Vascular Arterial Disease Archives - Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA

Vascular Malformations

Codeholic Admin — Mon, 13 Mar 2017 16:48:10 +0000

Vascular Malformations

Arteriovenous Malformation (AVM)

Normally, blood flows from the heart to the arteries of the body. The arteries branch and get smaller until they become a capillary, which is just a single cell thick. In this way blood pressure drops to very low levels that the thinner walled veins can cope with. In an AVM, usually early in life, arteries connect directly to veins. This is a high-pressure shunt or fistula. Veins are not able to handle the pressure of the blood coming directly from the arteries. The veins stretch and enlarge and create what we call a ‘nidus’. Usually, there are multiple feeding vessels in an AVM and many draining veins.

How can an AVM be treated?

Endovascular techniques are now the main route of treatment for AVMs. This involves treating the AVM through the blood vessel system.

Through a pinhole incision, a catheter is placed into an artery in the groin area and passed to the AVM using x-ray guidance. Once in the correct vessel, an embolic material such as a coil or glue is placed into the abnormal communication cutting off the blood supply, in turn shrinking and shutting down the AVM. This procedure requires no stitches, downtown or major incision and can be done under moderate IV sedation.

Venous Malformation

A venous malformation is a congenital defect of the veins. The veins are different than normal veins and contain, for example, less muscle cells. Feeding them less blood, which is actually their duty. That is why they sometimes look varicose. A venous malformation can be anywhere in the skin or in the body. Usually it is a venous malformation blue. A venous malformation feels soft and sometimes it can be empty. It is unclear why a venous malformation occurs exactly. Usually this gives cosmetic problems, sometimes pain. However, there may also be functional problems, as with a large deviation on the lip.

Important is the difference with the infantile hemangioma. Venous malformations are defects of the veins and exist from birth. Venous malformations grow along with the child and do not go away by themself (hemangiomas occur almost always after birth, then grow very fast; they can be quite large and then will go away).

Usually, the diagnosis may be made on the based on the history and look at the area. If the doctor is not sure he can order an ultrasound or a CT scan.

If treatment is required, it is typically treated with sclerotherapy. It is something sprayed in the blood vessels by an Interventional Radiologist that provides a chemical reaction which makes the walls of the blood vessels there decrease. This makes the place invisible. Correction is also possible with surgery or laser treatment. A deviation that is in the legs can also be treated with support stockings.

What is a lymphatic malformation?

A lymphatic malformation is an abnormality of the lymphatic system. The lymphatic system forms part of the immune system that identifies and fights off invaders, such as bacteria and viruses consisting of a network of vessels within the body through which lymph circulates, and many lymph nodes which filter the lymph fluid and help the body fight infection. The specific symptoms and severity of lymphatic malformations varies based upon the size and specific location of the malformation. Some lymphatic malformations can be massive. Lymphatic malformations regardless of size can potentially cause functional impairment of nearby structures or organs and disfigurement of affected areas.

How can lymphatic malformations be treated?

There are two main options for treatment: sclerotherapy and surgical removal.

Sclerotherapy

This is a procedure carried out by an interventional radiologist, who shrinks the lymphatic vessels by injecting a special substance through the skin under general anaesthetic. It may require several sclerotherapy sessions and even then, it might grow again.

Surgical removal

Sometimes, lymphatic malformations can be removed safely. Detailed scans will be needed to plan the operation. There will be a certain amount of scarring after the operation, as with all surgery.

The above information is not all inclusive of the risks, alternatives and benefits. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion. There are complications possible with any medical procedure. Overall, minimally invasive procedures have a lower complication rate than open surgeries.

The post Vascular Malformations appeared first on Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA.

Visceral Aneurysms

Codeholic Admin — Mon, 13 Mar 2017 16:47:34 +0000

Visceral Aneurysm

Visceral aneurysms

A visceral artery aneurysm is ballooning of a section of an arterial vessel, which becomes a risk for rupture and bleeding that can be fatal. These abnormally dilated vessels occur within abdominal cavity arteries, including the celiac artery, the superior mesenteric artery, the inferior mesenteric artery, the hepatic artery, the splenic artery and the renal arteries.

