Vascular Disease Foundation - Fighting Vascular Disease... Improving Vascular Health.

Interactive Learning : Ask the Doctor

 

Ask the Doctor Live Chat Transcript - Wednesday, February 20

Dr. Kenneth Cherry

Department of Vascular Surgery, University of Virginia

Vascular Disease Foundation Board of Directors

 


Moderator- VDF: Welcome and thank you for joining us today. We would like to introduce Dr. Kenneth Cherry who will be taking your questions today. Please type in your questions and wait for Dr. Cherry's response.


Hallie: How long do stents or graphs last for?

Speaker- Dr. Cherry: No one knows the answer to that with absolute certainty, the material itself in prosthetic grafts, as made now, will last a patient's lifetime. The patency of those grafts depends on what arteries are bypassed. The larger the artery, the better the patency in general. Stents have not been used as long, and we know that they may last and function well for up to 12 - 15 years, but long term data is still being determined.


Moderator- VDF: This next question was e-mailed to us ahead of time: I had an Achilles tear repair and found I had a DVT shortly after the cast was removed at the end of December. I'm currently on Coumadin, with the clot persisting (no discomfort) after 6 weeks (I had my 3rd scan was today). I'm 61 and in good shape and physically active before the tear. I'm a bit confused...in a catastrophic situation tPA (tissue plasminogen, clot-busting drug). would be administered to dissolve a clot. I understand it's risky, but persistence of the clot is detrimental too. Is there any protocol or study using enzymes or other substances to reduce the clots in a shorter period of time without increasing the risk for the clot traveling?

Speaker- Dr. Cherry: Most surgeons or other vascular specialists would not use “clot-dissolving" drugs for DVT confined to the calf short of extraordinary symptoms of pain or swelling. In general, the risks from those drugs outweigh the benefits for localized DVT.


Anna: My husband recently had an aneurysm and survived. What is the risk of him having another (he smoked in that past but has since quit) and does our son need to be concerned about having this same problem?

Speaker- Dr. Cherry: The chances he will develop another aneurysm either related to the repair itself or in another separate location is only about 8%. He should be followed by his doctor on an annual basis. The abdominal aorta is the most likely area for aneurysms. Other sites occur much less frequently. Your son should get an abdominal ultrasound when he is 55, which checks the size of your abdominal aorta below the arteries to the kidneys. It is not an invasive test.


Hallie: What’s the difference between a dissection and an aneurysm?

Speaker- Dr. Cherry: Hallie, an aneurysm is a localized enlargement or bulging of an artery, usually to twice its normal size. A dissection occurs when there is a split or tear in the inner most of the three layers of an artery allowing blood flow on both sides of that layer, dissecting the artery and creating 2 channels of flow. It may cause an aneurysm in about 30% of patients.


Hallie: So a dissection causes an aneurysm?

Speaker- Dr. Cherry: Hallie, a dissection may cause an aneurysm over time; it is a cause, not the cause of course.


Moderator- VDF: This next question was e-mailed to us ahead of time: I was diagnosed with DVT with a clot in my groin, and was hospitalized two weeks ago. My doctor said I could not go back to work until my INR was stabilized. I work as a secretary, sitting for long periods of time. Is it OK to be doing this?

Speaker- Dr. Cherry: Once your INR* is around 2.5, you could go back to work depending on the amount of swelling or pain that you have.

*INR stands for International Normalized Ratio and is used to determine the clotting tendency of blood.


Sarah: My neighbor had an aortic dissection but was kept on a watched program. I think he was on blood pressure medicine and then told to keep fairly inactive. Why not fix it right away as his family has been sort of on-hold for the past several months?

Speaker- Dr. Cherry: The indications to operate on dissections are for size increases with aneurismal changes; problems with ischemia or lack of adequate blood flow to one of the internal organs or extremities or persistent pain. The presence of a dissection beyond the arteries to the arms, which it sounds like your neighbor has, without those complicating features, it is better treated with blood pressure control than with surgery. Stent grafts are now being used instead of formal surgery in the right situations.


