure and high amounts of sugar in the blood due to diabetes. If you have a family history of this condition, you may be at higher risk of developing hardening of the arteries. Lack of physical activity increases your risk for a range of vascular conditions, including atherosclerosis.

Most of the time, there are no symptoms of this condition until a rupture occurs, or the blood flow is very restricted. In those cases, you may experience muscle cramps triggered by exercise in the thighs, calves, or feet and leg or foot pain, numbness, and cold legs or feet.

Treatment for atherosclerosis starts with heart-healthy lifestyle changes like aiming for a healthy weight, managing stress, increasing physical activity, stopping smoking and eating balanced diet. Medications are introduced when these changes alone aren’t enough to control cholesterol and blood pressure levels, reducing your risk of stroke or heart attack. For people with severe atherosclerosis, your doctor may recommend a procedure to open a blocked or narrowed artery or perform a bypass to go around it. 

The carotid arteries are responsible for providing the main blood supply to your brain. They’re located on each side of your neck, and you can feel their pulse under your jawline. Carotid artery disease occurs when the carotid arteries become narrowed or blocked due to a waxy substance called plaque that builds up inside the artery walls. Blockages in these arteries increases your risk of stroke, a medical emergency that deprives your brain of oxygen.

This condition develops slowly, and in early stages, you may not have any symptoms. As the plaque builds up, the sign of carotid artery disease may be a stroke or a transient ischemic attach (TIA), which is a small stroke that doesn’t cause lasting damage. 

Symptoms of a stroke or TIA included blurred vision, confusion, loss of sensation, loss of memory, problems with speech and language, vision loss, weakness in one part of the body and problems with memory, thinking or reasoning. If you or a loved one experience any of these symptoms, go to the emergency room or call 911 immediately. The sooner you receive treatment, the better chance for recovery.

Like other conditions that cause hardening and narrowing of the arteries, treatment options for carotid artery stenosis include blood thinning medications, medicine and diet changes to lower your cholesterol and blood pressure and checking your carotid artery every year. In some situations, a surgery to remove plaque buildup in the carotid artery or a procedure to open a blocked artery and stent placement may be necessary. 

Peripheral Artery Disease (PAD), is a circulation condition where narrowed blood vessels reduce blood flow to the limbs, kidneys and other vital organs. Approximately 20 million Americans have PAD and live with this often-silent condition. Those at highest risk are people who smoke, or have diabetes, high cholesterol, high blood pressure or are elderly.

The first sign of PAD is pain or weakness in the foot or legs when walking or standing. When patients are identified and screened from head to toe for vascular issues, they can be put on the proper medical and walking exercise regimen to reduce the risk of heart attack and stroke – the leading cause of death for those with PAD.

People with advanced PAD have limited blood flow to their feet, causing a range of issues including severe pain in their legs at night, the loss of hair on their lower legs, developing shallow ulcers or sores that don’t heal, and the increased risk of gangrene. If left untreated, people can and do lose their legs. The southeastern United States has the highest amputation rates in the country, having much to do the prevalence of smoking, diabetes, and kidney disease and the hardening of arteries that occurs as you age.

People referred for a PAD screening receive an ultrasound to look for potential blockages. In many cases, PAD can be treated medically, or with several different endovascular methods including angioplasty, atherectomy, stenting or a combination of approaches that are tailored to each individual’s specific needs. In people with severely compromised blood flow, critical limb ischemia, early identification and rapid treatment is often the only way to save someone’s leg.

People who have diabetes and high blood pressure are at increased risk for PAD as well as heart attack and stroke. If you notice any symptoms of PAD listed above, talk to your doctor immediately and request an evaluation.  

Deep vein thrombosis, commonly called DVT, occurs when a blood clot forms in vein deep within your body, typically your legs. It can cause serious health problems like a pulmonary embolism, a blood clot that dislodges and moves into your lung. Not only are they dangerous, blood clots in the legs can also cause pain or swelling in your calf. DVT mainly affects the large veins in the lower leg and thigh, most often on one side of the body. They can block blood flow and cause changes in skin color (redness), leg pain, swelling, and skin that feels warm to the touch.

