Advances in Vascular Surgery
Learn about the latest treatment advances for vascular conditions from Dr. Margaret Tracci, a UVA specialist in vascular surgery.
Featured Speaker:
UVA Heart & Vascular Center
Margaret Tracci, MD
Dr. Margaret Tracci is a board-certified vascular surgeon and president of Virginia Vascular Society who provides comprehensive treatment and care for a range of vascular conditions.UVA Heart & Vascular Center
Transcription:
Advances in Vascular Surgery
Melanie Cole (Host): The vascular system is a complex system in the body, but certain things can go wrong with it. My guest today is Dr. Margaret Tracci. She’s a board-certified vascular surgeon and president of Virginia Vascular Society who provides comprehensive treatment and care for a range of vascular conditions. Welcome to the show, Dr. Tracci. What are some of the most common vascular conditions that you encounter?
Dr. Margaret Tracci (Guest): Thank you for having me. The most common disorders that we treat are disorders of both the arteries and the veins. In the arterial system, really much of our practice is centered around the treatment of atherosclerosis. This is very closely related to coronary artery disease. What we most commonly see is atherosclerosis of the carotid arteries which can be associated with stroke, and atherosclerosis of the arteries of the legs which can be associated with a range of symptoms from cramping of the legs with exercise to failure to heal ulcers, longstanding persistent sores in the legs, to even loss of limb.
Melanie: Dr. Tracci, people are always worried about symptoms of vascular disease, peripheral vascular disease, heart disease. They’re always looking for those red flags to give them a better sort of chance. When you mentioned the legs, hot feeling, blood clots, tell us some symptoms that we might come up with for any of these vascular conditions that people really need to be aware of when they’re exercising and when they’re at rest.
Dr. Tracci: Absolutely. As I said, the most commonly treated condition for us in the legs is atherosclerotic disease. What people notice is essentially the symptoms of angina in the legs. When they exercise, the muscles demand more oxygen, the body is not able to deliver that, and they feel a cramping or “Charley horse” sensation in the leg with exercise. People will tell you, “I get 50 yards and my legs cramp up on me.” In more severe cases, people will find that they have ulcers that won’t heal or constant pain in their feet and those can both be associated with bad atherosclerotic disease of the legs. We also get inquiries about venous disease. People will see varicose veins or notice that they have swelling or bulging of veins in their legs. We then screen them for either occlusive disease which would be blood clot, or what we call reflux disease which is badly functioning valves in the vein.
Melanie: If people are experiencing this claudication or pain in their legs when they’re exercising or any of these other conditions, do you recommend vascular screening? Who should be screened?
Dr. Tracci: We absolutely do. There are a number of different screening tests available and each one of them has slightly different criteria. I think one of the most important screening initiatives that vascular surgery has supported is screening for abdominal aortic aneurysms. Unlike all of the other conditions that we’ve described, aneurysms are really insidious because they don’t come with symptoms typically. People will sometimes have a family history of aneurysm, but more often not. So we do recommend that people have a simple ultrasound screening for men over the age of 65, or 55 if they have any family history of aneurysm; and for all women over the age of 65 who have either a family history of aneurysm or a smoker. For peripheral arterial disease, anybody who has got significant atherosclerotic disease in other areas, known coronary artery disease, known carotid artery disease, ought to be screened. Certainly anybody who is having symptoms potentially of claudication or noticing that they’re having sores on their feet that won’t heal. With regard to carotid artery disease, again, this tends to be a condition that’s insidious. It’s not symptomatic until somebody has a stroke. Again, we do tend to recommend that people undergo simple ultrasound screening for this if they have other significant atherosclerotic disease, either coronary artery disease or known peripheral artery disease.
Melanie: Now tell us some of the latest advances in the treatment of some of these common vascular conditions.
Dr. Tracci: Sure. Vascular surgery has been one of the most exciting areas in medicine over the last 10 or 15 years, primarily in the area of minimally invasive treatment of each of these categories of disease. With regard to arterial aneurysms, particularly aortic aneurysm, virtually all of these can be treated with stents now rather than open surgery. We’re just becoming more able to treat aneurysms of the mid-portion of the aorta, the branch portion of the aorta, with stents. This was an area that historically we hadn’t had the technology to manage this one. It’s incredibly exciting. In the area of peripheral artery disease, new technology such as drug-eluting stents or balloons that actually chemically treat the lesions while we’re ballooning them or stenting them seem to be effective in reducing the rate of re-narrowing over time. We’re very excited about this as well. Finally, in a similar fashion, endovascular or minimally invasive catheter-based treatment has revolutionized the treatment of venous disease. A lot of people remember the old-fashioned vein stripping, which could be fairly extensive surgery and painful. For the vast majority of patients, that’s been transformed into in-and-out day procedure that essentially requires a single Band-Aid for a dressing.
Melanie: That’s fascinating. Can you give the listeners some of your best advice on prevention of vascular disease so maybe they don’t need any of these treatments?
