• Print Print
  • Share
  • Text Size: A | A | A

Answers from a Vascular Expert

Get answers to some of the most frequently asked vascular questions:

Aortic Aneurysm

My aneuryism is 5.3 and is the length of my aorta is of 2 weeks ago. My feet and ankles have been swelling for over a week and water pills, changed once, do not help. Could this mean my body is just breaking down?
Could an aortic aneurysm cause swelling and headaches?
What sort of delay is acceptable from diagnosis to treatment of an aortic aneurysm?
Do AAA stents last as long as a full, open repair?
How do the legs get any circulation during an open repair of an AAA, while the aorta is clamped?
How urgent is the repair of an abnormal aortic stent that has bent 180 degrees?
How are abnormal aortic aneurysms treated?

What is....?

What is an enlarged vascular artery and how is it treated?
What is peripheral artery disease?
What is an aortic aneurysm?
What is right sided subclavion artery stenosis? What are the symptoms?
What is thoracic outlet syndrome?
What is vascular calcification in the pelvis?
What is vascular flutter ?
What is reflux in my femoral vein?

ABI Test

What does "ABI's mitigating against the presence of significant vascular disease" mean?
How accurate is an ABI test?
Why do an ABI before a vascular ultrasound?

Calcification

Is there a relationship between lower limb calcification (ABI) and diabetes peripheral neuropathy?
What does "significant vascular calcification" noted on a CT scan of the brain indicate?
Can atherosclerotic calcification in the abdominal area be reversed?
Should I have further evaluation of my legs and feet since recent X-rays showed calcifications?
What is vascular calcification without aneurysm?
What is aortic calcification and what causes it?
Can calcification in the entire vascular system be reversed?
Could a pain in my right side be caused by vascular calcification?
My CT scan says I have atherosclerosis but my angiogram is clear. What does that mean?

Carotid Artery

What could be the cause of elevated pressure in the left carotid artery if narrowing / plaque have been ruled out and artery takes normal path / course?
Why does my carotid artery hurt?
What causes an intermittent fluttering feeling near the carotid artery?
Should I have surgery for carotid artery blockage?

Veins

If a vein doctor says I have significant venous insufficiency what does that mean? Is it chronic?
Can atherocalcific changes involving the abdominal aorta and iliac vessels cause swelling in the feet and legs?
Can you permanently get rid of varicose veins through treatment?
How do leaky veins affect you later in life?
When the veins in the arms and legs are not viable, can cadaver or synthetic veins be used? If so, what is the success rate?
My doctor is planning to put a stent in to open up my iliac vein. Will this help with the swelling in my leg even if the valves are damaged? The iliac vein is completely blocked.
Does endovascular laser ablation surgery for chronic venous insufficiency result in significant decrease in lower leg/ankle swelling or does it only help with the appearance of spider and varicose veins?
What is the prognosis for leaking valves if you deside not to have the laser surgery?
I had blockage in both legs and had stents put in about six months ago. I had to get it done again this week. Why did the blockage return so soon?
How long does a leg vein last in the heart? Is a second replacement needed?
Which test is more accurate for testing leg circulation?
How does your blood get from your big toe back to your heart when there is very little pressure in the venous circulation?
What causes leaky veins in the legs?
How do you treat "leaky veins"?
How could damage to heart valves lead to a backup of blood in my venous circulation?
I have a large dark area on the side of my leg and was told my veins are breaking down. Can anything be done about this?
What method of treatment is best for spider veins?
Who would be the better choice to treat venous stasis ulcers on the lower extremity?
I have had 14 surgeries, they cleared my ulcers and made my legs feel better. Now, I have painful ulcers below my ankles. The Vein Center told me they do not treat perforating veins below the ankle because it could cause problems later on. Is this true?

Deep Vein Thrombosis (DVT)

I had DVT 10 years ago. Can I have varicose veins removed?
What procedures can be done to damaged veins caused by DVT?
I can't wear regular socks after DVT. Is this normal?

Miscellaneous

What does "the right and left iliac and saphenous are incompetent" mean?
What is a benign vascular?
What can be done if your aneuryx stent leaks?
How long should your chest hurt or be sensitive to clothes touching it after triple-bypass heart surgery?
After heart surgery, why does the heart delay a beat for a minute and then start again?
I had a scan without contrast. One doctor says he saw degeneration of my lower spine, another said I had calcification of my aorta and iliac arteries. How do you tell the difference between the two in a scan?
After having double bypass surgery two years ago, my dad's red blood count has been low. What causes this and why?
Is groin pain related to a blocked artery?
Can a syndrome such as Wegener's granulomatosis cause acute onset of blood clots, center and periphery?
Will I be able to tell if my pig valve is wearing out?
What is the treatment if you have high pressure in the right thigh, pulse volumes decreased bilaterally and an abnormal stress exam on the right side?
Why would my toes turn purple without an injury?
Why would my patient have a lot of plaque in his lower extremity veins but normal velocity and waveforms?
What can be done to increase blood flow if you have small leg arteries?
Can a hemosiderin deposit on my leg be removed somehow?
Why is the blood in an artery brighter red than the blood in a vein?
Why do arteries lack valves yet they are present in veins?
Is there any treatment for pain in the toes and feet from compromised circulation?
How much should patients walk if they have a blood clot in the leg?

