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PVD, DVT, and other Vascular Disorders in the Arms and Legs

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Peripheral vascular disease (PVD), or peripheral artery disease (PAD), is vascular disorder characterized by a narrowing of the arteries that carry blood to the leg and arm muscles. This disease reduces blood flow, especially to the legs and feet, making walking painful and difficult. It can also cause insufficiency in the veins carrying blood back to the heart, creating pooling of blood in the lower extremities with heaviness and pain. The most common cause of PVD is atherosclerosis (the buildup of plaque in the artery wall). PVD is a slow and progressive circulation disorder.

Other vascular conditions associated with PVD include:

  • Deep vein thrombosis (DVT): A thrombus or clot forms in a deep vein, and has the potential to dislodge, travel to the lungs, and cause a potentially life-threatening event.
  • Varicose veins: These dilated, twisted veins are caused by incompetent valves (valves that allow backward flow of blood) allowing blood to pool. It is most commonly found in the legs or lower trunk. Symptoms include bruising and sensations of burning or aching and chronic venous insufficiency.
  • Buerger's disease (thromboangiitis obliterans): This chronic inflammatory disease in the peripheral arteries of the extremities leads to the development of clots in the small- and medium-sized arteries of the arms or legs and eventual blockage of the arteries.
  • Raynaud's phenomenon: In this condition, the smallest arteries that bring blood to the fingers or toes constrict (go into spasm) when exposed to cold or as the result of emotional upset.
  • Lymphedema: This peripheral vascular disease causes swelling in the arms or legs because of blockage in the lymphatic vessels.
  • Thrombophlebitis: Most commonly occurring in the legs, a blood clot in an inflamed vein causes red streaks in the area and danger of the clot traveling.

Why Choose UHealth?

Multidisciplinary care by recognized specialists in their field.  In complex cases, heart disease care may require the services of a cardiothoracic surgeon, an interventional cardiologist, a lung specialist, a diabetes specialist and a geneticist. Your doctors talk to each other and make sure all specialties involved in your care are on-board with a unified treatment plan.


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Over 80 million American adults (more than one in three) have cardiovascular disease (CVD). Nearly 2,300 Americans die of CVD every day — that’s one death every 38 seconds. This number can be significantly reduced through education and early detection.


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Treatments

  • PVD and atherosclerosis


    • Controlling risk factors, including regular exercise, proper nutrition, and smoking cessation are important for maintaining circulation.
    • Aggressive treatment of existing conditions that may aggravate PVD, such as management of diabetes, hypertension, and hyperlipidemia (elevated blood cholesterol) are critical to long-term health.
    • Different drugs such as blood thinners can help to improve blood flow, and medications that relax the blood vessel walls can be helpful.
    • In an angioplasty, a long hollow tube can be inserted into the vessel to create a larger opening and increase blood flow. Different types of angioplasty may be performed.

      • During a balloon angioplasty, a small balloon is inflated inside the blocked artery to open the blocked area and is then removed.
      • Atherectomy, the blocked area inside the artery is "shaved" away by a tiny device on the end of a catheter.
      • Laser angioplasties use a laser to "vaporize" the blockage in the artery.
      • Finally, a stent is a tiny coil which is expanded inside the blocked artery to open the blocked area and keep the artery open.

    • Vascular surgery involves a bypass graft using a blood vessel from another part of the body or a tube made of synthetic material being placed in the area of the blocked or narrowed artery to reroute the blood flow
  • Varicose Veins


    • The most common treatment for both spider and varicose veins, is sclerotherapy. This procedure involves a saline or chemical solution that is injected into the varicose veins so they harden and no longer fill with blood. The veins that received the injection will eventually shrivel and disappear. The scar tissue is absorbed by the body
    • Laser treatment can also be used to treat varicose veins. There are several types of lasers that may be used. A laser fiber inserted into a varicose vein through a catheter sends out laser energy that destroys the diseased portion of your varicose vein so your body can absorb it.
    • Finally, during Ablation, a thin, flexible catheter inserted into a varicose vein heats the walls of the veinand destroys the vein tissue so it can be absorbed.
  • Deep Vein Thrombosis (DVT)


    • Anticoagulants or blood thinners, can keep the clot from growing and prevent others from forming. Treatment with blood thinners may last from three to six months. If a blood clot develops after surgery, treatment may be shorter. If there have been previous clots or treatment for another illness is underway, the treatment may last as long as risk factors are present.
    • "Clot busters" such as Fibrinolytics or thrombolytics can dissolve a clot quickly, over a period of a few days and may be used in certain situations as determined by a physician.
    • Thrombin inhibitors can disrupt the formation of a clot. Patients who cannot take heparin may be given one of these medications.
    • In some cases, a vena cava filter may be inserted into the large vein which returns blood from the body to the heart if you cannot take medication or if blood thinners are not working. The filter is a kind of "clot catcher."

Tests

  • Angiogram

    After inserting a thin, flexible tube into an artery in the leg and injecting a contrast dye to make the arteries and veins visible, an x-ray of your arteries and veins can detect blockage or narrowing of the vessels. 

  • Ankle-Brachial Index (ABI)

    This test compares the blood pressure in the ankle with the blood pressure in the arm using a regular blood pressure cuff and a Doppler ultrasound device.

  • Blood Lipid Profile

    This blood test measures the levels of each type of fat in your blood: total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and others.

  • Doppler Ultrasound Flow Studies

    Doppler uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs to measure and assess the flow of blood. 

  • Magnetic Resonance Angiography (MRA)

    This noninvasive diagnostic procedure uses a combination of a large magnet, radio frequencies, and a computer to produce detailed images of organs and structures within your body, to assess blood flow.

  • Treadmill Exercise Test

    This test is given while you walk on a treadmill to monitor your heart during exercise.

  • Photoplethysmography (PPG)

    Comparable to the ankle brachial index, this test uses a very tiny blood pressure cuff around the toe and a PPG sensor (infrared light to evaluate blood flow near the surface of the skin) to record waveforms and blood pressure measurements compared to the systolic blood pressure in the arm.

  • Pulse Volume Recording (PVR) Waveform Analysis

    This technique calculates blood volume changes in the legs using a recording device that displays the results as a waveform.

  • Reactive Hyperemia Test

    Similar to an ABI or a treadmill test, this procedure is used for people who are unable to walk on a treadmill. While you are lying on your back, comparative blood pressure measurements are taken on your thighs and ankles to determine any decrease between the two sites. 

  • Segmental Blood Pressure Measurements

    This measurement compares blood pressure measurements in different areas using a Doppler device on the upper thigh, above and below the knee, at the ankle, and on the arm to determine any constriction in blood flow.

  • Duplex Ultrasound

    This is the most commonly performed diagnostic test for DVT and involves using high frequency sound waves to look at the speed of blood flowand the veins. Occasionally a blood clot may be visualized by ultrasound. This procedure is noninvasive (the skin is not broken) and involves placing ultrasound gel on the affected area and then moving a handheld device across it. A picture of the blood flow is displayed on a monitor. 

  • Magnetic Resonance Imaging (MRI)

    This diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body is particularly effective in diagnosing deep vein thrombosis in the pelvis.

  • Venogram

    Using X-rays and intravenous (IV) contrast dye to visualize the veins allows the physician to visualize the blood vessels being evaluated

  • Color-Flow Imaging (Triplex Ultrasound) 

    This procedure is similar to the duplex ultrasound that uses color to highlight the direction of blood flow.

  • Magnetic Resonance Venography (MRV)

    This diagnostic procedure uses magnetic resonance technology and intravenous (IV) contrast dye to visualize the veins. MRV is useful in some cases because it can help detect causes of leg pain other than vein problems.

Accepted Insurances

Note: Health plans that are currently contracted with UHealth are listed below. However, please check with your insurance provider to verify that UHealth is part of your provider network.

