Vascular surgeons with Carondelet Heart & Vascular Institute Physician group and those credentialed to work in our hospitals are experts in treating conditions of the circulatory system and advancing treatments and technology in the field of vascular and endovascular surgery. Through ongoing clinical research, they continue to expand the possibilities for minimally invasive treatment of thoracic aneurysms, renal artery stenosis, lower extremity disease and carotid artery disease. Using the latest technology and procedures, our vascular surgeons provide every patient with effective, compassionate care.
Thoracic and abdominal aortic aneurysm repair:The current standard surgical treatment of a thoracic aortic aneurysm is the open-chest approach. The main purpose of open-chest surgery to treat a thoracic aneurysm is to replace the weakened portion of the aorta with a fabric tube, called a graft. An abdominal aortic aneurysm, is a bulging, weakened area in the wall of the aorta, the largest artery in the body. Open repair of an abdominal aortic aneurysm involves an incision in the abdomen either lengthwise from below the breastbone to just below the navel or across the abdomen and down the center. Once the abdomen is opened, the aneurysm will be repaired using a long cylinder-like tube called a graft. The graft is sutured to the aorta connecting one end of the aorta at the site of the aneurysm to the other end of the aorta.
Endovascular aneurysm repair (EVAR) is a minimally-invasive procedure performed to repair an abdominal aortic aneurysm. A small incision is made in each groin to visualize the femoral arteries in each leg. With the use of special endovascular instruments, along with X-ray images for guidance, a stent-graft will be inserted through the femoral artery and advanced up into the aorta to the site of the aneurysm. A stent is a long cylinder-like tube made of a thin metal framework, while the graft portion is made of various materials, such as Dacron or polytetrafluoroethylene (PTFE) and may cover the stent. The stent helps to hold the graft in place. The stent-graft is inserted into the aorta in a collapsed position and placed at the aneurysm site. Once in place, the stent-graft will be expanded, attaching to the wall of the aorta to support the wall of the aorta. The aneurysm will eventually shrink down onto the stent-graft.
The doctor will determine which surgical intervention is most appropriate, either open repair or EVAR.
Carotid artery surgery and stenting:There is a carotid artery on each side of the neck, providing blood to the brain and face. Restricted blood flow to the brain because of the build up of plaque in the artery can cause a stroke. With carotid artery surgery, the surgeon cuts open the carotid artery, removes the plaque and then stitches up the artery. Alternatively, the surgeon can perform carotid angioplasty and stenting. In this case, a catheter (flexible tube) with a balloon on the end is inserted through an incision in an artery and moved up to the blockage in the carotid artery. The balloon is inflated, opening the artery. A stent (wire mesh tube) can be placed in the in area of the blockage to keep the artery open.
Peripheral arterial disease management and limb salvage:Peripheral artery disease (PAD) is the most common type of peripheral vascular disease and is similar to coronary artery disease because it occurs as a result of plaque buildup. PAD is often a sign of cardiovascular disease elsewhere in the body. With PAD the narrowing of blood vessels from plaque occurs in veins and arteries outside of the heart and brain, most commonly in the legs, but also in the arms and abdomen. If the plaque deposits are severe enough, they can block blood flow and tissue death. Untreated, PAD can lead to amputation of the foot or leg. A vascular surgeon may use open surgery or minimally invasive surgery to open up the blockage and increase blood flow to limbs. The goals of PAD management are save limbs, provide symptom relief, improve function, and prevent cardiovascular events, such as a heart attack, stroke, or vascular death.
Complex wound management:Complex wounds include leg ulcers, diabetic foot ulcers, wound fistulae (an abnormal tunnel between two body cavities created by ruptured abscesses) and wounds that fail to heal.
Treatment plans can include the use of:
- Negative pressure wound treatment (a vacuum is used draw wound edges together and remove infectious materials).
- Chemical/conservative or sharp removal of dead tissue.
- Hyperbaric oxygen therapy (using a repeated sessions in a hyperbaric chamber)
- Application of skin substitute
Vascular access for chemotherapy:A simple intravenous (IV) line is effective for short-term uses. However when it is necessary to draw blood or deliver medications and nutrients into the bloodstream over a longer period (weeks, months, or years) a flexible thin plastic tube (catheter)needs to be inserted into a blood vessel. In a vascular access procedure, a special catheter is inserted inside a major vein (generally in one of the large veins in the neck, arms or legs) with the tip of catheter positioned into a large central vein that terminates near the heart.
Varicose vein and venous insufficiency treatment:Valves in your deeper leg veins normally keep the blood flowing back toward your heart so it does not collect in one place. But the valves in varicose veins are either damaged or missing. This causes the veins to stay filled with blood, especially while standing. Chronic venous insufficiency is a long-term condition that occurs because a vein is partly blocked, or blood is leaking around the valves of the veins.
Surgical intervention or conservative treatments may be recommended if you have:
- Leg pain, which may make your legs feel heavy or tired
- Skin sores caused by poor blood flow in the veins
- Thickening and hardening of the skin on the legs and ankles