Dr. Marshall Benjamin
Associate Professor
Chief of Surgery
Director of the Maryland Vascular Center at Baltimore Washington Medical Center

Q. What is vascular disease?
A. Vascular disease affects the veins and arteries that carry blood and oxygen throughout the body. Although vascular disease can affect any blood vessel of the body, three common forms of vascular disease include abdominal aortic aneurysms (AAA), carotid artery disease and peripheral arterial disease (PAD).

Q. Who is at risk for vascular disease?
A. Generally, men and women 60 years of age or older, who have hypertension, high blood cholesterol, smoking, or diabetes are at increased risk of vascular disease. In addition, a family history of vascular disease, previous heart or leg treatments or a prior stroke, can be associate with increased risk.

Q. What is an AAA?
A. An AAA is a weakening or ballooning of the wall of the aorta in the abdomen. The aorta is the major “pipeline” carrying blood from the heart to all parts of the body, and its normal diameter (size) is about the size of our thumb. In some patients however, the aortic wall can weaken and form a bulge. This is like a bubble or bulge that can sometimes be seen on the sidewall of a car tire. Just like the tire, if the bulge in the wall grows too large, allowing it to grow too weak, it can rupture. This is a very serious condition and may even cause death. Generally, when an AAA gets to five centimeters (about the size of a large lemon) we will recommend treatment.

Q. What are the symptoms of an AAA?
A. Most people (3 out of 4) with an AAA rarely know it. They find out they have an aneurysm when they have a test for some other reason; say a CT scan or MRI for back pain or kidney stones. Most patients have no symptoms associated with their AAA, however they sometimes can cause lower back, abdominal or hip pain. An AAA can be detected with a simple non-invasive ultrasound scan.

Q. How is an AAA treated?
A. Today, AAAs can be treated safely and easily in the vast majority of patients, protecting them from rupture. Recently, a less invasive technique called an endovascular repair has been developed and approved by the FDA that is much less stressful on patients. Two small incisions in the groins allow the endograft to be inserted into the weakening of the aortic wall through a catheter. Once the procedure is complete, patients can usually have dinner the night of the procedure, and only stay overnight in the hospital.

Q. What is an endovascular repair?
A. An endovascular repair is a minimally invasive option for many people who need treatment of their AAA. It is a fairly recent development in vascular disease treatment and requires less recovery time and a shorter hospital stay. Physicians have to be specially trained to perform these procedures. Here at the Maryland Vascular Center, we have been doing endovascular repairs since the FDA approved the procedure in September 1999.

Q. What is carotid artery disease?
A. The carotid artery is the large artery on each side of the neck that is the major blood supply to the brain. Carotid artery disease is the build-up of plaque and/or cholesterol deposits in the artery that can block the flow of blood to the brain and put the patient at increased risk of stroke or mini-stokes. Carotid artery disease can be detected using a painless ultrasound scan.

Q. What are the symptoms of carotid artery disease?
A. Many patients have no symptoms even though they may have a significant build-up of disease in their carotid artery. This rough, uneven build-up of plaque can be thought of like rust in the pipes under the kitchen sink. If a small piece of the plaque breaks loose and travels downstream to the brain, it usually causes symptoms (either a stoke or mini-stroke). Symptoms of a mini-stroke typically are the sudden loss of vision in one eye, or a weakness or numbness in an arm or leg. Mini-stroke symptoms usually are short and last anywhere from a minute or two, to several hours. They usually are completely resolved by 24 hours however. Symptoms from a stroke are usually long-lasting.

Q. How is carotid artery disease treated?
A. Mild forms of the disease are usually treated with medication (typically aspirin or plavix), but as the blockage progresses, most patients are offered a small operation (carotid endarterectomy) to clean out the artery. Today, this surgery is the most effective method of treatment, and is typically performed in the operating room under local anesthesia, with only an overnight stay in the hospital. Newer forms of treatment, including carotid artery angioplasty and stenting hold promise for the future, but are still investigational. The Maryland Vascular Center has been a leader in both forms of treatment.

Q. What is PAD?
A. Peripheral Artery Disease (PAD) is caused by blockages in the leg arteries due to a build up of plaque. This is generally a reflection of a “body-wide” process, and thus individuals with PAD are three times as likely to die of a heart attack or stroke.

Q. What are the symptoms of PAD?
A. Symptoms include crampy, leg pain with walking or exercise, numbness of the legs or feet at rest, and muscle pain in the thighs or calves. PAD is detected using a simple Doppler ultrasound exam, measuring the blood flow to the legs to accurately determine if treatment is necessary.

Q. How is PAD treated?
A. Medical treatments and lifestyle changes alone usually prevent most serious complications of mild PAD. In patients with diabetes or a more advanced form of PAD, that may severely limit the flow of blood to the legs, other treatments may be necessary to save the leg. These can include balloon angioplasty or stenting, or sometimes a surgical bypass operation.

Q. What are varicose veins?
A. Varicose veins are caused when the one-way valves in the veins that prevent blood from flowing backwards, fail to close tightly. This allows blood to pool and causes the bulging and twisting characteristic of varicose veins.

Q. Should they be treated?
A. While generally not limb-threatening, the disease can often cause pain and swelling, especially during periods when the patient is on their feet for long periods. In some situations varicose veins should be treated to prevent other medical complications. In many cases, people chose to have them removed for cosmetic purposes.

Q. How are they treated?
A. In some institutions, surgery is performed to remove the damaged veins. We do that here at Baltimore Washington Medical Center is some cases, but we now have a new minimally invasive procedure to remove the veins without surgery.

Q. What does the new procedure include?
A. The new procedure, called Venacure, uses laser energy to eliminate the varicose veins. The body then automatically re-routes the blood to other healthy veins.

Q. What is the recovery time for the procedure?
A. There is no recovery time. The procedure is performed in Baltimore Washington Medical Center as an outpatient procedure utilizing local anesthesia, and the patient can walk out of the center and continue with their daily activities. There is little discomfort and the procedure takes about 45 minutes and requires no stitches.