Peripheral Arterial Disease

PAD is a common circulation problem in which the arteries that carry blood to the legs or arms become narrowed or clogged. This interferes with the normal flow of blood, sometimes causing pain, but often causing no symptoms at all. The most common cause of PAD is atherosclerosis, often called "hardening of the arteries." Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming a substance called "plaque" that clogs the blood vessels. In some cases, PAD may be caused by blood clots that lodge in the arteries and restrict blood flow. Left untreated, this insufficient blood flow will lead to limb amputation in some patients.

In atherosclerosis, the blood flow channel narrows from the buildup of plaque, preventing blood from passing through as needed, restricting oxygen and other nutrients from getting to normal tissue. The arteries also become rigid and less elastic, and are less able to react to tissue demands for changes in blood flow. Many of the risk factors-high cholesterol, high blood pressure, smoking and diabetes-may also damage the blood vessel wall, making the blood vessel prone to diffuse plaque deposits.

PAD Symptoms

• The most common symptom of PAD is called claudication, which is leg pain that occurs when walking or exercising and disappears when the person stops the activity.
• Other symptoms of PAD include: numbness and tingling in the lower legs and feet, coldness in the lower legs and feet, and ulcers or sores on the legs or feet that don't heal.

Many people simply live with their pain, assuming it is a normal part of aging, rather than reporting it to their doctor.

Prevalence

• PAD is a disease of the arteries that affects 10 million Americans.
• PAD can happen to anyone, regardless of age, but it is most common in men and women over age 50.
• PAD affects 12-20 percent of Americans age 65 and older.

PAD Treatments

Claudication
More information coming soon.

Lifestyle
Often PAD can be treated with lifestyle changes. Smoking cessation and a structured exercise program are often all that is needed to alleviate symptoms and prevent further progression of the disease.

Angioplasty and stenting
Interventional radiologists pioneered angioplasty and stenting, which was first performed to treat peripheral arterial disease. Using imaging for guidance, the interventional radiologist threads a catheter through the femoral artery in the groin to the blocked artery in the legs. Then he or she inflates a balloon to open the blood vessel where it is narrowed or blocked. In some cases this is then held open with a stent, a tiny metal cylinder. This is a minimally invasive treatment that does not require surgery, just a nick in the skin the size of a pencil tip.

Get Tested for PAD If You

• Are over age 50
• Have a family history of vascular disease, such as PAD, aneurysm, heart attack or stroke
• Have high cholesterol and/or high lipid blood test
• Have diabetes
• Have ever smoked or smoke now
• Have an inactive lifestyle
• Have a personal history of high blood pressure, heart disease, or other vascular disease
• Have trouble walking that involves cramping or tiredness in the muscle with walking or exercising, which is relieved by resting
• Have pain in the legs or feet that awaken you at night

Dialysis Access Procedures

Contact us for consult at 630.954.8346 or email.

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Varicose and Spider Vein

Overview
Dr. Louis Domenico and Dr. Richard J Gray will prvide the most effective treatments available, including radiofrequency ablation.  You will received a personalized consultation to help youfind the causes of your vein problems, and to choose the treatment that is best for you – all in a convenient and comfortable office.

Venous Radiofrequency Ablation (FAST)

• Injection and Laser Sclerotherapy of spider and reticular veins
• Sclerotherapy
• Microphlebectomy
• Microphlebectomy:   most people do not interrupt their normal activities  “for more than a few days” sclerotherapy

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Gynecological

Overview

• Uterine Fibroid Embolization
• UFE:    There are no known adverse effects on fertility. In fact, there are numerous reports of successful pregnancy after UFE.”  
  
  

Oncologic & Infectious Disease

• Central Line Placements (Powerports, PICCS, Mediport, Groshongs, dialysis/pheresis catheters)
• Venous Access

Vascular access procedures are performed when patients need:

• intravenous antibiotic treatment.
• chemotherapy, or anti-cancer drugs.
• long-term intravenous (IV) feeding for nutritional support.
• repeated drawing of blood samples.
• hemodialysis, a process used to treat patients whose kidneys are not working properly. It involves a special machine and tubing that removes blood from the body, cleanses it of waste and extra fluid and then returns it back to the body.

