Vascular Surgery
Vascular surgery is the discipline of medicine which focuses on the disorders and treatment of blood vessels throughout the body (with the exception of heart and intracranial vessels). Vascular surgeons use interventional radiology and endoscopy to observe internal structures and to diagnose problems.
All patients with these arterial problems are strongly encouraged to stop smoking because smoking accelerates the arterial plaque forming process as well as weakens the arterial wall for aneurysm formation.
This is an enlargement of the aorta (the main artery that carries blood away from the heart). As it enlarges, it can rupture and cause death. Depending on the patient's general health, the size of the aneurysm and the rate it is growing, surgery may be recommended.
The traditional method of repairing an abdominal aortic aneurysm begins with a large incision to the abdomen. Blood flow is temporarily stopped above and below the aneurysm. The aneurysm is opened and repaired by sewing a synthetic tube in the bed of the enlarged aorta.
A newer - yet widely accepted - procedure involves the placement of a stent graft. Using a small groin incision and possibly a small abdominal incision, catheters loaded with the tube graft are passed through the groin arteries into the abdomen. The stent graft is deployed under X-ray guidance. The tube graft occludes the aneurysm at the top of the normal aorta and at the bottom of the normal aorta. Patients go home soon after this procedure but long-term follow-up with serial CT scans is required.
Endarterectomy - For those people who have had a transient ischemic attack (TIA) or a stroke resulting from a narrowing of more than 70% of the carotid artery, an endarterectomy may be recommended.
The procedure is completed through a neck incision. With the carotid artery exposed, the artery is opened to allow your surgeon to remove the plaque causing the narrowing. During the repair, blood flow is redirected around the narrowed area using a shunt.
If necessary, a vein patch or synthetic patch may be sewn to the carotid artery opening to widen the artery. After the shunt is removed, the artery and incision are closed. This procedure is typically completed in about 1 to 2 hours. Patients with uncomplicated cases are discharged from the hospital 48 hours after surgery.
Angioplasty - This procedure is performed to widen a narrowed or blocked artery. Although you'll be awake during the procedure, you'll receive medication to help you relax. Angioplasty takes 1 to 2 hours and is performed at a hospital or surgical center.
The site where the catheters will be inserted is numbed. A guide wire is threaded through the flexible catheters into the artery to be treated. Watching an image of your artery on an X-ray monitor, a catheter is then inserted into the artery. On the end of this catheter is a balloon that is inflated to break down the plaque and/or push it against the artery wall. Then the balloon is deflated.
This is repeated several times until satisfactory results are achieved. Usually a wire stent is then placed through a separate catheter to help keep the artery open long-term. At this point, the catheters are removed and blood flows freely through the artery.
For severe cases of peripheral vascular disease (when circulation to the feet and legs is blocked due to a build-up of plaque or narrowed arteries), peripheral artery bypass surgery may be recommended. Arteriograms will be performed and, if the situation does not allow for an angioplasty, an arterial bypass will be discussed.
In this procedure, which is performed under general or regional anesthesia, the surgeon uses a graft to move blood from an open artery to an artery lower in the leg, bypassing the blockage.
A graft can be made from one of your own blood vessels or from synthetic materials. It is stitched to the artery above and below the blockage creating a new route for the blood to freely flow through.
If you have kidney disease and need dialysis, we'll need to create access to your bloodstream. Because for dialysis to work, blood has to leave your body, move to the dialysis machine (artificial kidney), and then come back to your body. We make this possible with a vascular access.
Here at the Division of Vascular Surgery, we use several types of vascular access, including arteriovenous (A-V) fistulas and grafts. Grafts are made out of manmade materials. Fistulas come from your own vein and artery. We can also place peritoneal dialysis catheters when necessary. In general, fistulas have fewer complications than other types of vascular access.
In most cases, your access can be placed on an outpatient basis. And you can rely on it as an effective way for blood to be carried to the dialysis machine and back without any discomfort.
When a person's kidneys fail, dialysis is often required if transplantation cannot be performed. Dialysis can be performed using the abdominal cavity (peritoneal dialysis) or by filtering the blood. In turn, blood for filtration can be obtained via a catheter or arteriovenous fistula (AV fistula). Catheters can be placed on short notice but have a short usable life-span and are difficult to care for. By contrast, a fistula requires surgery and cannot be used until they heal, but can last for years. Your nephrologist has recommended hemodialysis via a surgically constructed AV fistula.
Many types of fistulas are possible, but it is best to use your own veins and arteries and stay as far out on the arm as possible. The purpose of today's visit is to discuss the mechanics of surgery and to identify the best possible site(s) for fistula creation, as well as to discuss tentative plans for future fistulas.
