INDICATION: To prevent death from rupture of the aneurysm. Symptoms may vary but include back pain, and leg pain. The initial test to detect and measure the aneurysm is either an ultrasound or a CAT scan of the aorta. If aneurysm repair is undertaken, further anatomic information is obtained with an aortogram ( a dye test of the aorta). A cardiac workup including a stress test may be ordered as well. This is done to be sure that the heart is strong enough to withstand surgery.
The aneurysm is replaced with an artificial blood vessel made from special woven Dacron material. Most people have an ICU stay of 3-4 days followed by 3-4 days in a regular hospital room prior to discharge. Rehab may also be needed for certain patients.
CAROTID ENDARTERECTOMY
INDICATION: To prevent a stroke in patients with narrowed carotid arteries. Symptoms may vary, but usually are dizziness, slurred speech, weakness in the arms or legs, or acute onset of visual disturbances. The degree of narrowing in the carotid arteries is determined using an ultrasound (carotid duplex). A carotid arteriogram may be ordered to further define the anatomy. An arteriogram is a dye test much like a cardiac catheterization. During a carotid angiogram however, the dye is injected into the neck arteries instead of the heart vessels.
The carotid artery is exposed through an incision on the side of the neck. The artery is clamped above and below where the narrowing is located. The diseased material that is narrowing the artery is then removed.
FEMORAL to FEMORAL and FEMORAL to POPLITEAL BYPASS
INDICATION: Claudication (pain in the legs when walking), ischemic ulcers or non-healing wounds. Many people have pain in their legs. Pain may be due to many factors, including a decreased blood flow to the lower extremity. When this occurs, the oxygen in the blood can’t get to the muscles and bones and this causes ischemia (pain). Like with most vascular procedures, a workup is done which includes a physical exam. If indicated, a Doppler (ultrasound) is then ordered. The confirmatory test and gold-standard is the arteriogram. This gives a “road-map” to your disease process. If the blocked area is small, then a balloon and/or stent can help restore blood flow to the leg. Sometimes, the disease is greater and a bypass needs to be done. This is running a new conduit in your leg that goes around the blocked area. This is done in the operating room and the hospital stay is about 4-7 days.
VENOUS DISEASE
OVERVIEW: Venous disease is very common in the United States. Many people suffer from large, roping veins and pain due to swelling in their legs. In the past, there were very limited options for treatment. Most required a long incision and left a large scar. When there was an ulcer involved, this also led to an incision that may cross the ulcer and this also led to a lot of wound-healing problems. With advancement in technology, we can now offer advanced treatment for this disease. The laser is such an advancement. Here at SAMC, we have several lasers to treat a wide variety of venous diseases.
SEPS
Subfascial endoscopic perforator surgery (SEPS) is an innovative approach for treatment of chronic venous insufficiency or leg ulcers. SEPS surgically addresses the cause of the disease through an approach using 1 to 3 small incisions. Click HERE for detailed information on SEPS.
ELAS ENDOVENOUS LASER ABLATION OF THE SAPHENOUS VEIN
Endovenous Laser Treatment is a treatment alternative to surgical stripping of the greater saphenous vein. A small laser fiber is inserted, usually through a needle stick in the skin, into the damaged vein. Pulses of laser light are delivered inside the vein, which causes the vein to collapse and seal shut. The procedure is done in-office under local anesthesia. Following the procedure a bandage or compression hose is placed on the treated leg. Endovenous Laser Treatment is FDA-approved for the treatment of the greater saphenous vein. Click HERE for detailed information on ELAS.
INDICATION: To prevent pulmonary embolism in the presence of deep venous thrombosis. (Clots in the large deep veins of the legs that could then travel to the lungs or heart.) A venous duplex exam is performed to look for blood clots in the leg veins. The femoral vein (large leg vein located in the groin) has a hollow wire and catheter inserted into it. Dye is injected through the catheter and an x-ray picture of the vena cava (the largest vein in the body, which leads directly to the heart) is taken. A small umbrella-shaped device is placed into the vena cava to catch any traveling blood clots before they can reach the lungs. (This acts like a catcher’s mitt)
