Frequently Asked Questions


Steven L. Halbreich, M.D; Harold L. Kulman, M.D F.A.C.S; Steven H. Silverman, M.D F.A.C.S; Jonathan P. Yunis, M.D F.A.C.S; Douglas A. Dorsay, M.D F.A.C.S and Ralph T. DeCapua, P.A (Not shown above)

Carotid Artery Stenosis

What is carotid artery stenosis or carotid artery disease?

Carotid artery stenosis is the narrowing of the carotid arteries. These are the main arteries in the neck that supply blood to the brain. Carotid artery stenosis, also called carotid artery disease, is a major risk factor for ischemic stroke. (This is the most common form of stroke and is usually caused by a blood clot plugging an artery.)

The narrowing is usually caused by plaque in a blood vessel. Plaque forms when cholesterol, fat and other substances build up in the inner lining of an artery. This process is called atherosclerosis.

How is carotid artery stenosis diagnosed?

Carotid artery stenosis may or may not cause symptoms. A doctor may hear an abnormal sound called a bruit when listening to the artery with a stethoscope. The stenosis can be easily detected with an ultrasound probe placed on the side of the neck near the carotid arteries. This is called carotid ultrasonography.

How is carotid artery stenosis treated?

Depending on the degree of stenosis and the patient's overall condition, carotid artery stenosis can usually be treated with surgery. The procedure is called carotid endarterectomy. It removes the plaque that caused the carotid artery to narrow. Carotid endarterectomy has proven to benefit patients with arteries stenosed (narrowed) by 70 percent or more. For people with arteries narrowed less than 50 percent, anti-clotting medicine is usually prescribed to reduce the risk of ischemic stroke. Examples of these drugs are antiplatelet agents and anticoagulants.

Carotid angioplasty may be another treatment option. It uses balloons and/or stents to open a narrowed artery.

Abdominal Aortic Aneurysm

What is an aortic aneurysm?

An aneurysm is a bulge in a blood vessel, much like a bulge on an over-inflated inner tube. Aneurysms are dangerous because they may burst.  The aorta, the main artery leading away from the heart, can sometimes develop an aneurysm. Aortic aneurysms usually occur in the abdomen below the kidneys (abdominal aneurysm), but may occur in the chest cavity (This can happen if the wall of the aorta becomes weakened by build ups of fatty deposits called plaque). This is called atherosclerosis. Aneurysms may also be due to an inherited disease such as the Marfan syndrome.

How is an aneurysm detected?

Aneurysms can be detected by X-ray or by imaging techniques such as echocardiography , an MRI (magnetic resonance imaging) or a computed tomography (CT) scan. A small aneurysm may not cause symptoms. Then a patient's doctor will want to check it regularly to see if it's enlarging. Pain in the area of an aneurysm is a common symptom. The larger an aneurysm becomes, the more likely it is to burst.

How is an aneurysm treated?

Aneurysms are treated surgically. A patch or artificial piece of blood vessel is sewn where the aneurysm was.

Peripheral Vascular Disease

Peripheral Vascular Disease

What is peripheral vascular disease?

This refers to diseases of blood vessels outside the heart and brain. It's often a narrowing of vessels that carry blood to the legs, arms, stomach or kidneys. There are two types of these circulation disorders:

Functional peripheral vascular diseases don't have an organic cause. They don't involve defects in blood vessels' structure. They're usually short-term effects related to "spasm" that may come and go. Raynaud's disease is an example. It can be triggered by cold temperatures, emotional stress, working with vibrating machinery or smoking.

Organic peripheral vascular diseases are caused by structural changes in the blood vessels, such as inflammation and tissue damage. Peripheral artery disease is an example. It's caused by fatty buildups in arteries that block normal blood flow.

What is peripheral artery disease?

Peripheral artery disease (PAD) is a condition similar to coronary artery disease and carotid artery disease. In PAD, fatty deposits build up in the inner linings of the artery walls. These blockages restrict blood circulation, mainly in arteries leading to the kidneys, stomach, arms, legs and feet. In its early stages a common symptom is cramping or fatigue in the legs and buttocks during activity. Such cramping subsides when the person stands still. This is called "intermittent claudication." People with PAD often have fatty buildup in the arteries of the heart and brain. Because of this association, most people with PAD have a higher risk of death from heart attack and stroke.

How is peripheral artery disease diagnosed and treated?

Techniques used to diagnose PAD include a medical history, physical exam, ultrasound, X-ray angiography and magnetic resonance imaging angiography (MRA).

Most people with PAD can be treated with lifestyle changes, medications or both. Lifestyle changes to lower your risk include:

Stop smoking (smokers have a particularly strong risk of PAD).
Control diabetes.
Control blood pressure.
Be physically active (including a supervised exercise program).
Eat a low-saturated-fat, low-cholesterol diet.
PAD may require drug treatment, too. Drugs include:

medicines to help improve walking distance (cilostazol and pentoxifylline).
antiplatelet agents
cholesterol-lowering agents (statins)
In a minority of patients, lifestyle modifications alone aren't sufficient. In these cases, angioplasty or surgery may be necessary.

Angioplasty is a non-surgical procedure that can be used to dilate (widen) narrowed or blocked peripheral arteries. A thin tube called a catheter with a deflated balloon on its tip is passed into the narrowed artery segment. Then the balloon is deflated and the catheter is withdrawn.

Often a stent, a cylindrical, wire mesh tube is placed in the narrowed artery with a catheter. There the stent expands and locks open. It stays in that spot, keeping the diseased artery open.

