Vascular disease refers to conditions that affect the blood vessels (arteries and veins) that pump blood throughout the body. Arteries carry oxygen-rich blood from the heart to every part of the body, including the brain, kidneys, intestines, arms, legs and the heart itself. Veins return blood back to the heart. Like the coronary arteries in the heart, blood vessels in other parts of the body can become clogged and hardened from atherosclerosis, the build-up of fatty deposits (plaque) in the arteries. Sometimes, they can weaken and even burst.
At MMC, we treat the full range of vascular disease:
- Abdominal aortic aneurysm (AAA)
- Aortic dissection
- Buerger’s disease
- Carotid artery disease
- Critical limb ischemia (CLI)
- Chronic venous insufficiency (CVI)
- Congenital vascular malformation (CVM)
- Deep vein thrombosis (DVT)
- Fibromuscular dysplasia
- Mesenteric artery disease
- Peripheral artery disease (PAD) also called peripheral vascular disease (PVD)
- Pulmonary embolism
- Portal hypertension
- Post-thrombotic syndrome (PTS)
- Raynaud’s disease
- Renovascular hypertension (RAS)
- Thoracic aortic aneurysm (TAA)
- Varicose veins
Treating Vascular Disease
At the MMC Cardiovascular Institute, we offer the state’s most comprehensive resources for diagnosing and treating vascular disease. Through our Vascular Center, a highly skilled team of cardiologists, vascular surgeons, interventional radiologists and diagnostic radiologists works together to evaluate and tailor care to each patient. Patients also benefit from our state-of-the-art facilities, including a cutting-edge hybrid operating suite, access to today’s most advanced treatments, and opportunities to participate in clinical trials of new medications, devices and surgical techniques.
The Most Advanced Treatment Resources At MMC, our expert team works together to provide the best possible treatment for patients with vascular disease. These treatments can include lifestyle changes and medication to control risk factors, minimally invasive endovascular therapy and surgery. The treatment approach depends on how severe your symptoms are, how much narrowing or blockage there is in your blood vessels, and your overall health. The treatment options available at MMC include:
- Lifestyle changes – Smoking, high cholesterol, high blood pressure, an inactive lifestyle and having diabetes all increase the risk of vascular disease getting worse and the possibility of a heart attack or stroke. MMC provides extensive resources for quitting smoking, dietary/nutrition counseling, managing cholesterol levels, medically supervised exercise and guidance for achieving glucose (blood sugar) control for people with diabetes.
- Medications – People with vascular disease often benefit from medications that help reduce the risk of heart attack and stroke. These medications include drugs to help prevent blood clots, cholesterol-lowering medications, drugs to help control blood pressure, and certain vitamins and dietary supplements. At MMC’s Vascular Center, a medical treatment plan is tailored to the individual needs and risk factors of each patient, and carefully monitored over time.
- Thrombolytic therapy – When a blood clot forms, thrombolytic (clot-busting) drugs may be administered to try and dissolve it without surgery.
- Endovascular therapy – Endovascular refers to treating a problem from inside the blood vessel, using minimally invasive, catheter-based techniques.
- Angioplasty is a minimally invasive, non-surgical procedure that can be used to dilate (widen) narrowed or blocked arteries. A thin tube called a catheter with a deflated balloon on its tip is passed into the narrowed artery from an incision near the groin. The balloon is then inflated, compressing the plaque and dilating (widening) the narrowed artery so blood can flow more easily. A stent — a tiny wire mesh tube — often is placed in the narrowed artery via the catheter. The stent expands and locks open, keeping the artery open.
- Endovascular abdominal aortic aneurysm (AAA) repair – This technique enables a team made up of a vascular surgeon and interventional radiologist to repair the aortic aneurysm through two small incisions in the groin area. Using a catheter, a piece of synthetic material called a graft is threaded through blood vessels to the aorta. The graft is held in place by stents similar to those used to open blockages in blood vessels. The graft prevents blood from leaking into the aneurysm and enlarging it. The advantage of endovascular AAA repair is that a large abdominal incision is avoided and recovery is much faster.