Vascular surgeons at CHI Memorial diagnose and treat a wide range of vascular conditions, and your doctor will work with you to find the right treatment for you.

Treatment options for DVT include:

Anticoagulants or blood thinners are medications used to keep your blood from clotting. Although it won’t break up previously formed clots, it will prevent new clots from forming and keep existing clots from growing.

Compression stockings help prevent blood in your veins from pooling causing clots while also easing the swelling associated with DVT.

Thrombolytics are type of medication used to break up blood clots. Because they can cause other side effects including bleeding, they are only given in an emergency. These medications are administered through an IV or directly at the site of the clot. 

Filters inserted into the vena cava, a large vein in your abdomen, are used for people who are unable to take certain medications that prevent or slow the progression of blood clots. A vena cava filter catches blood clots that become loose and prevent them from traveling to your lungs.

The aorta is the largest artery of the body that supplies oxygen-rich blood to the circulatory system. An aneurysm is a bulging or abnormal widening of the aorta wall. Most commonly, aortic aneurysms occur in the portion of the vessel below the beginning of the renal artery. The aneurysm may extend into the vessels supplying the hips and pelvis. It’s most often seen in males over 60 or who have one or more risk factors including smoking, high blood pressure and other genetic factors.

Aneurysms typically develop slowly over time, often with no symptoms. When an aneurysm expands rapidly, tears open or leaks blood, symptoms of a rupture include:

• Pain in the back or abdomen, that may be severe, sudden, persistent or constant. It could also spread to the groin, buttocks or legs.
•  Passing out
• Clammy skin
• Dizziness
• Rapid heart rate
• Nausea and vomiting

Although the majority of aneurysms never rupture, those that do are surgical emergencies requiring immediate repair. An estimated four to five percent of sudden deaths are attributed to a ruptured AAA. If you have internal bleeding from an aortic aneurysm, you will need surgery right away. Well over 90 percent of people get an aortic aneurysm repair do so with a minimally invasive endovascular procedure. Two small incisions are made in the groin, and stents are delivered through the femoral arteries to the aorta. Most people spend one night in the hospital. This improved technology has led to a drastically quicker recovery from traditional, open surgery.

Having an endovascular surgery team that knows how to anticipate needs and quickly respond when there’s a rupture is critical. That’s the one of the reasons CHI Memorial was recognized as high performing in AAA surgery by U.S. News Reports. Because we work well together and know what the other person is going to do, there’s a seamless transition from pre-op evaluations to anesthesia and surgery to recovery. The combination of our high volume and the highly experienced team leads to excellent results.

Diabetes affects more than 30 million Americans and 1.5 million more are diagnosed every year. This condition results from too much sugar in the blood and is usually related to being overweight. The most common form of diabetes is type 2, which causes your body to not use insulin properly. This is called insulin resistance. Your pancreas makes extra insulin, but eventually it isn’t able to make enough to keep your blood sugar at normal levels. But there are things you can do to decrease your risk, including following a healthful diet and getting the American Diabetes Association’s recommended 30 minutes of moderate-to-vigorous exercise at least five days a week or a total of 150 minutes.

One of the most difficult aspects of diabetes control tends to be compliance with medications and a general misunderstanding of how diet choices are leading to uncontrolled diabetes. This can result in unpleasant symptoms and severe complications for your heart and blood vessels, kidneys, nerves, GI tract, and your eyes.

Could you have diabetes and not know it?

The initial symptoms of diabetes or pre-diabetes can be subtle – so subtle that you might not even notice them. If you’re experiencing one or more of these symptoms, talk to you doctor.

• Excessive thirst
• Using the bathroom more frequently, especially at night
• Increased irritability
• Blurry vision
• Feeling exhausted, even after sleeping all night
• Slow or non-healing wounds
• Recurring yeast infections

Support when you need it

Diabetes is a serious, chronic condition that affects nearly every part of the body. If you have diabetes or want to make preventive lifestyle changes, CHI Memorial can help. Learning to control your blood sugar through exercise and a balanced diet is key in preventing complications like blindness, heart disease, stroke, kidney failure or nerve damage.

