Additional Available Services:

• Personal Vascular Screening Program  
• FREE Smoking Cessation Program 

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Abdominal Aortic Aneurysm (AAA)

The aorta is the largest artery in the body, and the main blood vessel carrying blood throughout the body. An abdominal aortic aneurysm (AAA) is an area of weakening in the wall of the artery that may begin to bulge of dilate.  This is thought to be caused by an imbalance in the build-up and break-down of the aortic wall. If the aneurysm becomes large enough, it may rupture. 

AAA's occur in about 5% of men over the age of 60 and in women over the age of 70. It is the 10 ^th leading cause of death in men over the age of 55, usually due to the rupture (bursting) of the aneurysm; 80-90% of ruptured aneurysms result in death.  

Risk Factors:

The risk factors for AAA are similar to those of atherosclerosis (build up of fatty substances along the inner walls of the arteries).

• Age (anyone aged 50+)
• Family history of AAA
• Hypertension (high blood pressure)
• Male gender
• Smoking

Symptoms:

Most patients (about 70-75%) with AAA have NO symptoms. If the aneurysm begins to leak or rupture, you may experience:

• Abdominal or back pain
• Flank or groin pain
• Loss of consciousness
• Low blood pressure

Diagnosis:

AAA's are often found incidentally during a routine physical examination by feeling a pulsating mass in the abdomen or on an X-ray exam performed for other reasons.

Imaging modalities used to diagnose and characterize AAA include:

• Angiography: an X-ray dye study often required to plan endovascular stent graft repair.
• CT Scan: a specialized X-ray that shows the size and extent of the aneurysm and is used for planning operative repair.
• Ultrasound: a noninvasive test that can determine the presence and size of an aneurysm.

Treatment:

• Repair is the only treatment for AAA. Small AAA's (< 5cm) should be regularly followed with ultrasound to track changes in the size of the aneurysm.
• Endovascular grafting or open surgery is typically performed when the AAA reaches 5cm or larger in size due to increasing risk of rupture.

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Carotid Artery Disease (CAD)

A build up of plaque within the carotid arteries that reduces blood flow to the brain is a condition called Carotid Artery Disease (CAD). The most common cause of CAD is atherosclerosis, in which fatty deposits along the arteries' interior walls results in restricted blood flow to the brain. This blockage increases risk of stroke 

CAD Commonly occurs in:

• Age 
  • Men under age 75 have a greater risk than women.
  • Women over age 75 are at a greater risk.
• Diabetes
• Family history of Coronary Artery Disease
• Hypertension (high blood pressure)
• Lack of physical exercise
• Obesity
• Smoking

Signs of Carotid Artery Disease:
There are often no symptoms of CAD until an individual has a Transient Ischemic Attack ( TIA) or a stroke. 

Transient Ischemic Attack (TIA)
Symptoms are similar to stroke, but only last for a few minutes or hours and then resolve:

• Slurred or garbled speech or difficulty understanding others
• Sudden weakness, numbness, or paralysis of the face, arm or leg, typically on one side of the body
• Temporary loss of vision or graying out of vision in one eye

Stroke
An individual who has had a stroke may present with:

• Weakness, tingling, numbness in one side of the face, body, arm or leg
• Difficulty speaking
• Sudden lack of coordination, loss of balance, difficulty walking
• Sudden loss of vision (blurred or difficulty seeing in one/both eyes)
• Problems with memory

Diagnosis:
Most patients with carotid disease have no symptoms. Some patients present with signs of TIA or stroke (see above).

On physical examination your doctor may find a "bruit", or a noise heard with a stethoscope over the carotid artery caused by turbulent blood flow.

Diagnostic tests to detect carotid disease include:

• Duplex ultrasound of the carotid arteries
• Computerized Tomography (CT) Angiography
• Magnetic Resonance Angiography (MRA)
• Cerebral Angiography (Carotid Angiogram)

Treatment:
Medical treatment involves lifestyle modifications in the form of:

• tobacco cessation
• exercise
• diet changes
• drug therapy (antiplatelet drugs such as aspirin or Plavix)

Carotid Endartecrectomy: Surgically removes the plaque that has built up within the artery through a neck incision. This usually involves an overnight stay in the hospital.  

Carotid Artery Stenting:Involves opening the artery with a balloon and placing a stent (metal scaffolding) to hold it open. This is done through a small puncture hole in the groin and usually involves an overnight stay as well. Carotid artery stenting is only done in select cases.

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Central Venous Stenosis

Central venous stenosis or occlusion is narrowing or complete blockage of the large veins in the chest which drain blood from the arms and head back to the heart. 

Central venous stenosis may occur in patients who:

• Have had a catheter (tube) inserted into the jugular or subclavian veins (most common in dialysis patients).
• Also occurs in patients with a pacemaker in place, made worse when there is a dialysis access in the arm on the same side.