If the narrowing involves a long portion of an artery, surgery may be necessary. A vein from another part of the body or a synthetic blood vessel is used. It's attached above and below the blocked area to detour blood around the blocked spot.


What Are Hernias?
A hernia is an opening or weakness in the wall of a muscle, tissue, or membrane that normally holds an organ in place. If the opening or weakness is large enough, a portion of the organ may be able to poke through the hole. Imagine an inner tube poking through a hole in an old tire - that's what a hernia is like.

Hernias happen more frequently in certain parts of the body, like the abdomen, groin and upper thigh area, and belly button area. They also can happen in any place where you may have had an incision from surgery.

How Do People Get Hernias?
It might take a long time for a hernia to develop or it might develop suddenly. Hernias are caused by a combination of muscle weakness and strain, although the cause of the weakness and the type of strain may vary. Hernias are actually more common in babies and toddlers. And most teens who are diagnosed with a hernia actually have had a weakness of the muscles or other abdominal tissues from birth (called a congenital defect). In these cases, straining your muscles doesn't cause the hernia; it only makes the hernia more apparent (and painful!).

Here are some types of strain on the body that may induce hernias:

obesity or sudden weight gain
lifting heavy objects
diarrhea or constipation
persistent coughing or sneezing
These types of strain on their own probably won't give you a hernia. But when they team up with a weak muscle, a hernia is more likely to result.

Many hernias are discovered during routine physical exams. If you're a guy, you may have had a physical exam where your doctor gave you a testicular exam and checked your testicles for a hernia. By placing a finger at the top of your scrotum and asking you to cough, the doctor can feel if you have a hernia.

It's good for girls to know about hernias, too, because they can affect you, especially if you've been pregnant or are obese. A doctor can check for any possible hernias in girls by gently pressing on the organs or looking for possible signs during an examination.

Types of Hernias
Inguinal Hernias
Inguinal (pronounced: in-gwuh-nul) hernias are more likely to occur in guys than girls. More than 70% of all hernias that occur are inguinal hernias, which means that a part of the intestines protrudes through an opening in the lower part of the abdomen, near the groin, called the inguinal canal. In guys, the inguinal canal is a passageway between the abdomen and the scrotum through which a cord called the spermatic cord passes (the testicles hang from the spermatic cord). In girls, the inguinal canal is the passageway for a ligament that holds the uterus in place. Nearly all cases of inguinal hernias in teens are due to a congenital defect of the inguinal canal. Instead of closing tightly, the canal leaves a space for the intestines to slide into.

If you have an inguinal hernia, you might be able to see a bulge where your thigh and your groin meet. In guys, the protruding piece of intestine may enter the scrotum, which can cause swelling and pain. Other symptoms of an inguinal hernia might include pain when you cough, lift something heavy, or bend over. These types of hernias require surgery to repair; in fact, inguinal hernia operations are the most common type of surgery performed on kids and teens.

Umbilical Hernias
Umbilical hernias are common in newborns and infants younger than 6 months. They occur when part of the intestines bulge through the abdominal wall next to the belly button. In babies with umbilical hernias, parents may see bulging around the belly button area when the baby cries. Unlike other types of hernias, umbilical hernias may heal on their own, usually by the time a baby is 1 year old. If not, surgery can repair the hernia.

Epigastric Hernias
In an epigastric (pronounced: eh-pih-gas-trik) hernia, which is also called a ventral hernia, part of the intestines protrude through the abdominal muscles located between the belly button and the chest. It's mostly guys who have to worry about this type of hernia - about 75% of epigastric hernias occur in males. People with this type of hernia may notice a lump. Surgery is a common way to fix this problem.

Incisional Hernias
If you've had surgery in your abdominal area, you might experience this type of hernia. In incisional hernias, part of the intestines bulge through the abdomen around a surgical incision. In this case, surgery actually weakened the muscle tissue in the abdomen. This type of hernia requires another surgery to repair it.

Hiatal Hernias
This type of hernia occurs at the opening of the diaphragm where the esophagus (the pipe that food travels down) joins the stomach. If the muscle around the opening to the diaphragm becomes weak, the uppermost part of a person's stomach can bulge through the diaphragm. Hiatal (pronounced: high-a-tul) hernias are common, although small ones don't usually cause any symptoms. Unlike the other types of hernia, you won't be able to see a bulge on the outside of your body, but you might feel heartburn, indigestion, and chest pain. Hiatal hernias can be treated with medication and diet changes, but they do sometimes require surgery.

What Do Doctors Do?
If you notice a bulge or swelling in your groin, abdomen, scrotum, or thigh, you should talk to your doctor. Sometimes a hernia may also cause sharp or dull pain and the pain may worsen when you are standing.

With most types of hernias, including inguinal, umbilical, epigastric, and incisional, your doctor will be able to see and feel the bulge and diagnose you with a hernia.

Except for umbilical hernias in babies, hernias don't just go away on their own - you must talk to your doctor and receive treatment. Over time, your hernia may become larger and more painful, and in some cases of hiatal hernia, a piece of the intestine could become trapped (this is known as incarceration). In a true surgical emergency, the blood supply could be cut off to the incarcerated intestine (this is known as strangulation). This situation is painful and dangerous because it can cause infection and may cause the strangulated tissue to die, so it's important to call your doctor.

If you've had a hernia operation and you notice redness or discomfort around your incision (the area where the cut was made to perform the operation), be sure to let your doctor know. It could be a sign of infection that will require further treatment.


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