Vascular and Endovascular Surgery

Your vascular system is made up of arteries, capillaries and veins that carry blood throughout your body. When blood flow isn’t functioning the way it should, you may need to see a vascular specialist.

Conditions & Treatments

Aortic Aneurysm: When a weak spot in your aorta begins to bulge. The larger it becomes, the greater the risk of rupture. Treatment options include:

• Endovascular aneurysm repair (EVAR): Your vascular surgeon lines the aorta with a stent graft with the aim of preventing the aneurysm from getting bigger and rupturing. This procedure is less invasive than open repair, which means recovery time is shorter.

• Open aneurysm repair: This requires an incision at the area of the aneurysm (abdomen most commonly), and then replacing the diseased segment of your aorta with a synthetic tube.

Carotid Artery Disease: The most common disease is carotid artery stenosis, which occurs when plaque builds up in the blood vessels that carry blood to your brain. This increases your risk of stroke. Treatment options include:

• Carotid Endarterectomy (CEA): The plaque buildup in your blood vessels is removed through an incision in your neck. This is an open surgical repair procedure.

• Transfemoral Carotid Artery Stenting (TFCAS): A minimally invasive option where a stent is placed in your carotid artery from access through your groin. This helps decrease the risk of carotid plaque causing a stroke.

• Transcarotid Artery Revascularization (TCAR): This utilizes an innovative technology called “flow reversal” at the time of placing a stent in the carotid artery. Flow reversal is an ingenious mechanism of improving overall safety outcome during the stent placement. This requires a small incision in the neck and is less invasive compared to carotid endarterectomy (CEA).

Venous Disorders (Chronic Venous Insufficiency, Varicose Veins, Spider Veins): Venous insufficiency occurs when veins in your legs are damaged resulting in poor flow of blood to your heart. There is a backup of blood in the leg veins due to “reflux” from poorly functioning vein valves. This results in leg swelling, heaviness, discoloration and ulcerations. Varicose veins refer to enlargement and bulging of veins just under the skin of the legs and typically occur in the setting of chronic venous insufficiency. Treatment options include:

• Conservative measures: Involve mainly compression stockings and lifestyle changes, such as weight loss.

• Sclerotherapy: A chemical agent is injected into your veins to cause them to scar and close up.

• Endovascular venous ablation: The diseased vein scars and closes off using heat generated from laser or radiofrequency energy.

• Vein Surgery: The affected vein is tied off (ligation) or removed in some cases (stripping). Phlebectomy refers to the removal of varicose veins using tiny incisions in the skin.

Critically Diseased or Injured Limb: When you have cancer, severe infections, or a traumatic injury to your arm or leg. Treatment options include:

• Limb Salvage Surgery: Your vascular surgeon will repair and restore your limb in to try and prevent amputation. The surgery may include repairing, replacing, or reconstructing different parts of your limb.

Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE): Deep vein thrombosis (DVT) occurs when blood clots form in the deep veins of the extremities, most commonly the legs. The clots can move into the lungs – a condition referred to as pulmonary embolism. DVT results in leg pain and swelling. Some symptoms of pulmonary embolism include sudden onset of shortness of breath, chest pain, increased heart rate, dizziness and fainting.

The treatment of DVT/PE involves the use of blood thinner medication. In some cases, procedures like catheter directed thrombolysis (where clot busting medication is infused directly into the clot to break it up) or thrombectomy (where the clot is removed) are performed typically in a minimally invasive fashion to open the veins and restore blood flow through them. In a population of patients who have DVT but cannot tolerate a blood thinner, an IVC filter is placed to prevent clots from migrating from the legs to the lungs.

Mesenteric Ischemia: When there is narrowing or blockage of the arteries that carry blood to the gut/intestines. This results in reduced blood flow to the gut. This can occur slowly over a long period of time (Chronic Mesenteric Ischemia) or suddenly (Acute Mesenteric Ischemia). Some symptoms of chronic mesenteric ischemia include abdominal pain when eating, fear of eating food, weight loss and changes in bowel habits. Acute mesenteric ischemia results in severe constant abdominal pain and can cause changes in bowel habits, bloody stool and fever. Chronic mesenteric ischemia can lead to acute mesenteric ischemia. Treatment options include:

• Angioplasty/Stenting: The affected blood vessel to the gut is opened in an endovascular fashion (minimally invasive) using a balloon and stent.

• Thrombectomy: This refers to the removal of a clot that is causing blockage of the artery.

• Bypass Surgery: Your vascular surgeon will use a vein from your body or a synthetic tube to pass around your blocked artery.

• Transaortic Endarterectomy: An incision is made in your abdomen and the blockage is removed from the artery to restore blood flow.

• Medications: Depending on the cause of the blockage, blood thinners and antiplatelets (aspirin, clopidogrel) may be used.

• Bowel resection: If your artery has been blocked for too long, your intestines may start to die. If this occurs, your surgeon may remove part of your small intestine.

Peripheral Artery Disease (PAD)/Chronic Limb Threatening Ischemia (CLTI): A buildup of plaque that narrows the arteries in your legs or arms. This can result in pain in the leg muscles with walking that gets relieved at rest (intermittent claudication). This can progress to pain at rest and in even more severe cases ulceration in the feet/toes. CLTI is advanced PAD with an increased risk of limb loss. Treatment is geared toward limb salvage (preventing amputation). Treatment options include:

• Healthy lifestyle changes: Smoking cessation is key to preventing progression of PAD and minimizing risk of amputation.

• Medications: used to help control other risk factors of PAD like diabetes, hypertension and high cholesterol.

• Angioplasty/stent: Minimally invasive surgery where the artery is opened using a balloon and/or a stent.

• Bypass Surgery: A vein from your body or a synthetic tube material is used to go around your blocked artery and restore flow to the extremity.

Permanent Dialysis Access: Access for people who regularly receive hemodialysis for kidney failure or end-stage renal disease. How access is achieved:

• AV Fistula: Your vascular surgeon will join an artery with a vein.

• AV Graft: Your vascular surgeon will connect an artery to a vein using a synthetic tube.

Rest assured that our vascular team will thoroughly review your options with you and provide their individualized recommendation based on your situation.