Question: My aneuryism is 5.3 and is the length of my aorta is of 2 weeks ago. My feet and ankles have been swelling for over a week and water pills, changed once, do not help. Could this mean my body is just breaking down?

Answer: The aneurysm is not likely to be having any effect on the swelling of your feet. Rarely aneurysms can compress or even rupture into the vena cava leading to swelling, but this is unlikely and would be demonstrated on your imaging study. At that size, the risk of aneurysm rupture is starting to increase and I would recommend evaluation by a vascular surgeon for treatment. The surgeon can speak to you about your leg swelling as well.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: What is a benign vascular?

Answer: "Benign vascular" is usually followed by an object such as a lesion or calcification. In general terms, it usually refers to calcium lining the wall of a vein or artery as happens with plaque build-up. It is termed benign if the calcium is not limiting blood flow in that vessel.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: Can you please interpret this for me: "There is normal augumentation on both sides. The right and left iliac and saphenous are incompetent. The right popliteal is incompetent. The patient is very sensitive in the groin area." Does incompetent mean too small and maybe blocked?

Answer: "Incompetent" refers to the valves in the veins that were examined. It means that the valves are not working and blood is allowed to travel backwards. Clinically this shows as swelling and varicose veins. It does not mean that the veins are blocked or small, rather they often are enlarged. Sensitivity in the groin region is probably not related to the veins unless there are obvious varicose veins in that area.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: Can atherocalcific changes involving the abdominal aorta and iliac vessels cause swelling in the feet and legs?

Answer: Atherosclerotic changes in the aorta and iliac arteries would limit the blood flow into the legs. It should not cause swelling in the legs. That is more likely related to the veins which carry the blood out of the legs or your heart which may not be pumping blood effectively.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: If a vein doctor says I have significant venous insufficiency what does that mean? Is it chronic?

Answer: Venous insufficiency means that the veins in your legs are not working well. Veins rely on a system of valves which close when you stand. This is important as otherwise the blood would rush down to your feet. These valves can be damaged by clot, trauma or other factors and can lead to chronic leg swelling. There is also a superficial system of veins that rely on valves including the saphenous vein. The valves in these veins more commonly fail particularly if you have a family history of varicose veins, with pregnancy or with prolonged standing. When these fail, varicose veins and swelling occur. The superficial veins can be treated with minimally invasive surgery to remove them and relieve symptoms. The deep veins can only be treated with compression. Chronic venous insufficiency indicates that the veins have not been working for a long time and usually refers to deep vein problems. But without looking at your ultrasound, I cannot tell for sure.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: What does "significant vascular calcification" noted on a CT scan of the brain indicate?

Answer: Vascular calcification in the brain means that there has been plaque deposited in the walls of the arteries in the brain. This is due to risk factors of smoking, diabetes, elevated cholesterol and high blood pressure. The plaque can be a source of stroke if it occludes the artery. It is also important to realize that if there is plaque in the arteries in the brain then there is likely plaque elsewhere including the heart. It is important to lower your cholesterol, stop smoking and control your diabetes and high blood pressure.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: Is there a relationship between lower limb calcification (ABI) and diabetes peripheral neuropathy?

Answer: Diabetic neuropathy and arterial insufficiency are separate disease processes but may often occur together and can be difficult to diagnose. Diabetic neuropathy is microvascular disease casued by diabetes that affects the peripheral nerves, particularly on the foot. This results in decreased sensation in the foot as well as hypersensitivity and a burning sensation in the foot. Arterial insufficiency is the result of plaque buildup in the larger arteries of the leg. Diabetes (as well as elevated cholesterol and smoking) can lead to plaque deposition in the arteries of the leg resulting in "calcified" arteries of the leg. When the plaque becomes significant enough, the blood flow to the leg is limited causing a decrease in the ankle-brachial index (ABI) which is a ratio between the blood pressure in the arm and in the leg. Symptoms in this case are cramping when walking, and if severe, pain in the toes particularly at night. Diabetics often present with complaints of pain in the feet and it can be difficult to diagnose which (if not both) disease processes are responsible.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: Can atherosclerotic calcification in the abdominal area be reversed?

Answer: I'm presuming the calcification refers to the blood vessels in the abdomen. This means that calcium has been deposited in the wall of the aorta and iliac arteries which provide blood to your intestines, kidneys and legs. This is the bodies response to cholesterol buildup and damage to the artery walls. It is a marker for elevated cholesterol and is exacerbated by smoking. This calcification is otherwise known as plaque. The plaque may build up enough to limit the blood flow to your legs, causing pain when you exercise. If there is calcification of the aorta, then there is also plaque building in arteries in the heart and in the arteries going to the brain which means that you should make every effort to lower your cholesterol and stop smoking, if you do.

If the blood flow is limited to the kidneys, this may result in some kidney dysfunction and high blood pressure. If there is plaque limiting blood flow to the intestines, you would have symptoms of pain after eating and weight loss. This would need to be evaluated immediately.

If the plaque is limiting blood flow to the legs then you may have cramping when walking, pain in your feet at night or non-healing sores on your legs.