Signs of central venous stenosis or occlusion:

• In the absence of an arteriovenous fistula or graft for hemodialysis, many cases of central venous stenosis are asymptomatic or minimally symptomatic.
• In the presence of an arteriovenous fistula or graft for hemodialysis, patients may develop swelling of the arm which can interfere with daily tasks or work and may make it difficult to use the dialysis access because of the swelling.  Patients may also develop swelling of the face or neck.

Diagnosis:

• Central venous stenosis is difficult to detect on ultrasound.
• CT scan is better but unreliable.
• An angiogram is the best way to confirm central venous stenosis.

Treatment:

The endovascular department offers minimally invasive diagnostic venography with angioplasty (using a balloon to open the blockage), and stenting (placing a metal scaffold) when necessary.  Totally occluded (blocked) veins can often be opened, rapidly and markedly reducing swelling.  These procedures are performed through small punctures in the fistula and/or groin veins, and are usually done as an outpatient.

Prognosis:

Unfortunately, central venous stenosis or occlusion tends to recur over time and requires close surveillance.  Often, repeat angioplasties or stent placement is necessary to keep the veins open.  With careful follow up, the central veins can often be kept open for years, preserving the use of hamodialysis access fistulas and graft on the same side of the blockage for years.

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Mesenteric Ischemia

Mesenteric ischemia occurs when there is low blood flow to the intestines or bowel caused by a blockage of the arteries that supply the small and large intestine with blood flow.

There are three mesenteric arteries that supply blood flow from the heart to the small and large intestines. Mesenteric artery stenosis (MAS) occurs when there is a narrowing or blockage in one or more of these arteries. It may also be caused by a blood clot that moves through the bloodstream, blocking the mesenteric arteries, this is commonly found in individuals who possess abnormal heart rhythms.

Mesenteric ischemia may occur in patients with:

• A long history of smoking
• Atrial fibrillation (a fast and irregular heart beat)
• Recent heart attack

Other risk factors include:

• High cholesterol
• Hypertension (high blood pressure)
• Lack of physical exercise
• Family history of vascular disease (in particular, peripheral vascular disease or carotid artery disease)

• Abdominal pain after eating
• Fear of eating
• Diarrhea
• Weight loss 

Symptoms of sudden mesentery artery stenosis (due to a traveling blood clot):

• Sudden severe abdominal pain
• Vomiting
• Lack of appetite 

Diagnosis:
Diagnosis is usually based on a patient's history, symptoms, and physical examination. Blood tests that may be helpful include white blood cell ( WBC) count and lactic acid levels.

Imaging tests that may show narrowing or blockage in the mesenteric arteries include:

• Duplex ultrasound 
• CT Scan
• Mesenteric Angiogram

Treatment:
Chronic Mesenteric Ischemia:

• Mesenteric angioplasty and stenting
  • This involves opening the narrowed artery using a balloon and inserting a stent (metal scaffolding) to keep it open. This is done through a small groin puncture and usually involves overnight hospitalization.
• Mesenteric artery bypass
  • This involves a large open surgery using artificial bypass graft material or your own vein to carry blood around the blocked areas in the arteries. This may involve a hospital stay of several days.

Acute Mesenteric Ischemia:

• This is a surgical emergency -- if not promptly treated, it may result in death.
  • Treatments include:
    • Open surgery thrombectomy (removing the clot through an open operation)
    • Thrombolysis (performing an angiogram and using clot busting drugs to break up the clot).
      • This is seldom done in patients.

 **There is no medical treatment, per se, for mesenteric ischemia. However, tobacco cessation, healthy dietary habits, exercise, and drug therapy (antiplatelet drugs such as aspirin and cholesterol lowering agents) can help to slow the progression of disease and reduce the risk of recurrence.

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Peripheral Vascular Disease (PVD)

Affecting approximately 1.5-2 million people in the United States, peripheral vascular disease ( PVD) is a circulatory disorder characterized by narrowing of the blood vessels, usually in the legs.  Twenty percent of adults over 70 have PVD

This condition is typically caused by arteriosclerosis, a buildup of plaque (fatty substances along the inner wall of the arteries), the same process that causes blockages in the arteries of the heart.  Peripheral arterial disease is associated with an increased risk of heart attack. 

Risk factors for PVD include:

• Smoking - smokers have a 3-fold increased risk for PVD
• High cholesterol
• Diabetes
• High blood pressure
• Age (usually 50 and older)
• Those with a history of heart, carotid disease, or stroke
• A sedentary lifestyle (physical activity)

Symptoms of PVD vary, depending on the affected area, but may include:

• Claudication - cramping or fatigue in the legs while walking, which disappears after a few minutes of rest.
• Pain in the feet while in bed
• Slow healing or non-healing sores on the feet or legs
• Numbness, tingling, or coldness in the lower legs or feet

Diagnosis:

The first step in diagnosing PVD is thorough history and physical examination by your physician, including an examination of pulses and any sores on the legs or feet.

