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Vascular Center specialists repair blood vessels, restore quality of life - 05/04/2007

By Nancy Martin

Several months ago, Ronald Palumbo found trips to the store agonizing.

By the time the New Britain man walked from the handicapped parking spot to the store entrance, excruciating leg cramps and numbness in his feet forced him to stop and rest.

“I’d wake in the middle of the night with the cramps, too,” says Palumbo, 61. “I dreaded going to sleep.”

Palumbo suffered from peripheral vascular disease (PVD), caused when fatty deposits, cholesterol, calcium, and other substances build up as plaque in the arteries to the legs and restrict blood flow.

Palumbo was referred to Manny Katsetos, MD, a board-certified cardiologist at The Hospital of Central Connecticut’s Vascular Center.

The center, which opened last December on the New Britain General campus, is also staffed by surgeons and interventional radiologists experienced in diagnosing and treating conditions involving the body’s blood vessels.

The center treats a variety of conditions. Two of the most common are PVD and abdominal aortic aneurysms – which occur when a section of the artery supplying blood to the abdomen, pelvis and legs enlarges abnormally or balloons out.

“The center gives patients convenient access to physician specialists from three disciplines,” says board-certified interventional radiologist Kevin Dickey, MD, Vascular Center co-director. Katsetos and associate chief of surgery Robert Napoletano, MD, are the center’s other co-directors.
“Patients are seen by one of the specialists during their first appointment, and many tests may be performed that same day,” Dr. Dickey says. “Because patients don’t have to schedule multiple appointments for each diagnostic and treatment procedure, we can coordinate and expedite their care.”

That care may include conservative treatments like lifestyle changes, as well as medications, less-invasive surgical “endovascular” (performed inside the blood vessel) procedures and traditional surgical techniques such as bypass, says Scott Fecteau, MD, a board-certified vascular surgeon who specializes in peripheral and endo-vascular surgery. “We have a lot of tools available to treat vascular patients. The best treatment often depends on the severity of the problem, the patient’s anatomy and overall health and other factors,” says Dr. Fecteau.

“We offer the most current therapies available for the entire spectrum of vascular diseases – all in one setting,” Dr. Napoletano adds.

Getting patients moving again
The leg pain and fatigue Palumbo experienced during walking – called claudication – is a classic PVD symptom resulting from restricted blood flow. But many of the estimated 10 million Americans with PVD don’t know they have it.

“People with PVD in its earlier stages may have no symptoms or very subtle symptoms — one or both feet might feel a little cool or, a visit to the doctor for another problem might show they have no pulse in the foot,” Fecteau says.

Smokers and people with high blood pressure, heart disease and diabetes are more prone to PVD. “The disease can go undiagnosed because quite often other medical problems get most of the attention,” says Dr. Dickey. “Because of these other conditions, patients might not be that mobile. If they’re not walking, they probably won’t experience claudication.”

Other severe PVD symptoms caused by the plaque buildup or “hardening” of the arteries (atherosclerosis) can include leg-hair loss and/or non-healing leg and foot ulcers. Rarely, untreated PVD can lead to gangrene and leg amputation. The greatest risk is future heart attack and stroke, because people with PVD often have atherosclerosis in their heart and brain arteries.

The good news: many people can be treated with risk factor modification. “Quitting smoking, eating healthier, exercising, and controlling diabetes and blood pressure can keep the disease from getting worse,” Dr. Fecteau says.

Medication can also be effective. “In some cases we use the same medications and treatments we use for cardiac patients, including aspirin and other blood-thinning medications, as well as cholesterol-lowering medications,” Dr. Katsetos says.

Patients with more advanced PVD or other health conditions may require surgery. The traditional surgical treatment for blocked arteries in the legs and other areas of the body is bypass, in which surgeons create a new artery for blood to flow through, bypassing the blocked vessel. The new artery may be artificial or created from a piece of a patient’s vein. “For some patients, bypass is most effective,” says Dr. Napoletano, a board-certified general and vascular surgeon. “But other patients may benefit from the less-invasive endo-vascular procedures, which usually result in less pain and allow for a shorter hospital stay and faster recovery.”