Causes of Visceral Aneurysms

Visceral aneurysms may be caused by:

Atherosclerosis
Degeneration of the artery wall
Fibromuscular dysplasia
Disease in connective tissues
Trauma

Treatment of Visceral Aneurysms

Catheter-based embolization or stent-graft placement are two major treatment options. Embolization is a non-surgical, minimally invasive procedure where blood flow is cut off to the area and rerouted around the aneurysm.

Surgery may be necessary if the aneurysm is in a location which prevents adequate or safe repair by embolization or stent-graft placement. Generally, visceral aneurysms don’t need repair unless they are larger than 2 cm.

The post Visceral Aneurysms appeared first on Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA.

Mesenteric Ischemia

Codeholic Admin — Mon, 13 Mar 2017 16:47:00 +0000

Mesenteric Ischemia – Abdominal Pain

Mesenteric Ischemia

Mesenteric ischemia occurs when one or more of your mesenteric arteries become obstructed. As a result of the obstruction, your intestines do not receive an adequate amount of oxygen, and therefore cannot function properly. Over time, tissue in your intestines can die due to inadequate blood flow. Mesenteric ischemia usually affects your small intestine, but can also impact other organs such as your stomach, colon or liver.

It can come on suddenly, known as acute mesenteric ischemia, or gradually, known as chronic mesenteric ischemia. Acute disease often presents with sudden severe pain. Symptoms may come on more slowly in those with acute on chronic disease. Signs and symptoms of chronic disease include abdominal pain after eating, unintentional weight loss, vomiting, and being afraid of eating.

Risk factors

Atrial fibrillation, heart failure, chronic renal failure, being prone to forming blood clots, and previous myocardial infarction.

Mechanism

Acute mesenteric ischemia often occurs when a blood clot (embolus), which usually forms in the heart, travels into one of the mesenteric arteries and blocks the blood flow. People with an irregular heartbeat are at a higher risk for acute mesenteric ischemia.

Chronic mesenteric ischemia is commonly caused by atherosclerosis (hardening of the arteries). This occurs when a sticky substance, called plaque, builds up in your arteries and causes them to narrow and stiffen.

There are four mechanisms by which poor blood flow occurs: a blood clot from elsewhere getting lodged in an artery, a new blood clot forming in an artery, a blood clot forming in the mesenteric vein, and insufficient blood flow due to low blood pressure or spasms of arteries. Chronic disease is a risk factor for acute disease. The best method of diagnosis is angiography, with computer tomography (CT) being used when that is not available.

Treatment

Treatment of acute ischemia may include stenting or medications to break down the clot provided at the site of obstruction by interventional radiology. Open surgery may also be used to remove or bypass the obstruction and may be required to remove any intestines that may have died. If not rapidly treated outcomes are often poor. Among those affected even with treatment the risk of death is 70% to 90%. In those with chronic disease bypass surgery is the treatment of choice. Those who have thrombosis of the vein may be treated with anticoagulation such as heparin and warfarin, with surgery used if they do not improve.

The post Mesenteric Ischemia appeared first on Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA.

Hypertension/Renal Artery Stenosis

Codeholic Admin — Mon, 13 Mar 2017 16:46:43 +0000

Hypertension / Renal Artery Stenosis

Renal artery stenosis

Renal artery stenosis is a narrowing of arteries that carry blood to one or both of the kidneys. Most often seen in older people with atherosclerosis (hardening of the arteries), renal artery stenosis can worsen over time and often leads to hypertension (high blood pressure) and kidney damage. The body senses less blood reaching the kidneys and misinterprets that as the body having low blood pressure. This signals the release of hormones from the kidney that lead to an increase in blood pressure. Over time, renal artery stenosis can lead to kidney failure.

Causes of Renal Artery Stenosis

More than 90% of the time, renal artery stenosis is caused by atherosclerosis, a process in which plaque made up of fats, cholesterol, and other materials builds up on the walls of the blood vessels, including those leading to the kidneys.

More rarely, renal artery stenosis can be caused by a condition called fibromuscular dyplasia, in which the cells in the walls of the arteries undergo abnormal growth. More commonly seen in women and younger people, fibromuscular dyplasia is potentially curable.