  • Aetna WC
  • Aetna Affiliates/Signature Adm (ASA)
  • Aetna Behavioral Health
  • Aetna Elect Choice (EPO)
  • Aetna Florida Healthy Kids
  • Aetna HMO
  • Aetna Medicaid HMO
  • Aetna Medicare HMO
  • Aetna Medicare PPO
  • Aetna POS
  • Aetna PPO
  • Aetna UM Employee HMO 1
  • Aetna UM Employee HMO 2
  • Aetna UM Employee POS HRA
  • Aetna/Coventry Institutes of Excellence (IOE)
  • Amerigroup Florida Healthy Kids
  • Amerigroup Medicaid HMO
  • Argus Vision
  • AvMed Choice
  • AvMed HMO/POS
  • AvMed MDC and JHS Groups
  • AvMed Medicare HMO
  • AXIS
  • BCBS Blue Options Network Blue PPO
  • BCBS BlueCare HealthOptions HMO
  • BCBS BlueChoice PPC/PPO
  • BCBS Miami Dade Blue PPO Limited Benefits Plan
  • BCBS of Florida (All products except "SELECT" Plans)
  • BCBS of Florida (Commercial plans exclude HIX Select)
  • BCBS Traditional PHS/PPO
  • Beacon Health (ValueOption)
  • Beech Street PPO
  • Broward Health Medical Center
  • CarePlus Medicare HMO
  • Catholic Hospice
  • CCP/CMS Title XIX (Medicaid Enrolled in South Florida)
  • CCP/CMS Title XXI (Non Medicaid Enrolled in South Florida)
  • CCP/MMA (Broward County residents)
  • Charlotte County Sheriffs Office PPO
  • Cigna Affiliates
  • Cigna Behavioral Health
  • Cigna Dental HMO/PPO
  • Cigna EPO
  • Cigna HMO
  • Cigna Life Source (Intracorp is part of Cigna Lifesource)
  • Cigna MDCPS Jackson Sr. High
  • Cigna POS
  • Cigna PPO
  • Cigna Shared Administration
  • Clear Health Alliance SNP Medicaid HMO
  • CompCare (Comprehensive Behavioral Care)
  • Concordia Behavioral Health
  • CorVel WC
  • Coventry First Health WC
  • Coventry Health Care of Florida (HIP) HMO/POS
  • Coventry Health Care of Florida (HIP) PPO
  • Coventry Health Plan of Florida (Foundation) HMO
  • Coventry Health Plan of Florida (Foundation) POS
  • Coventry National PPO
  • Coventry Summit Medicare HMO
  • Coventry Vista Medicare HMO
  • Coventry Vista Medicare HMO
  • Delta Dental PPO
  • DentaQuest (ADI)
  • DIKLA
  • Dimension WC
  • Dimension Plus PPO
  • EHN PPO
  • EQUIAN (Health Systems International)
  • Europe Assistance/Global Corporate Solutions (Care Management Network)
  • eyeQuest
  • FCCI WC
  • Florida Healthcare Plan (Affiliate of BCBSFL)
  • Florida PACE (FPC)
  • Freedom Health Medicaid HMO
  • Freedom Health Medicare HMO
  • Gallagher Bassett WC (MDCPS & FCSRMC)
  • Global Excel Mgt PPO
  • Global Health Claims Services
  • Great West (Cigna) HMO/POS
  • Guardian Life PPO
  • HAA Preferred Partners
  • Health First Health HMO/POS
  • Health First Health Medicare HMO
  • Health First Health PPO
  • Health Net Veterans Choice HMO
  • Heritage Summit Healthcare WC
  • Humana Behavioral Health (LifeSynch)
  • Humana Dental/CompBenefits/OHS
  • Humana EPO
  • Humana HMO
  • Humana HUMx
  • Humana Medicaid HMO
  • Humana Medicare HMO
  • Humana National Transplant
  • Humana PPO
  • Humana Premier
  • iCare Health Solutions
  • Interlink Health Services
  • International Kids Fund (IKF)
  • League Medical Concepts Federal Inmates
  • Life Trac
  • Magellan Behavioral Health
  • Magellan Complete Care SNP Medicaid HMO
  • MDAbroad
  • Medica Medicare HMO
  • Medical Development In't (MDI)-Federal Inmates
  • Medicus
  • Metlife Dental PPO
  • MHNet Behavioral Network (MHNet)
  • Molina
  • Molina Market Place
  • Molina Medicaid HMO
  • Molina Medicare HMO
  • Morgan White International
  • MultiPlan PPO
  • Naphcare (Federal Prisoners)
  • National Healthcare Solutions Inc.
  • Neighborhood HealthPlan HMO/POS
  • Neighborhood HealthPlan PPO
  • North Broward Hospital District PPO
  • Olympus Managed Healthcare
  • Optum
  • Positive Healthcare SNP Medicaid HMO
  • Positive Healthcare SNP Medicare HMO
  • Prestige Health Choice Medicaid HMO
  • Prime Health Services WC
  • Quality Health Management
  • Religious Order of Jehovah's Witnesses PPO
  • Rockport Healthcare Group WC
  • Royal Caribbean Cruises PPO
  • Sanus Health Corporation
  • Simply Healthcare Medicaid HMO
  • Solstice Dental HMO/PPO
  • Start Healthcare Network
  • Sunshine
  • Sunshine AMBETTER
  • Sunshine Healthy Kids HMO
  • Sunshine Medicaid HMO
  • Sunshine Medicare HMO
  • Tricare South Prime HMO
  • Tricare South Standard PPO
  • United Behavioral Health (UBH)
  • UnitedHealthcare Affiliates
  • UnitedHealthcare Healthy Kids HMO
  • UnitedHealthcare HMO/POS
  • UnitedHealthcare Medicaid HMO
  • UnitedHealthcare Medicare Nursing Home Plan
  • UnitedHealthcare PPO
  • University of Miami Athletic Dept PPO
  • VUMI
  • Wellcare/Staywell Healthy Kids HMO
  • Wellcare/Staywell Medicaid HMO
  • Wexford Health State Inmates
  • Worldwide Managed Care