Access catheters may also be used for:

• blood transfusions.
• patients who have difficulty receiving a simple IV line.

Ultrasound is used to assess the vein that is being used for catheter placement and to provide guidance during the venous puncture. It is important to use ultrasound guidance during the venous puncture to reduce possible complications such as bleeding.

In contrast to the catheter used in a standard intravenous (IV) line, a vascular access catheter is more durable and does not easily become blocked or infected. These catheters are designed in a way that they extend into the largest central vein near the heart.

A catheter is a long, thin plastic tube, about as thick as a strand of spaghetti.

• Following are the major types of vascular access catheters:
  The peripherally inserted central catheter (PICC) is a long catheter that extends from an arm vein into the largest vein (superior vena cava) near the heart and typically provides central IV access for several weeks, but may remain in place for several months. These catheters are called “midline catheters” when they are placed in a way that the tip of the catheter remains in a relatively large vein, but doesn’t extend into the largest central vein. They may have one or two lumens and some may be able to be used for CT contrast injections (manufactured for forceful contrast injections).
• Non-tunneled central catheters are larger caliber than PICC, and they are designed to be placed via a relatively large, more central vein such as the jugular vein in the neck or the femoral vein in the groin.
• The tunneled catheter has a cuff that stimulates tissue growth that will help hold it in place in the body. Examples of the tunneled catheter include HICKMAN® catheters, BROVIAC® catheters and GROSHONG® catheters. There are several different types of dialysis catheters. The tunneled catheter is the best choice when access to the vein is needed for long period of time. It is secure and easy to access. They are more secure and usually work more efficiently than PICCs because of their design (cuff on the catheter stimulating tissue growth) and larger size.
• The port catheter, or subcutaneous implantable port, is a permanent device that consists of a catheter attached to a small reservoir, both of which are placed under the skin similar to tunnel catheters.
  
  Note: HICKMAN®, BROVIAC® and/or GROSHONG® are registered trademarks of C. R. Bard, Inc. and its related company, BCR, Inc.
• A small, hollow needle and long thin wire, called a guide wire, help the physician position the catheter.
  Other equipment that may be used during the procedure includes an intravenous line (IV) and equipment that monitors your heart beat and blood pressure.
• A midline catheter and some peripherally inserted central catheter (PICC) lines may be inserted without image guidance. These are inserted through a vein near the elbow and threaded through a large vein in the upper arm. You will be positioned on your back.
  
  A nurse or technologist may insert an intravenous (IV) line into a vein in your hand or arm so that sedative medication can be given intravenously. PICC placement usually does not require sedative medications.
• PICC: To place a PICC line, the physician will identify the vein using ultrasound or x-ray guidance and insert a small needle into the arm vein and advance a small guide wire into the large central vein, called the superior vena cava, under x-ray (fluoroscopy). The catheter is then advanced over the guide wire and moved into position. The guide wire is then removed. If this is done without x-ray guidance, a chest x-ray is needed to confirm the catheter position.
• NON-TUNNELED CENTRAL CATHETERS: These catheters are placed via a relatively larger vein such as the jugular vein in the neck or femoral vein in the groin.
• TUNNELED CATHETERS: For a tunneled catheter, the physician will make one small nick in the skin commonly in the lower neck. Using ultrasound guidance, access is gained into the vein, usually the jugular vein at the base of the neck, and a small guide wire is advanced into the large central vein, called the superior vena cava, under x-ray guidance (fluoroscopy). A subcutaneous tunnel is then created. Using x-ray guidance, the catheter is placed through the tunnel into the superior vena cava. The cuff, which is typically made of Dacron®, is located on the tunneled part of the catheter. Finally, the physician will place stitches at end of the tunnel to help keep the catheter firmly in place.
• PORT-CATHETERS: Implanting a subcutaneous port generally requires two incisions (except in the arm where a single incision may suffice). The port reservoir is placed under the skin following a small skin incision and creating a small subcutaneous pocket. The incision for the port is usually about two inches long. The rest of the procedure is similar to the tunneled central catheter placement. A small, elevated area remains on your body at the site of the reservoir. The port, which passes from an access site in a vein of your arm, shoulder or neck, ends in a large central vein in the chest. The reservoir has a silicone covering that can be punctured with a special needle.
  