Risk Factors for Renal Artery Stenosis

Renal artery stenosis is often found by accident in patients who are undergoing tests for another reason. Risk factors include:

Older age
Being female
Having hypertension
Having other vascular disease (such as coronary artery disease and peripheral artery disease)
Having chronic kidney disease
Having diabetes
Using tobacco
Having an abnormal cholesterol level

Symptoms of Renal Artery Stenosis

Renal artery stenosis usually does not cause any specific symptoms. Sometimes, the first sign of renal artery stenosis is high blood pressure that is extremely hard to control, along with worsening of previously well-controlled high blood pressure, or elevated blood pressure that affects other organs in the body.

Diagnosis of Renal Artery Stenosis

If your doctor suspects that you have renal artery stenosis, he or she may order tests to either confirm suspicions or rule it out. These include:

Blood tests and urine tests to evaluate kidney function
Kidney ultrasound, which uses sound waves to show the size and structure of the kidney
Doppler ultrasound, which measures blood-flow speed in arteries to the kidney.

Treatments for Renal Artery Stenosis

Initial treatment for renal artery stenosis is often medication. The condition may require three or more different drugs to control high blood pressure. Patients may also be asked to take other medications, such as cholesterol-lowering drugs and aspirin.

In some cases, an intervention such as angioplasty, often with stenting or surgery, may be recommended. With angioplasty, a catheter is inserted into the body through a blood vessel and guided to the narrowed or blocked renal artery. A balloon on the catheter is then inflated to open up the inside of the artery. A stent can then be placed to keep the area open.

Surgery to bypass the narrowed or blocked portion of the artery and/or remove a non-functioning kidney may be needed for some patients.

If you’re diagnosed with renal artery stenosis, it’s important to discuss the risks of the different treatments with your doctor. The side effects of blood pressure medications may include dizziness, sexual problems, headache, and cough. Complications of angioplasty include bruising, bleeding, additional kidney damage, and the possibility that the arteries can close again.

The post Hypertension/Renal Artery Stenosis appeared first on Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA.

Claudication

Codeholic Admin — Mon, 13 Mar 2017 16:46:20 +0000

Claudication

Claudication is the cramp like pain that develops in the muscles of the leg when walking. The pain is the result of narrowing or blockages of the arteries in the legs. The damage to the arteries is called peripheral arterial disease (‘PAD’).

Why does it occur?

Peripheral arterial disease occurs due to damage of the arteries usually as a result of smoking, high cholesterol, diabetes or high blood pressure. The arteries narrow or block or months and years to reduce the blood supply to the legs. The cramping symptoms are worse on exercising because the narrowed arteries cannot meet the muscles demand for oxygen. When exercise stops the pain usually improves within 5 minutes.

What problems can it cause?

Most people who develop claudication will have symptoms that remain the same for many years. A few patients will improve and some will get worsening of their symptoms (especially if they continue to smoke).

Treatment Options?

Walking and living a healthy lifestyle (exercising, not smoking etc) will help reduce the risk of intermittent claudication.

All patients with claudication should have their cholesterol and blood pressure measured and should be encouraged to stop smoking. It is recommended that all people with claudication should have a variety of medications to protect their arteries form further damage.

Some people will benefit from structured exercise classes to improve how far they can walk. Others may be recommended to have endovascular treatments to improve the circulation:

Balloon Angioplasty

To open a narrowed artery, a catheter with a very small balloon on its tip is placed in the artery and is advanced to reach the narrowed or blocked artery. The doctor then inflates the balloon, pushing aside the plaque that has built up against the vessel walls. The doctor then inflates and deflates the balloon several times to open the vessel.

Atherectomy

Atherectomy is a minimally-invasive method of removing plaque to re-open arteries. Unlike angioplasty and stenting which are designed to squish plaque to the side, atherectomy involves cutting and removing the plaque from the artery, restoring normal blood flow.

Stenting

A stent is a small, metal scaffold that is placed inside an artery. Similar to balloon angioplasty, stents restore blood flow by pushing the plaque to the side but remain inside the artery forever. Stenting often follows balloon angioplasty as an additional treatment to help the vessel remain open.