Support when you need it

Diabetes is a serious, chronic condition that affects nearly every part of the body. If you have diabetes or want to make preventive lifestyle changes, CHI Memorial can help. Learning to control your blood sugar through exercise and a balanced diet is key in preventing complications like blindness, heart disease, stroke, kidney failure or nerve damage.

CHI Memorial Endocrinology Associates offers self-management classes and nutrition counseling to help you take control of your health, including: 

• Glucose monitoring
• Using insulin and insulin pumps
• Integrating exercise into your daily routine
• Choosing wholesome foods and creating a realistic meal plan

For more information, call (423) 206-9025.

An aneurysm is a weakening of the artery wall that results in a ballooning or bulging artery and often has no symptoms until it ruptures. In AAA surgery, surgeons make an incision in the abdomen to uncover the aorta. Once inside, they use a graft to strengthen the artery wall and repair the aneurysm. Although the majority of aneurysms never rupture, those that do are surgical emergencies requiring immediate repair.

CHI Memorial is proud to be the first hospital in the Chattanooga region to offer endovascular abdominal aortic aneurysm (AAA) repairs using a new, minimally invasive technique. This new technique uses a fenestrated endograft and is the first graft in the world that incorporates customized openings that are made specifically to match a person’s unique anatomy.

The graft is inserted through two small incisions in the groin, positioned through image-guided technology that helps ensure proper placement. Once the graft is inserted, stents are placed in the fenestrated openings to secure it, ensuring blood flow to the correct arteries. This elective, minimally invasive option is indicated for people with compromised heart, lung and kidney health and who have an increased risk of death with an open surgery. 

This procedure is used to treat carotid artery disease, a condition that occurs in the arteries on either side of your neck that bring blood flow to your brain and face. Carotid artery surgery and stenting restores proper blood flow to the brain by removing plaque from the inside of the artery walls and keeping the artery open with carefully placed stents.

In this procedure, the surgeon makes an incision in the front of the neck to open the carotid artery and remove the plaque that is hindering proper blood flow. The artery is stitched back together, and a graft is sometimes used to strengthen the artery wall. 

The femoral artery is a large blood vessel located in the groin area on both sides of your body. Its job is to supply blood to your legs. A femoral endarterectomy is a procedure used to remove plaque that is blocking or hindering proper blood flow. In this procedure, the surgeon makes an incision in the groin to open the femoral artery. Once the plaque is removed, the artery is stitched together or secured with an artificial material called a graft. 

A fistulogram is an X-ray procedure used to diagnose and assess the shape and size of a fistula, a surgically made passage or connection between organs or vessels that don’t typically connect.

People who require dialysis for kidney disease need hemodialysis access to receive their treatment. Vascular surgeons place the three types of access for hemodialysis: a fistula, a graft or a catheter, which allow blood to be removed from the body, cleaned by a dialysis machine, and then returned to the body.

Percutaneous revascularization is a non-surgical method used to open narrowed or blocked arteries. This intervention is performed with a catheter that’s inserted through the skin in the groin or arm and into an artery. Several devices like a balloon or stent may be used to go directly to the area of narrowing and restore proper blood flow.

A peripheral arteriogram is a test that uses X-rays and dye to capture pictures of the arteries that supply blood flow to the body. It’s used to look for and evaluate blockages in the blood vessels.

Transcarotid artery revascularization is a minimally invasive procedure to treat carotid artery disease and is an option for patients who are considered high risk for traditional carotid endarterectomy. During the procedure, a special transcarotid neuro-protection system is used to reduce a patient’s risk of stroke by allowing the surgeon to access the carotid artery and temporarily reverse blood flow to protect the brain while implanting the stent. 

Thoracic endovascular aortic repair (TEVAR) is a procedure to treat aneurysms located in the upper part of the aorta, the largest artery that carries blood from your heart to the rest of the body. This minimally invasive procedure is performed with a small incision where a device called a stent graft is placed to reinforce the aneurysm and provide a clear route for the blood to flow.

A venogram is a test that allows the doctor to examine your veins on an X-ray to determine how healthy they are. This non-invasive test helps your surgeon more effectively diagnose and treat vascular conditions.