Dr. Tracci: Absolutely. And thanks for asking. That’s a wonderful question. Part of the reason that we’re so supportive of screening is that the most important thing about identifying vascular disease, particularly atherosclerotic disease, is that early management with exercise, aspirin, cholesterol management, blood pressure management, and in the case of those who are diabetic, blood sugar management, not only can slow or reverse the progression of disease, but ultimately the most significant impact is on the rate of heart attacks and strokes. They really have an opportunity to impact not just the symptoms from this particular manifestation of the problem, but actually extends people’s life times and quality of life.
Melanie: Why should patients come to UVA for their vascular care?
Dr. Tracci: We’ve got a wonderful group of fellowship-trained, board-certified vascular surgeons who are national and international experts in all areas of vascular surgery, and these are folks who are writing the textbooks and traveling nationally and internationally to teach other people about this. As a result, we really do have access to the latest techniques and technology, including access to technologies that are really only available through clinical trials. At this point, we’re a part of a number of large trials sponsored by the NIH, sponsored by industry, and have quite a bit to offer. We also have a great multidisciplinary team and we really view this as a cardiovascular center of excellence that involves having a certified top-quality vascular lab with technicians and equipment to do the best diagnostics, and a wonderful interdisciplinary relationship with cardiology, cardiovascular medicine, interventional radiology, cardiac surgery, endocrinology, and other specialties that really need to be involved in the 360-degree treatment of vascular disease. We also have an absolutely wonderful team of nurse practitioners and physician assistants who are specifically trained in vascular disease and incredibly dedicated to the care of our patients.
Melanie: In just the last minute, Dr. Tracci, if you would, give your best advice for people that might already be suffering with vascular disease, peripheral vascular disease, and just really give them your best advice about things that they can do, lifestyle management.
Dr. Tracci: Absolutely. I think that it absolutely makes sense to approach your physician about treating and managing peripheral arterial disease. Like all atherosclerotic disease, the management depends on exercise, which encourages your body to build up its own collateral system or other branch vessels to relieve symptoms. In management of atherosclerosis, really the mainstays of that are: medication such as aspirin, frequently statins in the management of high cholesterol, and the management of hypertension or high blood pressure and blood glucose or blood sugar in diabetic patients. All of these things are routine portion of that and absolutely things that can typically be managed by your regular primary care physician. It makes sense to involve a vascular surgeon, a cardiovascular expert because we can actually quantify the disease and in most instances, we can actually help get you feeling better. There are treatments for this. There are options for this. We can all work together to make sure that we’re doing absolutely everything we can do to offer you the longest, healthiest, most symptom-free life that we can, and all of that depends on really early lifestyle changes and, again, a 360-degree approach to this.
Melanie: Thank you so much. What great information! You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
Advances in Vascular Surgery
Melanie Cole (Host): The vascular system is a complex system in the body, but certain things can go wrong with it. My guest today is Dr. Margaret Tracci. She’s a board-certified vascular surgeon and president of Virginia Vascular Society who provides comprehensive treatment and care for a range of vascular conditions. Welcome to the show, Dr. Tracci. What are some of the most common vascular conditions that you encounter?
Dr. Margaret Tracci (Guest): Thank you for having me. The most common disorders that we treat are disorders of both the arteries and the veins. In the arterial system, really much of our practice is centered around the treatment of atherosclerosis. This is very closely related to coronary artery disease. What we most commonly see is atherosclerosis of the carotid arteries which can be associated with stroke, and atherosclerosis of the arteries of the legs which can be associated with a range of symptoms from cramping of the legs with exercise to failure to heal ulcers, longstanding persistent sores in the legs, to even loss of limb.
Melanie: Dr. Tracci, people are always worried about symptoms of vascular disease, peripheral vascular disease, heart disease. They’re always looking for those red flags to give them a better sort of chance. When you mentioned the legs, hot feeling, blood clots, tell us some symptoms that we might come up with for any of these vascular conditions that people really need to be aware of when they’re exercising and when they’re at rest.
Dr. Tracci: Absolutely. As I said, the most commonly treated condition for us in the legs is atherosclerotic disease. What people notice is essentially the symptoms of angina in the legs. When they exercise, the muscles demand more oxygen, the body is not able to deliver that, and they feel a cramping or “Charley horse” sensation in the leg with exercise. People will tell you, “I get 50 yards and my legs cramp up on me.” In more severe cases, people will find that they have ulcers that won’t heal or constant pain in their feet and those can both be associated with bad atherosclerotic disease of the legs. We also get inquiries about venous disease. People will see varicose veins or notice that they have swelling or bulging of veins in their legs. We then screen them for either occlusive disease which would be blood clot, or what we call reflux disease which is badly functioning valves in the vein.
Melanie: If people are experiencing this claudication or pain in their legs when they’re exercising or any of these other conditions, do you recommend vascular screening? Who should be screened?
