Should You Be Seeing a Vascular Specialist?

What is vascular medicine and how does it relate to your overall health? As part of American Heart Month, Resource editors spoke with Ian del Conde, M.D., associate chief of cardiology and director of vascular medicine with Baptist Health Miami Cardiac & Vascular Institute. Dr. del Conde leads several clinical programs within the Institute, including the Vascular Medicine Program, the Hypertension Clinic and the Venous Thrombosis program.

Dr. del Conde discussed how vascular medicine has helped fill a void in our nation’s intervention-focused healthcare system, and how vascular specialists strive to treat the complete patient over the long term – not just their symptoms at that moment in time.

Ian del Conde, M.D., associate chief of cardiology and director of vascular medicine with Baptist Health Miami Cardiac & Vascular Institute

Resource: What exactly is vascular medicine?

Dr. del Conde: Vascular medicine is a relatively new specialty that focuses on the diagnosis and treatment of circulatory problems within the blood vessels. It got its start some 40 years ago with the recognition that no single specialty focused on the diagnosis, evaluation and management of patients with vascular disease. That spurred the development of vascular training programs around the U.S.

Baptist Health Miami Cardiac & Vascular Institute is one of those programs and is today one of the country’s premier vascular centers, thanks to the vision of its founder, Barry Katzen, M.D., an innovator who continues to play a huge role in the field. Dr. Katzen has created a culture of excellence here and trained generations of vascular radiologists. The Institute’s residency program is considered to be one of the nation’s best.

Resource: What does vascular medicine encompass?

Dr. del Conde: Arteries and veins are the most important components of the vascular system. At Miami Cardiac & Vascular Institute, we specialize in treating arterial issues such as carotid artery stenosis, a narrowing of the large arteries on either side of your neck; atherosclerosis, a build-up of plaque on the vessel walls that can obstruct blood flow; peripheral arterial disease, or PAD, which is very common; and lymphedema, or swelling of the extremities due to a build-up of lymphatic fluid in the body.

We treat venous issues as well, including blood clots, deep vein thrombosis (DVT) and chronic venous insufficiency, which can occur when the veins in your leg don’t allow blood to flow back up to your heart. We also treat patients with congenital malformations; inflammatory conditions; vasculitis; aneurysms; and dissections, or tears of the arteries.

Resource: How would someone know if they have vascular disease?

Dr. del Conde: Vascular disease is a broad term – it doesn’t imply which vessel is affected – and symptoms can vary depending on which organ is being supplied by the affected vessel. But for the purpose of this discussion, let’s focus on perhaps the most worrisome form of vascular disease, which is peripheral arterial disease. PAD is a slow and progressive disorder in which the blood vessels, particularly those in your legs, become narrow or blocked due to atherosclerosis, or the build-up of cholesterol plaques. This prevents your extremities from getting enough blood, and it can be quite painful.

Patients at risk for PAD are the same patients who are at risk for heart attacks and stroke, which is why we pay such close attention to cardiovascular risk factors, which include a history of smoking, diabetes, levels of physical activity, high blood pressure and high cholesterol. As cholesterol builds up in the arteries over the span of many years, blood flow in those arteries is progressively obstructed, resulting in malfunction in the downstream tissues and organs.

Patients with PAD are at an increased risk for developing serious problems with their legs, which can result in amputation, and they also have a much higher incidence of heart attack and stroke. As a result, they require intensive and aggressive management – not just at the moment but over time. Symptoms of vascular disease can be treated and even reversed, but patients still need to be followed by a specialist.

Resource: How is vascular disease diagnosed?

Dr. del Conde: Diagnosing vascular disease – whatever form it takes – really starts with a physical exam. When performed by an experienced vascular medicine specialist, the exam itself can sometimes trump sophisticated and expensive tests. If needed, we can step up to non-invasive vascular lab testing with ultrasound, and if further imaging is required, we can move on to CAT scans and MRIs. A small number of patients will need an angiogram, in which a traceable dye is injected into the vascular system, allowing the radiologist to clearly see any issues.

If you’re experiencing leg pain or fatigue, especially that which occurs during physical activity but then disappears with rest, you should see your primary care physician or vascular specialist as soon as possible for an evaluation. If there’s any concern that whatever symptoms you have could be vascular but you can’t put a name to it, see a vascular specialist – we’re trained to diagnose even the rarest and most complex conditions. People with a parent, sibling or child who has had an aortic aneurysm (rupture) or dissection (tear) are also at higher risk for vascular disease and should be evaluated by a vascular medicine specialist.

Resource: How is vascular disease treated?

Dr. del Conde: The way that vascular conditions have typically been managed by the U.S. medical establishment is with vascular surgeons and other doctors who focus on vascular system interventions. What’s been missing is a clinical specialist – not a proceduralist or a surgeon whose focus is fixing the problem but someone who looks at the patient as a whole. This void has been filled in other countries by a specialty that historically hasn’t existed here in the U.S. until recently.

In the field of vascular medicine, we focus on the complete patient, from making the diagnosis to understanding the disease and – this is the critical part – managing the patient’s conditions over the long term. When treating vascular disease, the goal is not just to improve the patient’s symptoms and thus their quality of life, but also to prevent adverse events such as limb amputation, heart attack or stroke.

Surgery can be part of the solution but it’s not necessarily the only solution. Medications and lifestyle modifications play an important role, too, and that’s where a vascular medicine specialist fits in. Determining the appropriate treatment or procedure for the patient is the essence of what we do.

To be effective in our role requires close cooperation with other specialists, however. At Miami Cardiac & Vascular Institute, I’m extremely fortunate to have a multidisciplinary team of world-class interventional radiologists and vascular surgeons as my closest partners. We also have outstanding vascular imaging using the most advanced ultrasound, CAT scan and MRI technology.