AboutLauri Ordway Expertise I can answer your questions related to peripheral vacular disorders. This includes all arteries and veins except those inside the head and inside the heart. IE: neck (carotid), arms (carotid subclavian bypases to Thoracic Outlet) belly (aortic aneurysm & occlusive disorders, renal artery stenosis), legs (iliac, femoral, popliteal, peroneal, dorasalis pedis, posterior and anterior tibial) arteries. Aneurysm & occlusive disease, atherosclerosis, leg pain, arterial wounds and gangrene, amputation prevention. Vein disorders: Blood Clots (DVT), post-phlebetic syndrome, varicose veins, venous stasis ulcers. I can help with vascular wound treatments. Also, Raynauds, Buerger`s disease, Thoracic Outlet and other miscellaneous vascular disorders.
I CANNOT answer questions about your heart disease, blood pressure, brain aneurysm, although I can help with questions about the arteries that go to and from those organs.
Experience I am a nurse, I have worked for 14 years with two terrific peripheral vascular surgeons, one of them is also the inventor of very innovative wound care products and surgical instruments to make vascular surgery procedures better and faster. I wrote and manage our clinic website and field questions from patients all over the world.
Expert: Lauri Ordway Date: 2/15/2004 Subject: Carotid Arteries
Question Hi Lauri, I am a 62 year old type two diabetic male. Smoked about 20 years but quit 10yrs. ago.
About 8 years ago after arteriogram was dianosed with 100% occluded right internal carotid and approximately 35% left occlusion. Had tripple bypass in April of 2001. Patent Ductus in 1959. I have been checked each year for the carotid using ultra sound. All has remained the same for several years. Had dizzy spell and numbness of left hand for a few seconds one evening and then dizziness and "jelly" legs the next evening. Making it to a chair--recovered after a minute or two with no problems. Mentioned this to cardiologist(heart good) and he sent me back to the vascular surgeon who 6 months ago said all was good for another year, but now, he wants to open the left carotid. He also says the guidelines have changed and it is now recommended to open carotid at 40-60% which is where he says I now am(according to new guidelines) Ultra sound shows all is the same. He sent me for an MRI(with contrast)last week and that showed same info as ultra sound plus back arteries to brain open. Then said there was one artery not showing up in the left front of the brain, and this "surprised" him. Said if it were truly closed, I would have suffered massive stroke. Am now having arteriogram on Tuesday(17Feb) to look for the "missing" artery. My question is: What is the risk factor for opening left carotid with 100% occlusion of the right carotid. Diabetes, heart surgery, etc. have not caused major anxiety levels, but this carotid artery surgery does. Appreciate any thoughts, etc. Are they doing any experimental opening of 100% occlusions? Thanks, Dale Sorry this is choppy, etc.
Answer Dale,
you want to know what is the risk factor for opening left carotid with 100% occlusion of the right carotid?
my standard reply to our patients, in your situation is "much, much less than doing nothing."
obviously, we hope that your angiogram reveals what is called a "string sign" rather than 100% closed, if string sign is found, endarteredtomy can be done, where, as you know, nothing to be done for 100% out.
The term carotid string sign is been used to describe very high grade carotid stenosis with a long, thin, barely discernible poststenotic segment. To the vascular surgeon, neurosurgeon, or interventional radiologist, the presence of this sign usually signifies that the ICA is not occluded, and is potentially salvageable via carotid endarterectomy or carotid stenting .
you don't mention what type of surgeon you have helping you, I would suggest that you have another opinion with a peripheral vascualr surgeon, who has done more than 100 of these cases over the past few years
if yo dont have such a surgeon, and want a name or two, let me know where you are...nearest large cities or university towns
