Dr Bray provides care for all peripheral arterial conditions

Aneurysmal Disease

  • Aortic (Abdominal or Thoracic)

  • Iliac

  • Popliteal

  • Other (Renal, Visceral, Traumatic)

Carotid Disease

Occlusive Disease

  • Lower Limb

  • Upper Limb

  • Renal and Mesenteric

  • In some cases, a person with peripheral vascular disease may not have any symptoms until the condition is advanced and severe. Symptoms may include:

    • Intermittent pain (claudication), which may feel like cramps, muscle fatigue or heaviness (usually in the legs)

    • Worsening pain during exercise (usually in the legs)

    • Easing of pain at rest (usually in the legs)

    • Coldness of the affected body part

    • Numbness

    • Pins and needles

    • Muscular weakness

    • Blue or purple tinge to the skin

    • Wounds that won’t heal (vascular ulcers)

    • Blackened areas of skin or skin loss (gangrene).

    We recommend discussing any symptoms with your GP who can refer you to Dr Bray for full assessment and diagnosis.

  • In most cases the cause of Peripheral Vascular Disease is Atherosclerosis (a build up of fatty deposits within a blood vessel) that reduces blood flow to the area.

    Other causes of peripheral vascular disease include:

    • Diabetes – High blood sugar damages and weakens blood vessels, causing them to narrow.

    • Obstruction – A blood clot (thrombus) may lodge within the blood vessel.

    • Infection – Can cause scarring and narrowing of the blood vessels.

    • Arteritis – Inflammation of arteries. Some autoimmune diseases can cause arteritis.

    • Blood vessel defects – Blood vessels may be unusually narrow.

    • Blood vessel spasms – Conditions including Raynaud’s Disease may cause narrowing of blood vessels in response to certain factors, including cold temperatures or stress.

  • These include:

    • Diabetes – this is the most significant risk factor

    • Cigarette smoking

    • Advancing age

    • Family history of peripheral vascular disease, stroke or coronary artery disease

    • Medical history of stroke, cardiovascular disease or heart attack

    • Overweight or obesity

    • Sedentary lifestyle

    • High blood pressure (hypertension)

    • High blood cholesterol (hypercholesterolaemia).

  • Diagnosis of peripheral vascular disease includes:

    • Medical history

    • Physical examination

    • Family history

    • Using a stethoscope to listen for signs of reduced blood flow through a blood vessel

    • Ankle Brachial Indices (ABI’s), which compare the blood pressure readings of the arms and legs to check for differences

    • Exercise test, usually performed on a treadmill while blood pressure is taken to detect decreases in blood pressure in the affected body part during exercise

    • Non-Invasive Vascular Duplex (doppler ultrasound)

    • Magnetic Resonance Imaging (MRI) to locate narrowed sections of blood vessels

    • CTA/Angiography, the injection of a contrast dye into the blood vessel that will show areas of constriction on x-ray examination.

    https://anzsvs.org.au/patient-information/assessment-of-vascular-disease/

  • Treatment options may include:

    • Best Medical Therapy to manage known vascular risk factors, prevent the complications of atherosclerosis, and slow its progression:

      • Medications to help with smoking cessation

      • Lipid lowering drugs such as statins

      • Antithrombotic drugs to prevent clots such as Aspirin

      • Antihypertensive drugs to reduce blood pressure

      • Diabetic medications to reduce sugars

    • Drugs to treat blood clots – Anticoagulants and Anti-platelet drugs to prevent blood clots from developing, and Thrombolytics to dissolve blood clots.

    • Angioplasty – Endovascular procedure usually performed under sedation and local anaesthetic. Involves threading a thin tube (catheter) into the narrowed blood vessel through a small incision. Once the catheter reaches the narrowed or blocked site, a small balloon on its tip can be inflated to widen the blood vessel and improve blood flow.

    • Stenting - A metal ‘sleeve’ that is implanted inside the narrowed blood vessel during an angioplasty procedure to hold it open. Stents may be impregnated with medications that help to prevent scar tissue from narrowing the treated area of blood vessel.

    • Atherectomy – Cutting away the fatty obstruction.

    • Bypass surgery – Usually only performed in severe cases that do not respond to other treatments, or where extensive areas of a blood vessel is diseased. Blood flow is re-routed around a blockage.

  • Lifestyle changes are an important part of treatment. Be guided by your doctor, but general preventative measures include:

    • Take steps to properly manage risk factors, such as diabetes or high blood pressure, as advised by your doctor.

    • Quit smoking.

    • Exercise regularly. Ask your doctor for advice on appropriate activities.

    • Eat a low-fat, high-fibre diet.

    • Maintain a healthy weight for your height and build.

    • Take care of injuries to affected areas, for example, dress wounds promptly and seek medical attention if wounds are not healing.

    • Take all medications strictly as prescribed.

    • See your doctor for regular check-ups.

    • See your doctor if you have symptoms of infection in the affected body part.

Patient Information - Australia New Zealand Society of Vascular Surgeons

Aneurysmal Disease

An aneurysm is an abnormal bulge or balloon in a weakened blood vessel wall. Over time, pressure from blood flow can cause this weakened area to further enlarge which may lead to vessel rupture.

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    • Abdominal Aortic Aneurysm (AAA)
      Occur in the part of the aorta that passes through the abdomen.

    • Thoracic Aortic Aneurysm (TAA)
      Develop in the chest (thorax).

    • Smoking (major risk factor)

    • High blood pressure (hypertension)

    • Family history of aneurysms

    • Age (more common after age 60)

    • Atherosclerosis (hardening of arteries)

    • Genetic conditions (e.g. Marfan Syndrome or Ehlers-Danlos Syndrome)

    • Infections (mycotic aneurysms)

    • Trauma or injury

  • Most aneurysms are asymptomatic until they become large or rupture. When symptoms occur, they may include:

    • Abdominal Aneurysm
      Pulsating feeling in the abdomen. Severe and sudden back or abdominal pain may indicate leak or rupture.

    • Thoracic Aneurysm
      Chest or back pain, difficulty breathing or swallowing.

    • Ultrasound (commonly for AAA)

    • CT Scan or MRI (detailed imaging for thoracic and complex aneurysms)

    • Angiography (visualizing blood vessels with contrast dye)

  • Regular Imaging
    To monitor growth.

    Medications
    To control blood pressure, cholesterol, and prevent growth.

    Surgical Intervention if the aneurysm achieves a size where the risk of rupture is equal to or greater than the risk of intervention:

    • Open Surgery: Removing and replacing the affected vessel segment.

    • Endovascular Repair (EVAR): Re-lining the aneurysm in a minimally invasive procedure using a stent graft.

    • Quit smoking

    • Manage blood pressure and cholesterol

    • Regular screening for high-risk individuals

    • Healthy lifestyle: Balanced diet, exercise, and regular check-ups

  • Routine check-ups are important if you have risk factors, especially a family history of aneurysms.

    Ruptured aneurysms are medical emergencies. An ambulance should be called if you have an abdominal or thoracic aneurysm and are experiencing:

    • Sudden severe abdominal-back pain

    • Low blood pressure

    • Loss of consciousness

Carotid Disease

Carotid Artery Disease occurs when the major blood vessels in the neck that supply blood to the brain become narrowed or blocked due to a buildup of fatty deposits called plaque. This condition can lead to serious complications including Transient Ischaemic Attack (TIA) or stroke.

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    • Atherosclerosis: The primary cause, where plaque builds up in the arteries.

    • High blood pressure (Hypertension)

    • High cholesterol levels

    • Smoking

    • Diabetes

    • Obesity

    • Sedentary lifestyle

    • Family history of heart disease or stroke

    • Age (risk increases with age)

  • Carotid artery disease often develops without noticeable symptoms until the arteries are significantly narrowed or blocked. The first sign may be a mini stroke or transient ischaemic attack (TIA).

    Signs of a possible stroke or transient ischemic attack (TIA) include:

    • Sudden numbness or weakness in the face, arm, or leg on one side of the body

    • Trouble speaking or understanding speech

    • Sudden loss of vision in one eye

    • Physical Examination
      Listening for a bruit (an abnormal sound indicating turbulent blood flow) over the carotid artery.

    • Ultrasound (Carotid Doppler)
      Non-invasive imaging to assess blood flow.

    • CT Angiography (CTA) or MR Angiography (MRA)
      Provides detailed images of blood vessels

    • Maintain a healthy lifestyle

    • Regular health monitoring and active management of blood pressure, cholesterol and diabetes

  • Lifestyle Changes:

    • Quit smoking

    • Healthy diet (low in saturated fats, cholesterol and sodium)

    • Regular exercise

    • Weight management

    • Control blood pressure, cholesterol and diabetes

    Medications:

    • Blood pressure medications

    • Cholesterol-lowering drugs (statins)

    • Antiplatelet medications (Aspirin or Clopidogrel) to prevent clots

    Operative Procedures if recent symptoms or >80% narrowing:

    • Carotid Endarterectomy: Surgical removal of plaque from the artery.

    • Carotid Artery Stent: Inserting a stent to keep the artery open.

    • Stroke

    • Death

    • Call an Ambulance immediately if signs of stroke or TIA occur

    • Have regular check-ups if you have risk factors

Occlusive Disease

Occlusive disease refers to a condition where blood vessels become blocked or narrowed, restricting blood flow.

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  • Arterial Occlusive Disease (AOD):

    • Peripheral Arterial Disease (PAD): Affects arteries in the limbs, often the legs.

    • Coronary Artery Disease (CAD): Affects arteries supplying the heart, leading to angina or heart attacks.

    • Carotid Artery Disease: Affects arteries in the neck, increasing the risk of stroke.

    Venous Occlusive Disease:

    • Deep Vein Thrombosis (DVT): Blood clots in deep veins, commonly in the legs.

    • Venous compression: Affects pelvic veins.

    Lymphatic Occlusive Disease:

    • Causes lymphoedema due to blocked lymphatic vessels, leading to fluid retention and swelling.

    • Atherosclerosis: Build up of plaque in arteries (most common cause).

    • Thrombosis: Formation of blood clots.

    • Embolism: Clot or debris that can travel to block a vessel.

    • Vasculitis: Inflammation of blood vessels.

    • Trauma or Injury: Can lead to vessel damage and occlusion.

    • Congenital Defects: Inherited conditions affecting vessel structure.

    • Compression: Developmental anomalies.

    • Arterial Blockage: Pain in leg muscles with exercise (claudication), numbness, cold extremities, ulcers, or tissue death (gangrene).

    • Venous Blockage: Swelling, pain, discoloration, and warmth over the affected area.

    • Organ-Specific Symptoms: Stroke signs (confusion, weakness), heart attack symptoms (chest pain, shortness of breath), liver or renal compromise.

  • Physical Examination: Checking pulses, skin changes, and other signs of poor circulation.

    Diagnostic Imaging:

    • Doppler ultrasound

    • CT angiography (CTA) or MR angiography (MRA)

    • Conventional angiography

    Blood Tests: To check for clotting disorders, vascular risk factors or inflammation.

  • Lifestyle Changes: Smoking cessation, healthy diet, exercise.

    Medications: Antiplatelet agents (Aspirin), Anticoagulants (Warfarin, Heparin), Cholesterol-lowering medication, Diabetes medication, Nicotine replacement.

    Minimally Invasive Procedures:

    Angioplasty and stenting

    Thrombolysis (clot-dissolving drugs)

    Surgery:

    Bypass graft surgery

    Endarterectomy (removal of plaque)

  • Tissue damage or gangrene

    Organ failure

    Stroke or heart attack

    Chronic pain and disability

  • Medical therapy to control risk factors of diabetes, hypertension and high cholesterol

    Regular exercise

    Healthy diet

    Avoid smoking and excessive alcohol

    Routine medical check-ups