  Incisions are held together by stitches, surgical glue and/or a special tape.
  
  An x-ray may be performed after the procedure to ensure the catheter is positioned correctly.Your intravenous line will be removed.
  
  The implanted vascular access catheter is then ready for use.

Many angioplasty procedures also include the placement of a stent, a small, flexible tube made of plastic or wire mesh to support the damaged artery walls. Stents can be self-expandable (opens up itself upon deployment) or balloon expandable (balloon needed to open the stent). Balloon expandable stents are typically placed over a balloon-tipped catheter so that when the balloon is expanded, it pushes the stent in place against the artery wall. When the balloon is deflated and removed, the stent remains permanently in place, acting like a scaffold for the artery. Self-expandable stents are easy to deploy, but may require additional angioplasty with balloon to obtain satisfactory dilation (opening) of the diseased vessel. Covered stents or stent-grafts have additional advantages over bare stents and are becoming more commonly used.

Claudication

PVD can cause a variety of problems in the legs ranging from no symptoms at all, to amputation of the leg.  The mildest forms of arterial disease frequently do not produce any symptoms at all.  As the disease becomes worse, it leads to pain in the muscles of the leg on walking (intermittent claudication).  If the disease becomes very severe, more se rious problems can develop. 

The most worrying symptoms are a continuous pain (rest pain) in the foot especially at night, black toes (see right for an example of a gangrenous toe) and ulceration (see below left for an example of ischaemic ulceration).  When these problems develop the patients are sometimes described as having critical limb ischaemia.  This means that the patient has developed problems that are putting the leg at risk of amputation.

Many patients with and without PVD can experience night cramps in the legs.  Although these cramps can be quite severe, they are not caused by hardening of the arteries and are not a risk to the legs.

Pain develops because there is a narrowing or blockage in the main artery taking blood to the leg due to hardening of the arteries (atherosclerosis). Over the years cholesterol and calcium build up inside the arteries. This occurs much earlier in people who smoke and those who have diabetes or high levels of cholesterol in the blood.
The blockage in the arteries means that the blood flow is reduced. At rest there is enough oxygen in the blood reaching the muscles to prevent any symptoms.  When walking the calf muscles need more oxygen, but because the blood flow is restricted the muscles cannot obtain enough oxygen from the blood and cramp occurs. This is made better by resting for a few minutes. If greater demands are made on the muscles, such as walking uphill, the pain comes on more quickly.  Many patients also notice that if they are carrying heavy bags the pain comes on sooner because the leg muscles are having to work harder.

In some patients the blood flow to the legs can be so restricted that there is barely sufficient oxygen reaching the tissues even while resting.  In these patients severe pain can develop particularly at night and it is only eased when the leg is dangled down over the edge of the bed.  When this happens and tests show reduced blood flow, then critical limb ischaemia has developed and the leg is at risk of amputation.

Inferior Vena Cava Filter Placement and Removal

Using image guidance, a catheter is inserted through the skin into a blood vessel in the neck or groin and advanced to the inferior vena cava in the abdomen. The IVC filter is then placed through the catheter and into the vein where it will attach itself to the walls of the blood vessel.

To remove an IVC filter, a special catheter is advanced to the site of the filter in the vena cava. A removable IVC filter has a small hook or knob at one end that enables the catheter to take hold of and withdraw it from the body

Biopsy (thyroid, liver, soft tissue, bone)

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