Vascular Surgery

Vascular SurgeryThis department offers patients preventive, diagnostic, interventional and surgical treatment options. This is accomplished within a multidisciplinary framework of cardiologists, radiologists, interventionalists and surgeons working together to determine the best options for each patient. The program was expanded to accommodate the growing number of vascular patients coming to Deborah, and to raise awareness of the significant relationship between heart disease and vascular disease.

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Deborah’s Process of Care

Patients referred for vascular conditions will be evaluated by physicians specializing in vascular care. The patient’s risk factors will be assessed and/or the stage of disease progression will be determined. Many patients can manage their disease with medication or diet and exercise programs. Some can be treated with interventional catheterization procedures. Numerous surgical options are available for patients who are not candidates for medical or interventional treatments. At times, combined open/endovascular procedures can be offered to patients to minimize recovery time following the procedure.

Vascular Surgery

Vascular surgery is performed at Deborah after evaluation under the Comprehensive Vascular program. Elective vascular surgical procedures at Deborah include:

  • Traditional open vascular surgery
  • Carotid endarterectomy
  • Carotid stenting
  • Lower extremity revascularization
  • Dialysis access surgery
  • Distal bypass surgery of lower extremities
  • Venous diseases treatment with both open and endovascular techniques
  • Thoracic stent graft repair of thoracic aortic aneurysm

Abdominal Aortic Aneurysm (AAA)

An Abdominal Aortic Aneurysm, or AAA, is a weakening and bulging of the aorta – which is the largest artery in the body and the body’s main supplier of blood. When the weakening or bulge is in the chest, it is called a thoracic aortic aneurysm, and when lower, in the abdomen, an abdominal aortic aneurysm. If the aneurysm grows to a large size, it can spontaneously rupture, leading to profuse bleeding, shock and possibly death.

AAAs can grow slowly, and often have no symptoms. Some never rupture. Those that do, however, are usually life-threatening.

Each year more than 200,000 people are diagnosed with an AAA and close to 15,000 people die annually from this condition, in part because most never knew they had an aneurysm. For this reason abdominal aortic aneurysms are often called “silent killers.” AAAs are the 15th leading cause of death in the United States, mostly among men older than 65, and particularly among those who have smoked.

Causes of AAA

While an AAA can develop in anyone, it is most frequently seen in males over 60 with one or more risk factors, including:

  • Past or present smoker
  • High blood pressure
  • High cholesterol
  • Obesity
  • Emphysema
  • Genetic factors

Diagnosis

With almost no warning signs, an AAA is often difficult to detect, but preventive screening exams – to detect a bulge in the aorta – could quite literally mean the difference between life and death for some people.

A routine five-minute ultrasound can indicate the presence of an AAA, making this one of the most preventable, but neglected, conditions to be diagnosed and treated.

The U.S. Preventive Services Task Force has identified patients over 60 years old who are former or current smokers, or who have a family history of AAAs, as a patient group more likely to have an AAA. These patients should receive a one-time screening ultrasound. If an AAA is detected, a CT scan might be ordered.

Treatment

Treatment for an AAA will depend on its size. A small aneurysm under 4.5 cm in diameter will be monitored and watched, to see if it continues to grow. A medium-sized AAA (4.5-5.5 cm) is followed on an individual basis and those over 5.5 cm usually will require either surgical or minimally-invasive repair.

There are two types of repair for AAAs: Open Surgery and Endovascular Repair. Open surgery requires a surgical incision to replace the bulging portion of the AAA with synthetic tubing. An Endovascular Repair is performed in a minimally invasive manner with stents inserted via the groin. Both options have different recovery times.