If there are no symptoms like these then changing your lifestyle and lowering your cholesterol is the main treatment. You should be evaluated by a vascular surgeon to discuss your options.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: X-rays of my feet showed calcifications. I am now having lower leg cramps at night, when my feet are cold or after exercising. I'm on a heart-healthy diet and exercise plan. Should I have further evaluation of my legs and feet?

Answer: You likely have plaque built up in your arteries and this shows up as calcium on X-rays. The plaque can build up in your legs to the extent that it limits blood flow, but this usually manifests itself as cramping when you walk (claudication) as the muscles are not getting enough exercise. Cramping at night or at rest is not usually due to a lack of arterial blood flow. You are doing the right thing with your diet and medications. I would see a vascular surgeon if you begin to have pain with exercise.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: What can be done if your aneuryx stent leaks?

Answer: Aneuryx stent grafts are used to repair an abdominal aortic aneurysm. They rely on a fixation points above as well as below the aneurysm. If there is evidence of leakage into the aneurysm sac, it means that the seal is not complete or a blood vessel is feed blood directly into the sac. This needs to be addressed and I would recommend you see your vascular surgeon right away. Possible solutions include and additional stent or an angiogram to help seal the leak.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: I fell and injured my leg. I now have a bump inside my leg and it is numb. An ultrasound revealed that I have leaky veins. How will this affect me later in life and what do I need to be concerned about?

Answer: You may have suffered some damage to the valves in your veins. If the superficial veins are involved (such as the saphenous vein), this can be treated through an ablation procedure that gets rid of the vein and thus the leakage. If the valves of the deep veins are involved, there is very little that can be done to repair them. The treatment is generally compression stockings to help keep the swelling down. There is a risk in the future of chronic leg swelling, skin discoloration, varicose veins and, rarely, ulcers on your leg. I would recommend an evaluation by a vascular surgeon to discuss your options.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: After having double bypass surgery two years ago, my dad's red blood count has been low. What causes this and why?

Answer: Anemia can have many causes, and in this case, not related to the acute blood loss associated with his heart surgery two years ago. I would encourage him to speak to his primary care physician about this issue.

Dr. Pat Ryan, Cardiovascular Surgeon, Providence Physician Group


Question: My doctor is planning to put a stent in to open up my iliac vein. Will this help with the swelling in my leg even if the valves are damaged? The iliac vein is completely blocked.

Answer: If you iliac vein is occluded, opening the vein and placing a stent will improve the blood flow out of the leg and reduce the swelling. The swelling may not resolve entirely depending on how badly the valves in the rest of your leg are damaged but it should help.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: I had a scan without contrast. One doctor says he saw degeneration of my lower spine, another said I had calcification of my aorta and iliac arteries. How do you tell the difference between the two in a scan?

Answer: It should be very easy to tell the difference in the two on the scan as they are in different areas. It sounds like they are reporting two different findings and that you probably have both. If the scan was for pain then likely the spine is the culprit. Calcification or plaque in the arteries does not usually cause pain but would lead to limitation of blood flow to the legs affecting your ability to walk.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: After heart surgery, why does the heart delay a beat for a minute and then start again?

Answer: Minor cardiac arrhythmias are common following cardiac surgery. The best thing to do is notify your cardiologist. They can evaluate the cardiac rhythm and make recommendations regarding cause and possible medication changes.

Dr. Pat Ryan, Cardiovascular Surgeon, Providence Physician Group


Question: When the veins in the arms and legs are not viable, can cadaver or synthetic veins be used? If so, what is the success rate?

Answer: Cadaver and synthetic veins have an extremely low success rate and are rarely used.

Dr. Pat Ryan, Cardiovascular Surgeon, Providence Physician Group


Question: How long should your chest hurt or be sensitive to clothes touching it after triple-bypass heart surgery?

Answer: It varies somewhat, but usually about 2-3 months.

Dr. Pat Ryan, Cardiovascular Surgeon, Providence Physician Group


Question: Does endovascular laser ablation surgery for chronic venous insufficiency result in a significant decrease in lower leg/ankle swelling or does it only help with the appearance of spider and varicose veins?

Answer: Laser ablation of the saphenous vein can help with swelling in the lower leg if the vein is signicantly incompetent, meaning the valves do not work. Leg swelling can be due to several sources including the heart and kidneys. Additionally, if there is a problem with the deeper veins, ablation of the saphenous vein may not change leg swelling at all.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: I had Deep Vein Thrombosis (DVT) ten years ago in my left leg that damaged valves. I've been wearing compression stockings since then but my left leg is now showing signs of varicosities. What are the chances of having varicose veins removed in this context?

Answer: It would be reasonable to look at the varicose veins in your legs. You well could have valve damage in some of the superficial veins as well as the deep veins. Treating the superficial veins will not make the deep veins worse and may help with leg swelling.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: A year ago, I had a lot of nausea and intense abdominal pain. I had an ultrasound that found a 3 cm aortic aneurysm. Now my abdomen is swelled again and this time my blood pressure is high and I have headaches. Could the aortic aneurysm cause this?