Dr. Tracci: We absolutely do. There are a number of different screening tests available and each one of them has slightly different criteria. I think one of the most important screening initiatives that vascular surgery has supported is screening for abdominal aortic aneurysms. Unlike all of the other conditions that we’ve described, aneurysms are really insidious because they don’t come with symptoms typically. People will sometimes have a family history of aneurysm, but more often not. So we do recommend that people have a simple ultrasound screening for men over the age of 65, or 55 if they have any family history of aneurysm; and for all women over the age of 65 who have either a family history of aneurysm or a smoker. For peripheral arterial disease, anybody who has got significant atherosclerotic disease in other areas, known coronary artery disease, known carotid artery disease, ought to be screened. Certainly anybody who is having symptoms potentially of claudication or noticing that they’re having sores on their feet that won’t heal. With regard to carotid artery disease, again, this tends to be a condition that’s insidious. It’s not symptomatic until somebody has a stroke. Again, we do tend to recommend that people undergo simple ultrasound screening for this if they have other significant atherosclerotic disease, either coronary artery disease or known peripheral artery disease.
Melanie: Now tell us some of the latest advances in the treatment of some of these common vascular conditions.
Dr. Tracci: Sure. Vascular surgery has been one of the most exciting areas in medicine over the last 10 or 15 years, primarily in the area of minimally invasive treatment of each of these categories of disease. With regard to arterial aneurysms, particularly aortic aneurysm, virtually all of these can be treated with stents now rather than open surgery. We’re just becoming more able to treat aneurysms of the mid-portion of the aorta, the branch portion of the aorta, with stents. This was an area that historically we hadn’t had the technology to manage this one. It’s incredibly exciting. In the area of peripheral artery disease, new technology such as drug-eluting stents or balloons that actually chemically treat the lesions while we’re ballooning them or stenting them seem to be effective in reducing the rate of re-narrowing over time. We’re very excited about this as well. Finally, in a similar fashion, endovascular or minimally invasive catheter-based treatment has revolutionized the treatment of venous disease. A lot of people remember the old-fashioned vein stripping, which could be fairly extensive surgery and painful. For the vast majority of patients, that’s been transformed into in-and-out day procedure that essentially requires a single Band-Aid for a dressing.
Melanie: That’s fascinating. Can you give the listeners some of your best advice on prevention of vascular disease so maybe they don’t need any of these treatments?
Dr. Tracci: Absolutely. And thanks for asking. That’s a wonderful question. Part of the reason that we’re so supportive of screening is that the most important thing about identifying vascular disease, particularly atherosclerotic disease, is that early management with exercise, aspirin, cholesterol management, blood pressure management, and in the case of those who are diabetic, blood sugar management, not only can slow or reverse the progression of disease, but ultimately the most significant impact is on the rate of heart attacks and strokes. They really have an opportunity to impact not just the symptoms from this particular manifestation of the problem, but actually extends people’s life times and quality of life.
Melanie: Why should patients come to UVA for their vascular care?
Dr. Tracci: We’ve got a wonderful group of fellowship-trained, board-certified vascular surgeons who are national and international experts in all areas of vascular surgery, and these are folks who are writing the textbooks and traveling nationally and internationally to teach other people about this. As a result, we really do have access to the latest techniques and technology, including access to technologies that are really only available through clinical trials. At this point, we’re a part of a number of large trials sponsored by the NIH, sponsored by industry, and have quite a bit to offer. We also have a great multidisciplinary team and we really view this as a cardiovascular center of excellence that involves having a certified top-quality vascular lab with technicians and equipment to do the best diagnostics, and a wonderful interdisciplinary relationship with cardiology, cardiovascular medicine, interventional radiology, cardiac surgery, endocrinology, and other specialties that really need to be involved in the 360-degree treatment of vascular disease. We also have an absolutely wonderful team of nurse practitioners and physician assistants who are specifically trained in vascular disease and incredibly dedicated to the care of our patients.
Melanie: In just the last minute, Dr. Tracci, if you would, give your best advice for people that might already be suffering with vascular disease, peripheral vascular disease, and just really give them your best advice about things that they can do, lifestyle management.
Dr. Tracci: Absolutely. I think that it absolutely makes sense to approach your physician about treating and managing peripheral arterial disease. Like all atherosclerotic disease, the management depends on exercise, which encourages your body to build up its own collateral system or other branch vessels to relieve symptoms. In management of atherosclerosis, really the mainstays of that are: medication such as aspirin, frequently statins in the management of high cholesterol, and the management of hypertension or high blood pressure and blood glucose or blood sugar in diabetic patients. All of these things are routine portion of that and absolutely things that can typically be managed by your regular primary care physician. It makes sense to involve a vascular surgeon, a cardiovascular expert because we can actually quantify the disease and in most instances, we can actually help get you feeling better. There are treatments for this. There are options for this. We can all work together to make sure that we’re doing absolutely everything we can do to offer you the longest, healthiest, most symptom-free life that we can, and all of that depends on really early lifestyle changes and, again, a 360-degree approach to this.
Melanie: Thank you so much. What great information! You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.