CMHVI Vascular and Endovascular Surgeons Offer Numerous Treatments and Surgical Procedures

Among the Vascular and Endovascular Treatments and Surgical Procedures CMHVI offers:

Abdominal Aneurysm Repair/Grafting

An aneurysm is a ballooning in the wall of an artery. Aneurysms pose a danger because once ruptured, the loss of blood can cause death within minutes. Atherosclerosis (sometimes called "hardening of the arteries"), high blood pressure, genetics and lifestyle choices such as smoking may cause aneurysms. Most aneurysms occur in a large blood vessel called the abdominal aorta. They are usually asymptomatic, meaning symptoms are not always experienced; symptoms that might occur include back, chest or stomach pain. At highest risk are men between the ages of 65 and 75, especially smokers. Screening tests are available.

Most aneurysms occur in a large blood vessel called the abdominal aorta. They are usually asymptomatic, meaning symptoms are not always experienced; symptoms that might occur include back, chest or stomach pain. At highest risk are men between the ages of 65 and 75, especially smokers. Screening tests are available.

Surgeons can repair an aneurysm using one of two procedures. In an open repair, the surgeon makes an incision in the abdomen and inserts a tube, known as a graft. The graft is attached to the aorta at the site of the aneurysm.

In an endovascular aneurysm repair (EVAR), a tube known as a stent-graft is inserted through the femoral artery, through a small incision in the groin. Using x-ray images and special tools, the tube is advanced to the aneurysm, where it is anchored.

Carotid Artery Stenting

Endovascular surgeons perform carotid artery stenting to widen an artery that has become too narrow or damaged by plaque build-up.

This procedure also includes an angioplasty, which is the insertion of a catheter (a thin tube) into an artery such as the femoral artery. The catheter is guided to the diseased carotid artery. Once there, a guide wire pushes a stent into place; a balloon inside the stent widens the stent, which widens the artery.

Patients may require a hospital stay of one or two days.

Carotid Endarterectomy

A carotid endarterectomy is a surgical procedure that involves removing plaque from the carotid artery in the neck. Plaque build-up can be dangerous and may lead to a stroke, if a piece of a plaque breaks off and travels to the brain or if the artery becomes too narrow.

During this procedure, a vascular surgeon makes a small incision to expose the artery, then shunts blood flow away from it, temporarily. The artery is opened and the plaque is removed. Often the surgeon will then graft a piece of vein taken from the leg, in order to widen and repair the artery. Blood flow is then returned to the artery.

Patients may have a hospital stay of one to three days.

Dialysis Access

  • Vascular Access for Hemodialysis - Hemodialysis is the circulation of a patient's blood through a machine that cleans the blood of impurities. Patients with severe kidney failure (also known as renal failure) who undergo hemodialysis on a regular basis need a portal into the bloodstream that can be used repeatedly. Several types of portals are used.

  • Arteriovenous (AV) Fistula - An AV fistula is created surgically by connecting an artery directly to a vein. This greatly increases the blood flow into the vein and, over time, the vein grows larger and stronger. An AV fistula has a lower risk of infection and clotting than other forms of venous access. However, the fistula can take months to fully develop.

  • Arteriovenous (AV) Graft - An AV graft uses a synthetic material to surgically connect an artery to a vein. This surgical procedure is performed when the patient's veins are not suitable for developing a fistula. AV grafts can be used several weeks after surgery, but are more prone to infection and clotting than fistulas.

Microphlebectomy

Microphlebectomy is a relatively simple procedure used for some varicose vein conditions. In this procedure, veins are removed to improve the appearance of the legs.

For this surgical procedure, patients are given a local anesthetic. Small incisions or needle punctures are made for the vein removal and little scarring results. The procedure is not suitable for more serious conditions, where reflux if present. Reflux is a disease that affects the ability of the veins to transport blood to the heart.

Following the procedure patients can go home, but usually remain in bandages for at least 48 hours. They are advised to walk frequently, and to avoid sitting or standing for long periods. Other restrictions include avoiding strenuous activities and exercise and staying out of the sun.

Sclerotherapy

Sclerotherapy, a method of treating small varicose (enlarged) veins and spider veins, involves the injection of a solution that scars and collapses the veins. The procedure, which takes about 40 minutes, is performed in a doctor's office.

Very fine needles are used, and patients experience minimal discomfort; some may feel a burning sensation for 15 to 20 minutes afterward. Anesthesia usually is not required. If necessary, the procedure may be repeated after several weeks.

Possible side effects of sclerotherapy include: temporary hardening of larger veins; discoloration, bruising or inflammation at injection sites; temporary formation of tiny, new blood vessels (which is called "matting" and usually fades within months without further treatment); mild itching and swelling. Severe side effects are rare.

After sclerotherapy, a compression stocking or ace wrap is applied. In most cases, patients may drive themselves home after the procedure and return to work the next day. Compression stockings for several weeks may be recommended.

Sclerotherapy is not advised for women who are pregnant or breastfeeding, or for those with skin infections or certain medical conditions, including uncontrolled diabetes or blood clots.

Smoking Risks

Medical research is clear: smoking cigarettes damages arteries and often leads to fatal diseases.

The cessation of smoking is considered by medical experts to be the number one preventable cause of death. The top three causes of death in the U.S. are: heart attack, cancer and stroke. Smoking contributes to all of these, because chemicals in the cigarettes cause arteries to narrow and harden. The cessation of smoking can stop or slow this process, if stopped early enough.

Cigarettes are also a stimulant that speed the heart rate and raise blood pressure, which also leads to arterial disease.

Smoking is also linked to abdominal aortic aneurysms, particularly in men. (Free ultrasound screenings are available to males who are smokers or have a history of smoking, and who are new Medicare patients.)

If you are a smoker or have a history of smoking, be sure to discuss this with your primary healthcare provider. He or she may have recommendations for you that include health screenings and smoking cessation medications, measures and/or other resources to help you quit.