Vascular And Endovascular Surgery

Vascular Surgery

Vascular surgery is a surgical subspecialty in which diseases of the vascular system, or arteries and veins, are managed by medical therapy, minimally-invasive catheter procedures, and surgical reconstruction.

Endovascular AAA (Abdominal Aortic Aneurysm)

Endovascular abdominal aortic aneurysm repair is surgery to repair a widened area in your aorta. This is called an aneurysm. The aorta is the large artery that carries blood to your abdomen, pelvis, and legs. An aortic aneurysm is when a part of this artery becomes too large or balloons outward. It occurs due to weakness in the wall of the artery. This can be repaired by traditional open surgical approaches and more commonly by minimally invasive endovascular techniques.

Carotid Endarterectomy

Carotid endarterectomy is a procedure to treat carotid artery disease. Over time, plaque buildup hardens and narrows the arteries. This may limit the flow of oxygen-rich blood to your brain. During the procedure, the surgeon peels the plaque away from the carotid artery and repairs the artery with a patch. Removing the plaque can improve blood flow in your carotid artery and reduce your risk of stroke.

Peripheral Vascular Disease

Peripheral vascular disease (PVD) refers to diseases of blood vessels outside the heart and brain. It is often a narrowing of vessels that carry blood to the legs, arms, stomach or kidneys. There are two types of these circulation disorders:

• Functional PVD doesn’t have an organic cause. It doesn’t involve defects in blood vessels’ structure. It’s usually short term and related to spasms that may come and go. Raynaud’s disease is an example. It can be triggered by cold temperatures, emotional stress, working with vibrating machinery or smoking.
• Organic PVD is caused by structural changes in the blood vessels, such as inflammation and tissue damage. Peripheral artery disease is an example. It’s caused by fatty buildups in arteries that block normal blood flow.

Surgical treatment for peripheral artery disease involves either bypass surgery or endarterectomy. Bypass surgery involves using a vein from your body or a portion of synthetic vessel (known as grafts) to create a detour around the blockage. One end of the graft is sewn to a healthy segment of the artery above the blockage and the other end is sewn below the blocked area. Blood flow is then able to bypass the area of narrowing or blockage Bypass surgery is a major surgical procedure requiring general anesthesia and a hospital stay. Endarterectomy is a procedure in which the surgeon cleans out plaque buildup inside the artery of the affected leg or arm. Minimally-invasive techniques using wires and catheters allow diseased areas to be repaired using a combination of ballons (angioplasty), stents and special devices to remove plaque from the artery (atherectomy).

Dialysis Access

When your kidneys fail, your body is unable to clean and filter your blood. Electrolyte levels, such as potassium and phosphorous, can become dangerously high. When kidney function falls below a certain threshold, dialysis is needed.  Dialysis access can be established in one of four ways:

• A tunneled catheter in your neck—temporary, because the possibility of infection is high.
• An AV fistula—taking a piece of a vein from your arm or leg and sewing it into a nearby artery, and allowing the sewn-in vein to enlarge and become thicker, like an artery. Considered the best option because it has the lowest risk of infection.
• An AV graft—the sewing of a prosthetic graft between an artery and vein in your arm or leg. The preferred option if your veins are too small for an AV fistula. AV grafts tend to close more quickly and are more prone to infection because they are not formed from natural tissue.
• Peritoneal dialysis—placement of a small tube, called a cannula, in your abdomen to allow the use of the lining of the abdomen (peritoneum) to filter your blood. It requires several “exchanges” every day: you introduce and remove fluid through the tube. A convenient option because you perform the dialysis therapy at home, but infections sometimes occur and the tube can become clogged.

Vein Ablation

Vein ablation relieves symptoms associated with painful varicose veins, improves the appearance of the legs, and has a low risk of side effects. It is a minimally invasive technique that destroys varicose leg veins. Varicose veins occur when weak veins near the surface of the leg stretch, bulge, and twist. They can be visible through the skin and if left untreated, can cause fatigue; aches; swollen ankles; scaly, dry skin; and leg sores. The treatment sends bursts of radiofrequency or laser energy through a catheter; the resulting heat intentionally destroys vein wall tissues along the length of the vein. This closes the vein to any blood flow that may contribute to varicose vein symptoms and can decrease the risk of recurrent ulcers.