Non-Invasive Testing at Anaheim Regional includes:

• Ankle brachial index:    
  • Uses blood pressure cuffs and a handheld doppler device to determine the blood pressure at the ankle and in the arms.  If the blood pressure in the lower part of your leg is lower than the pressure in your arm, you may have PVD 

•  Arterial Duplex
  • A noninvasive ultrasound test to look for areas of narrowing or blockage in the arteries of the legs and pelvis

• CT angiography
  • A state of the art CT scanner is used to determine if there are areas of narrowing or blockage in the arteries.  This test involves x-rays and the injection of dye into the veins, which is used to visualize the arteries.  Arteries throughout the body can be examined using this test.

• Digital subtraction angiography (DSA)
  • DSA is the "gold standard" to diagnose, and often to treat vascular disease.  It involves getting detailed x-ray images of the arteries while injecting dye directly into the arteries.  For patients with poor kidney function, a non-toxic gas carbon dioxide can be used in place of IV dye.  Blockages can often be opened minimally invasively during an angiogram.

Treatment

• Medical:  Most people who have cramping or pain with walking can be treated medically to relieve symptoms and reduce the risk of heart attack by measures such as smoking cessation, exercise, and drug therapy

• Interventional:  People who have cramping or pain that significantly affects their daily life, or those with non-healing sores or gangrene may require intervention.  The goal of intervention is to relieve symptoms, allow for healing, and reduce the risk of amputation by improving blood flow.  The Advanced Endovascular Institute seeks to achieve optimal outcomes using minimally invasive techniques involving lower risks, minimal discomfort, and shorter hospitalizations than traditional open surgical approaches.
  •    Minimally invasive angioplasty and stenting can usually be done as an outpatient or with a short hospitalization.  It is less invasive and less painful than open surgery.  However, it may also be less durable than open surgery 

 




The specialists of the Endovascular Institute are trained in both angioplasty techniques as well as open surgery, and customize treatment to each patient.

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Reno Artery Stenosis (RAS)

Narrowing of one or both arteries of the kidney is a condition called renal artery stenosis (RAS). The most common cause of RAS is atherosclerosis, in which fatty materials are deposited along the arteries' interior walls, restricting blood blow to the kidney. Lacking sufficient blood supply triggers the kidney to "think" that the body's blood pressure is too low, and it secretes a hormone called Renin, which causes the body to retain salt and water, resulting in hypertension (high blood pressure). Approximately 5% of people with high blood pressure can attribute their condition to RAS. RAS can also cause progressive kidney failure and pulmonary edema (fluid in the lungs).

Signs of Renal Artery Stenosis: 

• Deterioration of kidney function
• Elevated blood pressure unresolved with oral medications
• Sudden worsening of hypertension previously well-controlled

The diagnosis of renal artery stenosis can be made using a combination of:

• Catheter Angiography
• Computed Tomographic  (CT) Angiography
• Duplex ultrasound imaging
• Magnetic Resonance Angiography (MRA)
• Radionuclide renal scanning 

Treatment:

• Many lesions can be fixed using minimally invasive angioplasty and stent placement.
• Other narrowings require more invasive surgical reconstruction for optimal results.
• Restoring normal blood flow to the kidneys may lower the blood pressure, preserve renal function and decrease the risk of pulmonary edema. 

Outcomes:

• Following stenting, 30-60% of patients experience improved blood pressure control, often requiring fewer medications. Renal function is improved in a smaller percentage of patients.

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Personal Vascular Screening Program

Anaheim Regional Medical Center offers a screening program for patients with risk factors for and possible indicators of vascular disease. 

Physician referral is not required. For more information, please call: (714) 774-1450.

Menu of Vascular Screenings: 

• Leg Pain Assessment with Medical History - Free
• Vascular Assessment and Akle Brachial Index (ABI) - $25
• Carotid Ultrasound - $80
• Abdominal Ultrasound - $80
• Vascular Assessment, ABI, and Carotid Ultrasound - $100 
• Vascular Assessment, ABI, Carotid Ultrasound, and Abdominal Ultrasound - $125

Vascular Assessment Includes: 

• Blood pressure
• Body temperature
• Family medical history review
• Heart rate
• Medical history review
• Medications review
• Neurological assessment
• Pulse oximetry
• Pulses
• Respiratory rate
• Risk assessment
• Symptom review

Results will be sent to you and your physician.  Our vascular nurse coordinator will also follow up with you to make sure you are receiving the highest quality of care

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FREE Tobacco Cessation Program

We can help you quit smoking for free! 

Anaheim Regional Medical Center offers a free tobacco cessation program to help you become tobacco free. All services address issues such as identifying triggers, developing coping skills, making lifestyle changes, creating a support system, preventing a relapse, and more.   

Our Free Tobacco Cessation Program Provides:

• A Five-week cessation class series
• Single meeting educational seminar
• Individual counseling sessions
• Telephone hot-line
• Support group

If you are interested in the Tobacco Cessation Program, click here to see future program dates.  If you have any questions about the program or would like more information, please call: (714) 999-3991.    

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For information about the Endovascular Department, or if you have questions please call: 

Anaheim Regional Medical Center

(714) 774-1450

1211 W. La Palma Ave.

Anaheim, CA 92801
 

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