Answer: An aneurysm of 3 cm in the aorta is quite small and is almost always without symptoms. The normal aorta is 2 to 2.5 cm, so your aneurysm is not very large. We would generally follow this with another ultrasound in 1 to 2 years. Aneurysm symptoms usually include abdominal and back pain but not swelling and not headaches.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: What is the prognosis for leaking valves if you decide not to have the laser surgery?

Answer: Laser treatment of the saphenous vein is intended to seal the vein off. This stops blood from flowing in the vein and thus the leaking valves are not a factor any longer. Untreated, the leaking valves can cause swelling, pain, varicose veins, discoloration of the leg and occasionally ulceration of the skin as the pooled blood prevents oxygen from reaching the skin.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: What is vascular calcification without aneurysm?

Answer: Vascular calcification refers to the build-up of plaque in a blood vessel. This is visualized on an X-ray or CT scan. It generally results in narrowing of a blood vessel. Aneurysms are enlarged arteries due to weakening of the artery wall. As the vessel gets bigger the wall becomes thinner and can rupture. There is often plaque associated with an aneurysm as well but it shows up as lining the wall and is not obstructing the artery.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: I had blockage in both legs and had stents put in about six months ago. I had to get it done again this week. Why did the blockage return so soon?

Answer: Stents in the legs are not perfect and recurrence is pretty common, usually within three years. They have a lower patency rate than a bypass which often lasts five years or more. There are many reasons, but essentially the body reacts to a stent and causes scar tissue to build up inside of it. Also, with a stent, the plaque is not removed, just pushed out and there can be a reaction to that resulting in more plaque being deposited.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: How long does a leg vein last in the heart? Is a second replacement needed?

Answer: About 60 percent of vein bypass grafts will wear out by 10 years; some last much longer.

Dr. Pat Ryan, Cardiovascular Surgeon
Everett Cardiovascular & Thoracic Surgical Associates


Question: I have been told I have a blocked artery in my left leg and I have really bad pain on my upper leg near my groin area. I had asked my doctor whether this pain is connected to the blocked artery and he said no, but I think it is and wanted your advice about where arteries start in the leg and where to they finish. Everytime I sit down I get a tingly feeling.

Answer: Usually we think of blocked arteries affecting muscles during exercise. At rest, your muscles don't need much oxygen. With walking, your muscles are doing more work and require more blood flow. If there is a blockage in one of the arteries, then there is not enough oxygen delivered and you experience cramping. Additionally, a blocked artery in the thigh usually results in pain in the calf. So I would tend to agree that the groin pain while sitting is likely not related to the blocked artery.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: I received the following when I had my Ankle Brachial Test: "ABI's mitigating against the presence of significant vascular disease." Could you please explain what this means?

Answer: I think that means that your test was normal. In a normal test, the blood pressure in the arm is equal to the blood pressure in the leg, indicating that there is no blockage in the arteries in your leg.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: Can a syndrome such as Wegener's granulomatosis cause acute onset of blood clots, center and periphery?

Answer: Wegner’s granulomatosis affects the blood vessels in the lungs, kidneys and upper respiratory tract. It is an autoimmune disease causing a vasculitis and occlusion of the blood vessels in these organs. It is not thought to cause large vessel blood clotting or peripheral clotting.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: Which test is more accurate for testing leg circulation?

Answer: The most helpful test to evaluate leg circulation depends on the clinical scenario. For someone with claudication (pain in the leg with walking) or suspected arterial disease, an exercise test with ABI (ankle-brachial index) is most diagnostic. In this case, the arm and ankle blood pressures are compared. At rest, these should be equal. If the blood pressure at the ankle is lower than the arm, there is likely arterial disease. Sometimes, however, the blood pressure at the ankle is normal, but decreases with exercise (such as toe lifts or on a treadmill). This indicates that there is an arterial blockage limiting the flow into the leg.

In someone else with a wound on the foot that won't heal, a TBI (toe-brachial index) is the most helpful because it indicates how much perfusion is getting to the foot and estimates the ability to heal.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: What is the treatment if your ABI study results show that you have high pressure in the right thigh, pulse volumes decreased bilaterally and an abnormal stress exam on the right side?

Answer: This is difficult to answer without looking at the study. The decision to treat arterial disease in the lower extremity is based on symptoms. Absolute indications for treatment are non-healing ulcers and pain in the foot at rest. Pain with walking (claudication) is an indication for intervention only if it is severely lifestyle limiting and all conservative treatments have been exhausted (exercise program, smoking cessation) as well as the level of blockage. All interventions have a limited duration of patency as well as risks; these need to be carefully weighed against the benefits. In summary, an abnormal stress exam in one leg may indicate arterial blockage, but treatment really depends on the severity of symptoms.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: Will I be able to tell if my pig valve is wearing out? Will I be able to tell in any way?

Answer: The most common symptoms are fatigue, shortness of breath and possibly chest pain.

Dr. Pat Ryan, Cardiovascular Surgeon
Everett Cardiovascular & Thoracic Surgical Associates


Question: My CT scan says I have 'premature calcific atherosclerosis of the aorta' but my angiogram is clear. What does that mean? Is calcification different from the more common type of plaque? Could this be the cause of my recent heart attack?

Answer: If you have calcium in your arteries even without evidence of blockages, you do have atherosclerosis. This is not different than common plaque, it's just a different form. And, yes, it could be the cause of your heart attack.

Dr. Chris Price, Caridologist, The Everett Clinic


Question: Could a pain in my right side be caused by vascular calcification?

Answer: Calcification of the arteries is a process that occurs with aging but is exacerbated by elevated cholesterol, diabetes and smoking. In general, calcification of the arteries can limit blood flow to the area it is supplying, like the legs or the heart, but it does not cause pain. I think there is something else going on to cause your discomfort; I would get another opinion. If you do have vascular calcification, it may be time to consider modifying your diet, smoking cessation and exercise.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: How could damage to heart valves lead to a backup of blood in my venous circulation?

Answer: Generally if a heart valve "leaks " or has severe stenosis or " blockage," blood will go where it should not. What happens when a valve is not working is that blood will pool or migrate to the low pressure venous system, where it will stay and back up. This can cause shortness of breath or leg swelling, among a long list of other symptoms that venous congestion can cause.

Dr. Jeff Gress, Interventional Cardiologist, Everett


Question: What is right sided subclavion artery stenosis? What are the symptoms?

Answer: This is when the artery to your right arm has a narrowing. Usually the symptoms are extreme fatigue in the right arm with exertion. Usually this only happens when you are using both your arms when your right gives out sooner than the left. It can also sometimes show symptoms of a stroke.

Dr.Chris Price, Cardiologist, The Everett Clinic


Question: What is thoracic outlet syndrome?

Answer: Thoracic outlet syndrome is compression of the vessels in the thoracic outlet which is a narrow space between the clavicle and the first rib. The subclavian artery, subclavian vein and brachial plexus nerves run through this area. Compression of these structures can cause symptoms such as weakness of the arm or swelling.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: If the arteries in one leg to the foot are small, what can be done to increase the blood flow to the limb?

Answer: If the arteries in the foot are truly small, then there is not much that can be done to make them bigger. For arteries that are blocked, there are options including bypass or stents, but this is usually in the arteries higher up in the leg. Unfortunately, small distal arteries are often seen in patients with renal failure or diabetes and there are limited treatment options.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: Why is the blood in an artery brighter red than the blood in a vein?

Answer: The color of blood has to do with the amount of oxygen in the blood. Oxygen binds to hemoglobin in the red blood cells making the blood appear red. Hemoglobin without oxygen has a more blue color. Arteries carry oxygenated blood from the heart to the extremities and so the arteries appear red. Oxygen is taken out of the blood in the extremities and the veins then carry the blood without oxygen back to the heart, which explains why they appear blue.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: Can a hemosiderin deposit on my leg be removed somehow?

Answer: Unfortunately, there is not a good way to remove hemosiderin from the leg. It is the result of deposition of hemoglobin in the skin and the skin is now permanently stained.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: What is vascular flutter ?

Answer: In a person with advanced arteriosclerosis, the Bernoulli effect produces a symptom called vascular flutter. In this situation, the artery is constricted as a result of accumulated plaque on its inner walls. To maintain a constant flow rate, the blood must travel faster than normal through the constriction. If the blood speed is sufficiently high in the constricted region, the artery may collapse under external pressure, causing a momentary interruption in blood flow. At this moment, there is no Bernoulli effect, and the vessel reopens under arterial pressure. As the blood rushes through the constricted artery, the internal pressure drops and again the artery closes. Such variations can be heard with a stethoscope and are an indication of advance atherosclerotic disease.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: I recently had a x ray done on my leg and I was told that I had multiple pelvic phleboliths and a cortical bone island. What are these?

Answer: A bone island, also known as an enostosis, is a focus of compact bone located in cancellous bone. This is a benign entity that is usually found incidentally on imaging studies; rarely, however, the bone island may mimic a more sinister process, such as a metastic cancer, such as prostate cancer.

Phleboliths are calcifications in small veins that have been closed of for a long time. They are typically present low in the pelvis. They are a frequent normal finding in X-rays that include the pelvic region. They are not related to trauma, back injuries or otherwise.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: What causes leaky veins in the legs?

Answer: "Leaky veins" in the legs refers to the state of the valves in the veins. These valves keep blood from rushing down to the feet when you stand. Damage to these valves can result in blood traveling backwards and pooling in the legs, causing swelling and varicose veins. The damage can be due to several reasons including genetics (if your parents have varicose veins, you are at risk), pregnancy, prolonged standing or trauma to the legs. The valves are fragile and cannot be repaired surgically and don't regenerate.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: What is reflux in my femoral vein?

Answer: Reflux in the femoral vein means that the valves are not functioning correctly. This can lead to swelling in the leg. Damage to the valves can be caused by trauma, such as a broken leg, or from a prior deep vein clot. Unfortunately, for deep veins, the treatment is primarily limited to compression stockings as the valves cannot be repaired.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: I have a large dark area on the side of my leg and was told my veins are breaking down. Can anything be done about this?

Answer: This sounds like venous disease and it can be treated. The dark spot on your leg is possibly due to the deposition of red blood cells in the soft tissues that have accumulated because the veins are not draining effectively. The hemoglobin in the cells breaks down and stains the skin. While there is a large range of venous disease from spider veins to ulcers, hemosiderin deposits, like what you are describing, usually indicates more advanced venous disease and should be addressed by a vascular surgeon.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: What sort of delay is acceptable from diagnosis to treatment of an aortic aneurysm?

Answer: Treatment of an abdominal aneurysm is really dependant on size and symptoms. Arteries are considered aneurismal when they are twice their normal size. In the abdominal aorta, this is about 3 cm, depending on the surrounding arteries. The risk of rupture of an aneurysm increases with size as the wall of the aneurysm becomes thinner. Many aneurysms do not grow and can be stable for years. These need to be followed with ultrasound or CT. When an aneurysm is larger than 5 cm, the risk of rupture begins to increase significantly and this is the size at which we consider intervention. We would also consider intervention if the aneurysm is causing symptoms of back pain or abdominal pain as this can be a sign of pending rupture.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: How much should patients walk if they have a blood clot in the leg?

Answer: We used to think that when a patient was diagnosed with a deep vein thrombosis (DVT), they needed to be on strict bedrest. There actually was never any evidence to prove this was beneficial, it just seemed like a good idea. There recently has been several studies that show no difference between patients placed at bedrest to those allowed to ambulate early. In fact, there is evidence that early ambulation may reduce some of the pain and swelling associated with DVT.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: Who would be the better choice to evaluate or treat venous stasis ulcers on the lower extremity and why? A dermatologist, plastic surgeon or vascular surgeon?

Answer: Vascular surgeons are well trained in the treatment of venous stasis ulcers. The source of these ulcers is often due to a problem with the veins in the legs and there are several treatment options including new, minimally invasive treatments. Vascular surgeons are the only ones specifically trained to make the diagnosis and provide the full complement of treatments. This is evidenced by the fact that venous disease is part of the board certification for vascular surgery. Sores on the legs can also be caused by other reasons including arterial disease. Vascular surgeons can diagnose and treat this as well.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: I have had 14 surgeries, they cleared my ulcers and made my legs feel better. Now, I have painful ulcers below my ankles. The Vein Center told me they do not treat perforating veins below the ankle because it could cause problems later on. Is this true?

Answer: If your legs are having recurrent ulcerations and there is no other source of reflux (deep or superficial), then it would be very reasonable to treat the perforating veins decrease the venous pressure on the skin and allow for healing.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: How do the legs get any circulation during an open repair of an AAA, while the aorta is clamped?

Answer: During aneurysm repair, clamps are placed on the iliac arteries which normally carry blood down to the legs. There is no temporary bypass and so the legs are without circulation for 30 to 60 minutes. The patient is given a large amount of blood thinner before the clamps are applied so the chance of blood clotting is very low. Before the repair is completed, the clamps are released to flush the blood back out of the legs to make sure. Then, once the repair is completed, we check the pulses in the feet to make sure circulation has been restored.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: Do AAA stents last as long as a full, open repair?

Answer: "AAA Stents" or endovascular repair of an abdominal aortic aneurysm has been proven to be effective in long term follow-up out to about 8 years. The difference is that patients who receive an endograft must be followed with ultrasound or CT scan forever as there is a small chance the device could move and a leak develop. In general, an open repair is higher risk initially, but has proven to last a long time without any particular follow-up. I recommend open repair in younger, healthier patients who can tolerate it but this of course has to be individualized to each patient.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: What could be the cause of elevated pressure in the left carotid atery if narrowing / plaque have been ruled out and artery takes normal path / course?

Answer: If there is no evidence of plaque or narrowing in the artery then the artery should be normal and any source of elevated "pressure" would be from the heart. However, the only way to truly know the pressure in the carotid artery is to stick a needle or catheter into the artery and measure it. If your blood pressure is normal, then there likely is nothing wrong.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: Why does my carotid artery hurt? I exercise with high intensity daily, am I endangering my health with high intensity exercise?

Answer: Carotidynia is pain along the carotid artery. It is usually related to the nerves along the carotid artery and is associated with migraine headaches. The carotid artery itself does not usually have pain unless there is disease in it (such as an arteritis) or a dissection (a tear in the wall of the artery). Carotidynia is usually the last diagnosis I would make after other more serious causes of pain are ruled out. If you haven't had it done, I would have a carotid ultrasound and then see a vascular surgeon.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: What causes an intermittent fluttering feeling near the carotid artery?

Answer: Arteries are rarely the source of sensations such as fluttering or pain. A fluttering feeling in the neck seems most likely due to a muscle fasciculation or spasm.

Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease


Question: Why do arteries lack valves yet they are present in veins?

Answer: Veins have one-way valves to assist the return of blood from the legs back to the heart. When humans are standing or sitting, blood has to travel upward, against the force of gravity, from the legs to the heart. These valves prevent gravity from pushing the blood back down the leg. The calf muscles are the "pumps" which propel the blood upward.

Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease


Question: In 2006 I had bilateral pulmonary emboli/DVT. Still today I cannot wear "regular socks" as it cuts into my affected leg and causes severe indentation/swelling. Is this normal?

Answer: Wearing graduated compression stockings after an episode of DVT will diminish leg swelling and help minimize symptoms of postphlebitic syndrome and lower the risk of venous ulceration. These prescription stockings come in various lengths and compression strengths. They should be as tight as possible, since more compression is better; however, if the compression is excessive, then compliance with their regular use is decreased. Start out with 20-30 mmHg compression.

Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease


Question: I have been told that I have vascular calcification in my pelvis. What is this?

Answer: Vascular calcification in the pelvis is due to either calcium in the walls of arteries (usually the iliac arteries) or phleboliths, which are small non-dangerous blood clots in the veins of the pelvis. Phleboliths are extremely common, and have no clinical importance. Arterial calcifications indicate at least a moderate amount of atherosclerotic disease.

Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease


Question: What procedures can be done to damaged veins caused by DVT?

Answer: DVT (deep vein thrombosis) refers to blood clots in the deep veins of the legs; the arteries are not affected. There is currently no good way to repair the damage done to the veins after an episode of DVT. The damage may be limited by maintaining adequate blood thinning for 6 months and wearing graduated elastic support stockings. There is some data to suggest that using medicine to dissolve the clots when they are first discovered may further limit vein damage; however, this thrombolytic therapy has some risk of fatal bleeding, so it is not commonly used at this time.

Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease


Question: How do you treat "leaky veins"?

Answer: I think by "leaky veins" you are referring to incompetence of venous valves, which may be the source of varicose veins. If varicose veins are associated with valvular incompetence in the greater and/or lesser saphenous trunks, then successful treatment involves eradication of the saphenous veins and removal of the varicose branches. Until a few years ago the saphenous veins were removed by surgical stripping, which usually requires general or regional anesthesia in an outpatient surgery center or hospital. Currently, most incompetent saphenous veins are treated with endovascular laser ablation, which is done in the office with only local anesthesia. This minimally invasive procedure allows patients to resume full activity much more quickly than after conventional surgery.

Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease


Question: I have had extensive, unsightly spider veins accompanied by a few varicose veins on my thighs, calves, and ankles all of my adult life. I suspect the cause is both heredity and obesity. What method of treatment is most successful in the removal/treatment of this combination?

Answer: The best treatment depends upon the function of the valves in the greater and lesser saphenous veins, as well as any perforating veins of the legs. If the valves are "leaky", then often the saphenous veins require treatment with either surgical stripping or endovascular laser ablation, and the smaller branch veins can be treated with injection sclerotherapy and/or miniphlebectomy. If the valves in the saphenous veins are normal, then injection sclerotherapy alone works well.

Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease

For more information on veins, visit www.radiaveincenter.com


Question: Is there any treatment for pain in the toes and feet from compromised circulation?

Answer: If pain in the feet and toes is determined to be caused by severe arterial insufficiency, then revascularization is indicated to relieve the pain as well as prevent tissue loss and possibly major amputation. Sometimes the leg can be successfully treated with percutaneous catheter-based devices; other times surgical bypass is necessary.

Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease


Question: Why do an ABI before a vascular ultrasound?Answer: The ABI (ankle - brachial index, or the ratio of the systolic BP at the ankle to the arm BP) answers the question: is there arterial insufficiency present at rest? If there is a post-exercise ABI, then this determines whether there is true claudication (ABI decrease of 0.15 or more, and associated exercise related leg symptoms).

Answer: The vascular ultrasound (duplex scan) only looks at arterial anatomy. It does not quantitate the severity of the arterial insufficiency, or determine whether the patient's leg symptoms are really due to arterial disease.

Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease


Question: I have a 60% blockage in my left carotid artery. I have not had any symptoms; the blockage was found by a routine exam. My doctor suggest surgery, but I feel the risks are rather high for 60% blockage. Can you give me any insight to my problem?

Answer: Optimal treatment of patients with asymptomatic carotid disease remains somewhat controversial. The best scientific studies consistently show that carotid surgery definitely reduces the risk of stroke in patients with greater than 60% carotid stenosis (blockage); however, the size of the benefit appears relatively small. It seems that surgery may benefit men more than women. Although it seems logical that greater degrees of carotid blockage would benefit more from surgery, this has not been proven in several studies.

For surgery to be of maximal benefit, complications must be kept to a minimum – less than 3% incidence of operative stroke or death. Many centers of excellence in the United States (including Providence Everett) have complication rates much less than this.

Studies are in progress to determine whether carotid angioplasty and stenting is beneficial in asymptomatic patients. No rigorous scientific studies have yet been published, although some centers claim good results.

Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease


Question: How accurate is an ABI test? Can it produce an abnormal reading due to tiny arteries?

Answer: The ABI (ankle-brachial index) is calculated by dividing the systolic blood pressure obtained in the tibial arteries at the ankle by the highest systolic pressure obtained in the arms. Normally the ratio is 0.9 or higher. In non-diabetic patients the test is highly specific to diagnose the presence of significant lower extremity atherosclerotic disease.

The sensitivity of the test can be increased by calculating the ABI after exercise. In other words, some patients with significant arterial blockages in the legs may have a normal resting ABI, but an abnormal post-exercise ABI.

Diabetic patients may have calcification in the walls of the tibial arteries in the lower leg and foot. These calcified arteries may not be compressible by the blood pressure cuff, which makes determination of the ankle blood pressure inaccurate or impossible. In these cases, it is often possible to determine the blood pressure in the toes where the arterial calcification is less.