Bypass

Surgical bypass treats narrowed arteries by directly creating a detour, or bypass, around a section of the artery that is blocked. During a bypass procedure, a physician creates a new pathway for blood flow using a graft. A graft can be a portion of a vein or a synthetic tube that connects above and below a blockage to allow blood to flow around it.

The post Claudication appeared first on Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA.

Non-Healing Wound/ Ischemia

Codeholic Admin — Mon, 13 Mar 2017 16:46:03 +0000

Non-Healing Wound/Ischemia

Critical Leg Ischemia

Critical leg ischemia is a lack of blood flow that endangers all or part of the leg and is usually defined as experiencing persistent and recurring pain while at rest, for more than two weeks, or ulceration or gangrene of the foot.

The pain of severe limb ischemia is felt in the toes and forefoot and is typically worse at night when cardiac output drops. Patients wake up in the early hours with severe pain, relieved by hanging the leg out of the bed allowing blood to flow down to the foot. Some patients take to sleeping in a chair. Many patients get up and walk around in the night that stimulates flow and reduces pain. During the day the patient may suffer short distance intermittent claudication. This pattern of symptoms: calf claudication by day and rest pain in the toes at night is strongly suggestive of critical limb ischemia.

Without treatment, critical limb ischemia will progress, causing worsening pain and debility. Ulcers develop on the lower leg and foot, and ultimately gangrene sets in. If the problem is left too late it can become impossible to salvage the leg and amputation may become the only way to save the patient’s life.

Duplex scanning is the first method used to assess the affected limb and establish where the main blockages are that are limiting the blood flow.

Treatment Options?

Some people will benefit from structured exercise classes to improve how far they can walk. Others may be recommended to have endovascular treatments to improve the circulation:

Balloon Angioplasty

Atherectomy

Stenting

Bypass

The post Non-Healing Wound/ Ischemia appeared first on Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA.

Peripheral Arterial Disease

Codeholic Admin — Mon, 13 Mar 2017 16:45:41 +0000

Peripheral Arterial Disease

Peripheral Arterial Disease (PAD)

PAD refers to plaque formation in the arteries of the arms and legs. It usually happens because your arteries harden and narrow. (That’s called atherosclerosis). Smoking, high blood pressure, high cholesterol, and not being active are the main causes.

If you have diabetes, you’re more likely to get a worse case of peripheral artery disease that improves less with treatment.

Symptoms

When atherosclerosis narrows the long arteries of the legs, your leg muscles don’t get enough blood flow. As a result, you may feel muscle pain. It usually comes on with exercise and stops when you rest.

It can affect different muscle groups, including:

Calf (most common)
Buttock and hip
Thigh
Foot (less common)
Some people feel burning or numbness. Others have severe blockages with no pain at all, usually because the body grows blood vessels that go around the blockages.

Other signs and symptoms of peripheral artery disease include:

Wounds that heal poorly
Legs are cooler than the arms
Shiny skin over the legs
Loss of hair on the legs
Fainter pulse in the feet

Diagnosis

The tests you’ll take to see if you have peripheral artery disease are simple and painless.

Doctors usually start by checking your “ankle-brachial index,” which compares your blood pressure at your ankle and upper arm. Those measurements should be about the same. If your blood pressure in your ankle is a lot lower, you may have peripheral artery disease.

If your case is severe, you may take a type of X-ray called an angiogram to see exactly where the blockage is. Your doctor will inject a dye into a blood vessel to help show what’s going on.

Treatment

You can do a lot to stop peripheral artery disease in its tracks, such as:

Exercising
Controlling your cholesterol and blood pressure
Not smoking
Eating a healthy diet
The drug cilostazol eases symptoms in many people. Pentoxifylline is another that can improve symptoms in people with poor circulation. Doctors may also prescribe aspirin or other anticlotting drugs.

For severe peripheral artery disease, your doctor may recommend surgery or less invasive procedures to bypass a blocked artery and restore blood flow. See treatment options here.

The post Peripheral Arterial Disease appeared first on Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA.