Cold feet. Heavy legs. Cramping. As the years pile up, we deal with life’s extra little discomforts every day. They can be a real pain in the you-know what. Dealing with them, however, does not mean ignoring them. If annoyances such as these persist, it may be prudent to speak with a vascular surgeon. The fact of the matter is that each of the aforementioned symptoms (including, yes, buttock pain) could point to something more serious. “We’re not talking about spider veins here,” says Salvador Cuadra, MD. “Vascular system disorders such as Peripheral Artery Disease (PAD) and Carotid Artery Disease—including Transient Ischemic Attacks (TIAs)—can begin with relatively mild symptoms. The earlier we catch these problems, the more likely a patient is going to have a favorable outcome.” As a vascular surgeon, Dr. Cuadra is a specialist who treats diseases of the major blood vessels. A member of the Cardiovascular Care Group (with offices at Trinitas and in Westfield, Springfield and Belleville), he treats problems with the carotid arteries in the neck, as well as the veins and arteries in the abdomen, arms and lower extremities. One of Dr. Cuadra’s specialties is called a carotid endarterectomy. In lay terms, this is a surgical procedure that addresses blockages in the artery feeding the brain. Plaque can build up and potentially cause a stroke. The surgery literally “shells out,” or removes, the plaque through a small neck incision. Although the condition is extremely serious, the surgical prognosis is excellent and recovery time is relatively short. Typically, it involves only an overnight hospital stay. Within the past decade, there have been other advances in the development of less invasive treatments for vascular system disorders. Most of these involve the use of stents, which are applied through a catheter inserted through the groin area. The less invasive nature of this procedure certainly makes it more attractive to patients. Vascular surgeons routinely perform angioplasty to repair arteries that are blocked or narrowed. There has been much recent research and discussion about the relative efficacy of stents compared to surgery. The much-publicized CREST Trial has indicated that stents have no statistical advantage over surgery and, in certain cases, might even run a higher risk of subsequent stroke. However, Dr. Cuadra is uniquely qualified to perform either angioplasty or surgery. He has found that some patients have better results with angioplasty and stents, while others benefit more from surgery. Another problem that can be addressed by inserting a stent is an aneurysm. In such a case, an artery develops a bulge (widening) rather than a blockage. Over time, this can cause a weakening in the arterial wall. A vascular surgeon will perform a procedure to insert a specialized stent that allows blood to pass through it removing the pressure on the arterial wall (the aneurysm) thereby reducing the risk of rupture. At present, dialysis patients constitute approximately 50% of Dr. Cuadra’s group practice. In cases of kidney failure— which requires hemodialysis to remove toxic waste and excess fluid from the bloodstream—surgery is done to establish the necessary connection between an artery and a vein thereby allowing for dialysis to be performed. Of the remaining 50%, different people land in his office in a number of different ways. Many patients come via their PCP referral already suffering from obesity and/or diabetes; their doctor may have found an abnormality through physical examination or through an ultrasound, or some other procedure such as a CT scan. Others come because of physical symptoms such as loss of circulation to the legs causing pain, ulcerations, and even gangrene in the extremity. Although Dr. Cuadra says he enjoys working with patients to prevent the onset of vascular disease, he embraces the myriad challenges he faces every day. Being a surgeon suits him, he says. “I like using my hands to solve relatively serious patient problems. Surgery is more rewarding to me than some other specialties. I can see a problem, diagnose it and fix it in a relatively short time period.” EDGE
Editor’s Note: Dr. Salvador Cuadra attended Cornell University as an undergrad and received his medical degree—and became Chief Resident in surgery—at the State University of New York at Stony Brook. He has authored a number of vascular surgery treatises, receiving awards for several of his publications.