Dr. Jay Cook, Vascular Surgeon, Radia Center for Vascular Disease


Question: What is peripheral artery disease?

Answer: Peripheral artery disease blocks (PAD) circulation to vital structures, commonly the legs and feet. It can be associated with high blood pressure, heart disease and stroke. PAD can cause pain in the calves when walking, but in its more severe form cause leg ulcers, and even gangrene that can lead to amputation.

Dr. Phil Feliciano, Vascular Surgeon, Radia Center for Vascular Disease


Question: What is an aortic aneurysm?

Answer: The aorta is a large blood vessel that carries blood from the heart to all the vital organs. An abdominal aortic aneurysm (AAA) is caused by a progressive weakening of the vessel wall that causes the aorta to dilate or "balloon". The aneurysm will grow larger and even rupture causing death if not treated.

Dr. Phil Feliciano, Vascular Surgeon, Radia Center for Vascular Disease


Question: How are abdominal aortic aneurysms treated?

Answer: Surgical treatment of AAA has been done for many years and is a durable procedure. Today at Providence Everett Medical Center we commonly repair these aneurysms using surgery, but also we can repair these aneurysms using a less invasive technique which allow us to repair the aneurysm using a catheter-based method using small incisions in the groin. We have been performing the less invasive procedure since 1999, when it was approved by the FDA. This minimally invasive technique has allowed our patients to have a quicker recovery and decrease their hospital stay to only one or two days.

Dr. Phil Feliciano, Vascular Surgeon, Radia Center for Vascular Disease


Question: What is an enlarged vascular artery and how is it treated?

Answer: Enlarged vascular artery is a bit of a vague term. If the artery is abnormally enlarged more than twice its normal size, it can be considered an aneursym. We worry about aneurysms because as they grow, the artery wall becomes thinner, increasing the risk that it could burst. Also, the flow in the aneurysm is somewhat abnormal and clots can form that then may flow out of the aneurysm and affect another artery downstream. There are different size criteria for fixing different aneurysms, but it is best to be evaluated by a vascular surgeon to understand your options.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: Why would my toes turn purple without an injury?

Answer: Purple discoloration of the toes can be due to multiple diseases. Sudden discoloration of one toe can be due to a small clot or plaque lodged in the artery referred to as an embolus. This is usually quite painful. Reddish/purple discoloration can be associated with poor arterial circulation. This is often associated with pain in the toes, particularly when the foot is elevated and during sleep. There can also be some pain in the calves while walking due to poor blood supply to the calf muscles. Purple toes can also be due to vein disease, with accumulation of venous blood in the feet, such as seen in patients with severe varicose veins. Finally, there are vasospastic disorders, such as Raynaud's phenomenon, that cause the blood vessels to spasm, limiting the flow to the toes. This may or may not be associated with pain but is not a sign of a severe circulation problem.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: What is aortoiliac calcification and what causes it? Is it serious?

Answer: Aortoiliac calcification is a marker of plaque in the arteries. In people with elevated cholesterol, diabetes or tobacco use history, cholesterol is deposited in the wall of the arteries. This occurs in characteristic areas such as in the carotid arteries in the neck, the coronary arteries in the heart, the aorta and in the legs. The cholesterol in the wall of the artery then becomes calcified and this is what is visualized on X-rays.

When the plaque build up is significant, it can limit blood flow in the affected artery. When blood flow is limited in the aorta and iliac arteries, a patient may experience pain in the legs when walking, pain in the feet at night and non-healing ulcers, all due to a lack of blood flow. These symptoms are an indication for evaluation and treatment. Also, when plaque is visible in the aorta, it also exists to some extent in the heart and neck. This is an indication to begin diet modification, exercise and smoking cessation.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: Can calcification in the entire vascular system be reversed?

Answer: Unfortunately, no, it cannot be reversed. Diet modification, smoking cessation, exercise and cholesterol lowering medications can keep the plaque from getting worse.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: How urgent is the repair of an abnormal aortic stent that has bent 180 degrees?

Answer: While I'm not sure of the specifics related to your case, I would say that generally if there is a significant deformity in a previously placed aortic stent, I would think it needs to be addressed urgently before it occludes.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: Why would my patient have a lot of plaque in his lower extremity veins but normal velocity and waveforms?

Answer: I assume that there is a lot of plaque in the arteries and not the veins. There can be plaque that is not obstructing and the flow is preserved. This would make the waveforms appear normal. It is a sign that your patient needs to take steps to reduce cholesterol, stop any tobacco use and get blood pressure under control to help prevent more plaque from building up.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease


Question: How does your blood get from your big toe back to your heart when there is very little pressure in the venous circulation?

Answer: The venous circulation depends on the calf muscle as a pump. Everytime you walk, your calf squeezes on the deep veins and forces the blood back to the heart. The valves in the veins keep the blood from travelling back down, otherwise every time that you stand, you would pass out! If the valves in the veins don't work, either due to damage from a deep vein clot, trauma or hereditary changes, the blood can pool in your leg causing swelling as well as ulcers that don't heal. When you stand, your calf muscle isn't contracting, so people that work on their feet should try to move around a little to pump the blood out of their legs.

Dr. Mark Papenhausen, Vascular Surgeon, Radia Center for Vascular Disease