Dr. Timothy C. Pringle, MD

This question should be directed to your primary care doctor or cardiologist who can evaluate the differential diagnosis for chest pain in a young male. Many are non-surgical and can be managed with medicine. If your tests were negative, then you should entertain other causes.

I hope that helps.

Most abdominal aortic aneurysms are asymptomatic. When they become symptomatic they will perforate or rupture which increases mortality significantly. Finding an abdominal aortic aneurysm incidentally is a good thing. It is often found while working up back pain or other causes of abdominal pain. The size and location of the aneurysm often determines management. They can be repaired with an open technique or endovascular technique. Currently endovascular repair has been used more often because it's less invasive and has a lower morbidity and mortality. For younger healthy patients an open repair is sometimes used or with patients who have difficult anatomy not amenable to an endovascular repair. The size of the aneurysm is a predictor of rupture. Aneurysm greater than 6 cm have increase risk of rupture and should be repaired. Most AAA are diagnosed early and they are followed with Abdominal CT scan or Ultrasound. When they reach 5 cm most vascular surgeon will begin planning for repair. This is where excellerated growth begins an the anatomy of the AAA is more favorable for an endovascular repair.

The answer to your question is yes. I tell my patients that arteries carry blood away from the heart to the body. Arteries Supply oxygen and nutrients to the body's organs and tissue. The body needs nutrients and oxygen therefore the arterial blood is pumped to the body. Once oxygen and nutrients have been extracted from the arterial blood it enters the venous system starting at the skin level. The sole purpose of veins is to bring the blood back to the heart. This is done through one-way valves in the venous system. Only 10% of your venous blood should be in your superficial system. This is the skin and fatty tissue. 90% of your venous blood should be in the Deep system. Deep system veins run between your muscles. Every time your muscles contract it pushes blood back to the heart where it can receive more oxygen to be pumped to the body. When the valves in your superficial system fail to close and hold the blood in the Deep system, deep system blood backs up into the superficial system which is your fatty tissue and skin. When this happens the Superficial veins will become large and overtime they will become diseased and leak out protein which draws water into the fatty tissue and hemosiderin which begins to tattoo the skin. These are the skin changes that many people will see along with varicose veins and large spider veins. So in the morning after you have been lying down all night your legs will look the best. Because the blood has been able to flow back to the heart. In the upright position your valves are required to hold the blood in the deep system. When you go to work and sit all day or stand all day, blood will pool in your legs because the valves are not holding that blood in the Deep system where it can be pumped back to your heart. This leads to swelling in the legs. Depending on how many valves are not working will determine how quickly you develop swelling. Some people will develop it immediately after getting out of bed, some will develop it in the early afternoon and some will develop it at night. Additionally people will complain of dull aching pain at night time, restless leg syndrome, itching, burning, numbness, heaviness in the legs and fatigue as the day goes on. When you complain of swelling to your primary care doctor most of the time you will be evaluated for heart disease, lung disease ,liver disease and kidney failure. These are other causes of swelling in the legs and are more detrimental to your health. Venous disease often does not kill you it is just debilitating. Venous disease has a slightly higher increase risk for deep Venous Thrombosis. Most patients if they present with swelling will often be sent for venous duplex to rule this out. This is because a deep Venous Thrombosis has the potential to move up the venous system into the lungs and cause a pulmonary embolus which can be lethal. If you have swelling regardless of external findings the easiest thing to do is wear graded compression stocking (20-30 mmhg) when you are working, sitting, standing for long periods of time, long car rides or plane ride. Finally get a vein mapping of your legs which will diagnose the problem and allow it to be treated. When you have symptoms it is not considered cosmetic. When it is worked up properly treatment is covered by most insurances including medicare.

I have not seen any medication make varicose veins go away. Additionally venous disease which presents that early should be evaluated for other congenital etiologies which are often more difficult to manage. Aggressive compression therapy is best to control swelling. If she is a candidate for surgical treatment, laser ablation can be done successfully in the office with local anesthesia and it is well tolerated.

PAD is usually a chronic condition. Finding PAD in someone who is in their thirties is concerning. If this was found incidentally, a thorough medical evaluation should be done focusing on history of familial hypercholesterolemia, diabetes, HTN and smoking. If there is a smoking abuse history, in a young male in their thirties, the concern for Buerger's disease should be entertained and ruled out by exam, history and, sometimes, an angiogram. As mentioned above, PAD is not common in young people. Medical management and aggressive lifestyle modification is recommended reserving interventions for debilitating and limb-threatening conditions. Finally, the best way to halt progression of disease is through lifestyle
modification and compliance.

Improving blood flow to the body is always good. If your vessel is blocked due to atherosclerosis caused by high cholesterol and diabetes, then improving blood flow will help your end organs. In the case of diabetes type 2, this is your pancreas. Of note, the only surgery that has a direct effect on your diabetes is a pancreatic transplant. Vascular surgeries
improve blood flow, but do not replace proper diet and management of your diabetes. I did not mention type 1 diabetes because, in this case, the pancreas is usually no longer working.

This is a great question because much confusion surrounds these two specialties. A vascular surgeon is trained in diagnosing and treating peripheral arterial disease. This includes arteries and veins in the arms, legs, neck and abdomen. Vascular surgeons may treat these vessels using an open or endovascular approach. The endovascular approach is a
minimally-invasive technique that uses balloons, wires and catheters to open up block arterial vessels. When treating venous insufficiency, which presents with pain, swelling, discoloration of the skin, and varicose veins, we use an endovenous technique to close the non-working veins and, in some cases, an open technique to remove them. Vascular surgeons also treat carotid disease, aneurysms in the abdomen and extremities along with many other disorders of the arteries and veins. Finally, vascular surgeons also
repair vessels that have been injured from trauma. Cardiologist are trained to study the heart and treat it medically. Interventional cardiologist will also treat the arteries of the heart with endovascular techniques using wires catheters, balloons, and stents. Some cardiologist are trained to do interventions on peripheral vessels and focus in this area more than the heart. The main difference between the two specialties is cardiologist do not operate. Vascular surgeons operate which provides the unique advantage of being a complete service line when it comes to management of peripheral arterial and venous disease.