WHY HAVE SURGERY IF YOU DON’T HAVE TO?

It has been said that major changes occur in any given field only every generation or so. Such an event has occurred in our lifetime with a huge jump forward in the field of vascular surgery. The method of arterial bypass surgery has served the patient well but is rapidly being replaced by less invasive procedures. Today, endovascular surgeons now perform angioplasty, stent, and endograft placement in the majority of patients suffering from arterial blockages or aneurysm.

WHAT IS VASCULAR DISEASE?

The disease process is called atherosclerosis or hardening of the arteries and although it affects arteries throughout the body, some arteries are more commonly affected than others. Stroke is the 3rd leading cause of death in the U.S. today and most often a result of narrowing of the arteries that supply the brain. The aorta, a large artery in the abdomen is the most common location for the development of aneurysms. An aneurysm is an enlargement of the artery that over time can lead to weakening and possible rupture. Some forms of high blood pressure and poor kidney function are a result of narrowing of the arteries to the kidneys. Finally, some patients will experience thigh or calf pain with walking (called claudication) or even chronic wounds of the legs if the arterial blood supply is not adequate. The build-up of fatty deposits — sometimes called plaques or lesions — on the inside walls of the blood vessels obstruct the flow of blood through the vessel.

HOW IS IT DIAGNOSED?

The process begins with an office interview and exam. On the same day, a vascular ultrasound is performed (in our nationally accredited vascular lab) to determine the severity of the arterial blockage or any aneurysm development. Vascular ultrasound is a non-invasive, painless test performed in the office providing immediate results. Additional testing is usually unnecessary and in most cases, the treatment plan can be discussed with the patient on the initial visit.

HOW CAN IT BE TREATED?

Today, the endovascular surgeon can offer non-invasive options for many of the problems due to atherosclerosis. Angioplasty and stent placement for narrowed arteries, stents with Dacron covering to prevent embolization of arterial fragments to other areas of the body, and finally aortic endografts to treat aneurysms. Angioplasty is not a new procedure but with the advances in the technology and our understanding, these techniques can now be applied to as many as 70% of all patients suffering the ravages of atherosclerosis. Today’s procedures are completed without incisions, are over within about an hour, and the patient literally walks out of the hospital the same day. Symptoms begin to improve immediately and patients are encouraged to restart an active lifestyle. In the future, technology will provide medicated coated stents to prevent arterial narrowing from recurring, small filters or baskets that catch clot from embolizing during angioplasty, and even lasers that can reopen clogged arteries.

The stent is placed on the balloon catheter and directed to the blocked area of the vessel. Once the balloon and stent are in the correct position, the balloon is inflated, causing the stent to open.

SUMMARY

• Patients with atherosclerosis are at risk for stroke, aneurysms, claudication, and chronic wounds.
• Diagnosis or screening is quick, painless, and without risks. Vascular ultrasound can provide immediate test results in the office.
• Treatment often does not require surgery, but involves outpatient techniques called angioplasty and stent placement.
• Results can be experienced immediately with minimal risks and short or no recovery periods.