Dr. Katsetos performed an endo-vascular angioplasty and stenting procedure on Palumbo. With Palumbo under local anesthesia, Dr. Katsetos inserted a catheter into his groin area and guided it to the blockages using fluoroscopy (a moving X-ray image projected onto a monitor). For the angioplasty part of the procedure, he inserted a tiny deflated balloon through the catheter into the arteries and expanded the balloon to break up the plaque. To keep the arteries open, Dr. Katsetos then inserted narrow, wire mesh tubes called stents. Once in place, the stents were expanded to hold the arteries open.

Palumbo had two stents placed in one leg and one in the other. His procedure was performed in the morning and “by 6 p.m. I was up walking.” After an overnight hospital stay, he began easing back into the exercise routine that helps him manage his heart disease and diabetes. Now, instead of parking in handicapped spots, he parks at the far end of the lot and takes a little stroll inside the store, too.

“My legs feel great,” he says. “I shake my head sometimes and wonder why I didn’t take care of this a long time ago.”

Disarming a “time bomb”
Leo Manville lived for years with a slowly growing danger.
Eighteen years ago, the Meriden man was getting an ultrasound to check for heart problems when his doctor discovered a 2-centimeter aneurysm in his abdominal aorta.

Aneurysms – enlarged, weakened areas of a blood vessel – most often occur in the abdominal aorta and pose two major risks: blood clots can form in them and travel to other arteries, or the aneurysms can rupture. According to the Society of Interventional Radiology, 50 percent of people with untreated abdominal aortic aneurysms (AAA) die of rupture.

While an aneurysm can sometimes be felt as a pulsing lump in the abdomen or cause abdomen, side or back pain, “in most cases there are no symptoms, so a lot of people don’t know they have this very dangerous condition,” says board-certified surgeon Akella Sarma, MD. “I was living with a time bomb, and I had no symptoms,” says Manville, 71.

“We usually find the aneurysm by accident when the patient is being examined for another condition, or we decide to screen for aneurysms based on family history,” Dr. Sarma says.

Doctors often monitor aneurysms under 5.5 centimeters for changes in size and status; Manville had regular CT scans for 18 years. When his aneurysm had grown to 5 centimeters, Dr. Sarma advised repair.

Currently there are no effective non-surgical treatments for AAA. Depending on the patient, AAAs can be surgically repaired using minimally-invasive endovascular procedures or traditional “open” surgery to replace the damaged section of the aorta.

Because of his aneurysm’s size and Manville’s anatomy, Drs. Sarma and Fecteau removed the damaged part of the aorta and implanted a manmade tube called an aortic graft. Now blood flows through the tube instead of the weakened blood vessel walls.
The hospital’s Vascular Center also offers endovascular stent grafting to reinforce artery walls. Small incisions are made in the groin, and catheters threaded to the weakened area of the blood vessel are used to place a special endovascular stent graft (endograft).

“Many patients who receive endografts go home the next day and return to their regular activities fairly quickly,” Dr. Fecteau says.

“The less-invasive endovascular procedures are a big advantage for patients who can have them,” Napoletano says. “We’ve been performing them for years with great success.”

After years of watching and waiting, Manville can go dancing with his wife, Hildegard, and exercise with friends in the cardiac rehab program at the hospital’s Bradley Memorial campus without worry.

“My experience at the hospital has been great,” he says. “It’s a relief to have this taken care of. I feel good.”


What Is the Vascular System? (sidebar)
The vascular system – also called the circulatory system – is often compared to a network of highways. The “roads” include the veins and arteries (known as blood vessels) that run throughout your body.

Arteries carry blood rich with oxygen and other nutrients throughout the body for use by muscles, organs and other tissues. The blood is pumped from the heart to the aorta, the main artery, then travels through a series of progressively smaller arteries.

The oxygen-rich blood then travels to capillaries, tiny blood vessels in the body’s tissues. The capillaries transfer the oxygen to the tissues, then pick up oxygen-depleted blood and deliver it to the veins.

The veins carry blood back to the lungs, where the blood receives a fresh supply of oxygen. The pulmonary vein carries the oxygenated blood to the heart, so it can be pumped back out through the arteries, completing the circulatory circuit.