- Carotid stenting – Carotid stenting is a procedure in which a tiny, slender metal-mesh tube (a stent) is fitted inside a carotid artery to increase the flow of blood blocked by plaque (a build-up of fatty material on the inside of the artery). The stent is inserted following angioplasty, and it acts as scaffolding to prevent the artery from collapsing or being closed by plaque after the procedure is completed.
- Vena cava filter placement – A vena cava filter is inserted into the vena cava, the large vein that returns blood to the heart from the abdomen and legs, to help prevent blood clots from traveling to the lungs (pulmonary embolism). This device is usually only used if a person is at high risk for pulmonary embolism and is not able to take blood thinners. It may also be used in cases of recurrent deep vein thrombosis (DVT, or blood clots in the legs) or if a patient has a pulmonary embolism while taking blood thinners.
- Surgery – A full range of surgical options is available at MMC:
- Endarterectomy – This is the surgical removal of fatty deposits (plaque) from the walls of the arteries. Endarterectomy is an open surgical procedure in which a vascular surgeon makes an incision to access the obstructed artery. The blood that normally flows through the artery is first rerouted through a tube connecting the blood vessels above and below the surgical site. The surgeon then cuts the blocked artery lengthwise and cleans away the accumulated plaque. The artery is then sutured (sewn) closed or patched with a piece of a vein, usually from the patient's leg, to enlarge the repaired artery and prevent future narrowing from post-operative scarring.
- Carotid endarterectomy is the most common non-cardiac vascular procedure performed nationwide. This operation is performed to help prevent a stroke and transient ischemic attacks (TIAs) by restoring blood flow to the brain.
- Peripheral endarterectomy is performed to restore blood flow to the lower extremities (legs and feet).
- Lower extremity grafting or bypass – If the narrowing involves a long portion of an artery in the abdomen, groin or lower extremities (legs and feet), bypass surgery may be necessary. A vein from another part of the body or a synthetic blood vessel is used to reroute the blood around the blockage. It is attached (grafted) above and below the blocked area to detour blood around the blocked area. There are three major types of bypass procedures to treat PVD:
- Aortobifemoral bypass surgery is used to bypass diseased large blood vessels in the abdomen and groin.
- Femoral-tibial bypass surgery (also known as infra-popliteal reconstruction) is used to bypass diseased blood vessels in the lower leg or foot.
- Femoropopliteal (fem-pop) bypass surgery is used to bypass diseased blood vessels above or below the knee.
- Open aortic aneurysm repair – If there is bleeding inside the body from an abdominal aortic aneurysm, open surgery is performed. Surgery also is usually recommended for patients who have aneurysms larger than 2 inches and those that are growing quickly, with the goal of performing surgery before complications or symptoms develop. In the open procedure, a large incision is made in the abdomen and the abnormal vessel is replaced with a graft made of man-made material such as Dacron.
- Lower extremity amputation – When advanced peripheral vascular disease (PVD) leads to leg ulcers that will not heal and gangrene occurs, amputation – surgical removal of a lower limb – becomes necessary. MMC not only provides expert surgical services but also careful planning for rehabilitation and a return to independence.
- Varicose vein treatment – Varicose veins are twisted, enlarged veins near the surface of the skin, and are most common in the legs and ankles. While varicose veins usually aren't a sign of a serious problem, in some cases they can indicate a blockage in the deeper veins, a condition called deep vein thrombosis (DVT), which often requires treatment. Several treatment options for varicose veins are available at MMC including:
- Sclerotherapy to close off the vein (a chemical is injected into the vein)
- Laser treatment to destroy the vein
- Radiofrequency treatment to close off the vein
- Surgery to tie off or remove the vein
- Wound care – With peripheral vascular disease (PVD), poor circulation caused by atherosclerosis (the build-up of fatty deposits in the arteries) can lead to leg ulcers, wounds or open sores that will not heal or keep returning. At MMC, we have specialists in wound care who can provide treatment to protect the skin’s surface, prevent new ulcers, and monitor the signs and symptoms of infection that may involve soft tissue or bone. Treatments include antibiotics (if infection is present), topical therapies/dressings, compression garments, and prosthetics or orthotics to restore or enhance normal functioning.
- Clinical trial access – MMC participates in a variety of clinical trials to study new and improved medications, devices and surgical techniques, giving patients with vascular disease access to innovative treatment options that are not available anyplace else in Maine.
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