Moderator- VDF: This next question was also e-mailed to us ahead of time: My father (79) had a bypass in his leg but it failed within 6 months. At the moment he is pain free but no doubt the pain will soon return. Amputation seems the only option but I understand that the body may be able to grow new veins to bypass the blockage itself. Is this true? Is so, what can he do to encourage the growth? Is there anything else you can recommend, he is taking clopidogrel, simvastatin and aspirin and is a dialysis patient. Thanks!

Speaker- Dr. Cherry: The pain may not necessarily return. You did not mention whether he smokes or not. Diabetes, kidney failure, and especially smoking are a witch's brew for trouble. He may well develop natural bypasses. I don't believe any other drugs would help.


Peter: Hi Dr., Do you know anything about May Thurner Syndrome? My mother was diagnosed with that in 2006 and is on warfarin, will she have to be on it the rest of her life?

Speaker- Dr. Cherry: Peter, It is as you know compression of the iliac vein by the overlying artery. Most are treated now with stenting. Usually people need Coumadin for acute DVT, but once it is treated and the acute phase over 3- 6 months depending on your doctor, she would be taken off Coumadin.


Sarah: What's a stent graft and how long do they last? Is it a risky procedure? Why not do it right away since someone can die from the dissection?

Speaker- Dr. Cherry: Sarah, a very good question. It is a point of controversy. The stent which is supported by a metal lattice work and exerts outward force on the aorta may contribute to aneurismal degeneration. Some people advocate early intervention with stents, but most advocate their use for the classic reasons I mentioned earlier.


Maria: My uncle died from a sudden aneurysm in his abdomen. I worry because my father (his brother) has high blood pressure and cholesterol. Is family history a risk factor for aneurysm?

Speaker- Dr. Cherry:: Maria, family history is a risk factor. With the added problems of high cholesterol and most especially high blood pressure, your dad should be checked for this by a doctor. An abdominal ultrasound would be the preferred test.


Hallie: Would a carotid artery balloon the same way an abdominal one does, or does it rupture in a different way? Is plaque, etc. more likely to cause the rupturing in the carotid?

Speaker- Dr. Cherry: Hallie, carotid arteries may develop aneurysms, but they are much, much less frequent than those of the abdominal aorta. They are more prone to develop dissections, usually related to high blood pressure. The most common problem with carotid arteries is blockage or narrowing, restricting flow or breaking off and letting debris go to the brain.


Peter: Are they as dangerous as abdominal aneurysms? I've heard the abdominal aneurysms are incredibly dangerous and that they don't really have any symptoms until it’s too late. Would a carotid rupture be in that same category- like if you don't know that you have one and it bursts or breaks is it a critical life threatening problem?

Speaker- Dr. Cherry: Peter, problems with the carotid are not as likely to cause rupture with massive bleeding, as are abdominal aneurysms. The problem with carotid dissections and with those rare aneurysms is worry about stroke. You are more likely to be hit by lightning than to have spontaneous rupture of a carotid aneurysm. Ultrasound, or duplex, is a very safe, noninvasive, and accurate way to have your doctor look at your carotid anatomy.


Moderator- VDF: This next question was also e-mailed to us ahead of time: Is frequent and severe dysentery possibly a symptom of AAA? I am 56 years old and have stomach cramps. I have had a colonoscopy with good results and no problems at all.

Speaker- Dr. Cherry: Regarding symptoms from aneurysms, it is unlikely to cause bowel symptoms. Usually they are without symptoms until they rupture or are rapidly enlarging. They may cause problems in the legs occasionally because the clot in the aneurysm may break off and block blood flow in the leg.


Moderator- VDF: Thank you all for joining us today! Please join us on March 26 for our next chat. Thank you Dr. Cherry for your time today, we wish you all a healthy day!

Speaker- Dr. Cherry: Thank all of you for your participation and for your thought-provoking and, I must say, very good questions. Ken Cherry.

Disclaimer

The material provided on VDF's Web site and Live Ask the Doctor chat are for educational purposes only and are not to be used as a substitute for professional medical services or advice. For more information, please read VDF's important disclaimer.