Vascular Care

Many factors play a part in the development of varicose veins. They can affect adults of all ages, but there are certain factors that make you more likely to develop them:

• Heredity – if your mother or father has varicose veins, there is a greater likelihood you will develop them.

• Age – the development of varicose veins can happen at any age, but usually occurs between the ages of 18 and 35 years, and peaks between 50 and 60 years.

• Gender – females are affected approximately four times as much as males.

• Pregnancy – during pregnancy varicose veins can form, but may disappear after the delivery of the baby. A vascular specialist can discuss your situation with you three to six months after birth and after you have stopped breastfeeding, and if needed, a treatment plan can be developed. 

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The veins that cause symptoms do not play an important role in transporting blood back to the heart; therefore, they can be closed off or removed without causing problems. In fact, removing them improves venous circulation.

Diagnosis is pain-free and is offered in our office. Treatment may begin with things you can do on your own under the direction of your doctor and progress to other options if necessary. Treatment options your healthcare provider may discuss with you include:

• Elevating your legs when possible, keeping your feet positioned higher than heart level.

• Exercising daily. Walking, climbing stairs, cycling and swimming keep your calf muscles in motion and improve circulation. 

• Moving your legs frequently by taking short walks.

• Using compression hose. This provides pressure on your legs which can aid in blood flow to the heart. 

• Sclerotherapy, which involves injecting a solution into your legs to close smaller veins.

• Laser or radiofrequency endovenous ablation, which heats the veins and results in their closure.

• When other approaches are not effective, surgery is an option. 

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During your initial appointment, a member of our team will review your medical history, discuss your diagnosis, and answer any questions you may have. Varicose veins can cause both physical pain and cosmetic concerns, and our goal is to help you understand your treatment options and help you start on a path to looking and feeling your best.

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Most health insurance plans cover your initial evaluation, and many cover treatment of varicose veins. To find out if your insurance plan covers treatment for varicose veins, please call us at 207-973-6670. Your insurance may require a referral from your primary care provider. We can help you determine your next steps for care.

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Direct surgical repair of the aneurysm has been the standard approach for over 50 years. An incision is made in the abdomen, the aneurysm is isolated and opened, and a synthetic graft is sewn to the aorta. The vascular graft is usually made of a polyester type material, and essentially replaces the diseased portion of the aorta. This is a major surgery performed under general anesthesia. Recovery from the operation typically requires 7 to 10 days in the hospital and another 6 to 8 weeks of convalescence at home. Although this is a significant undertaking, results of this operation are generally good, and the chances of further problems are remote.

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This procedure has been developed over the past 10–15 years to repair an aneurysm with surgery that is less invasive. Incisions are made in the groins, and a device is maneuvered through the...

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The best treatment for an abdominal aortic aneurysm depends on a number of factors, including the size and location of the aneurysm, whether or not it is causing symptoms, and the age and general health of the patient. Many aneurysms can only be repaired with the open operation. While this is a major operation, the outcomes are generally very good. Other aneurysms may be candidates for either open or endovascular repair. Both approaches have advantages and disadvantages in this circumstance, and you should understand the pros and cons of both approaches before deciding how to proceed. We encourage you to discuss all of these factors and any other questions you have with your primary care provider and vascular specialist.

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The treatment for carotid artery disease depends on the severity, the symptoms you have experienced, and your overall state of health. Mild or moderate stenosis may be treated with medication and by reducing as many risk factors as possible to slow the growth of the stenosis. Your healthcare provider will discuss the importance of reducing your risk factors and regular medical follow-up.

More severe carotid artery stenosis may sometimes be treated with an operation know as carotid endarterectomy (CEA). This is a surgical procedure in which the plaque and inner lining of the artery is removed. An incision is made, the carotid arteries are located; clamps are placed above and below the surgical site; the carotid artery is opened; and the plaque is carefully removed. The artery is then closed with a patch of a vein or an artificial/synthetic material; sutures or staples are applied to the skin and the area is covered with a dressing. In certain instances, it may be possible to treat carotid stenosis through catheters inserted in the groin with stents placed in the carotid artery to improve the flow through the region. This approach is very new and the devices have only recently been approved for use by the FDA. As the technology develops, more and more patients will be candidates for this procedure.

We offer TransCarotid Artery Revascularization, or TCAR, a minimally invasive procedure for patients with carotid artery disease. TCAR is a less invasive alternative to a carotid endarterectomy (CEA), the procedure that is most commonly used to treat severe carotid artery disease. CEA starts with a three to four inch incision at the front of the neck, where TCAR gains direct access to the common carotid artery through a much smaller incision above the collarbone, allowing just enough room to place a sheath into the artery and place a stent. The stent is then inserted in the artery to open and stabilize the narrowing and help protect patients from future stroke risk. Throughout the procedure, blood flow is temporarily reversed in the carotid artery to divert dangerous debris away from the brain, preventing a procedural stroke. 

The best treatment for carotid artery disease depends on a number of factors, including the size and location of the stenosis, whether or not it is causing symptoms, and the age and general health of the patient. You should discuss all of these factors and any other questions you have with your primary care physician. 

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Treatment of PVD has three aims, some of which overlap.

1. The first important aim is to treat the systemic disease of atherosclerosis. People with PVD are at increased risk of suffering a heart attack. Treatment for this purpose consists of lifestyle modifications and medication, including quitting cigarette smoking, maintaining a healthy diet, and increasing activity levels. Medications designed to inhibit platelets (aspirin) and control cholesterol are frequently recommended.

2. The next aim in treating PVD is to increase the ability to walk. Smoking cessation alone usually increases pain free walking distance. Exercise programs are also effective. There are medications that can improve the walking distance as well, and these may be recommended by your doctor in certain instances. In the most severe cases, or in otherwise young healthy individuals, your doctor may recommend repair or bypass of blocked arteries to improve the circulation and increase exercise tolerance.

3. The final aim in the treatment of PVD is to increase the circulation to the extremity by either addressing the blockages directly or by performing bypass procedures around the blockage. These types of treatment are generally reserved for those with more severe degrees of blockage, or for otherwise healthy patients who are very limited by their circulation. Two general options are available to increase the circulation of the leg. The first approach is called endovascular or percutaneous therapy. This is a minimally invasive procedure where catheters and other devices are used to treat the blockages directly without the need for open operation. These types of procedures can frequently be done as an outpatient, or with an overnight stay. When feasible, this approach is well tolerated and can provide durable relief of symptoms.

Not all patients can be treated with endovascular therapy. In those individuals, open surgical approaches to remove or bypass the blockages in the arteries are necessary. These are major surgical procedures, and are usually only performed when the disease is advanced and there are no other alternative to save the limb. These types of procedures are generally very successful however, and long term durability is quite good.

Treatments for PVD are chosen carefully for the individual patient. In those with minimal symptoms, lifestyle modification and medication are typically all that is required. Please be sure to discuss all options with your healthcare provider and understand why a particular course of action has been planned for your situation.  

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