Vascular and Endovascular Surgery

Peripheral Vascular Disease

Our hybrid operating room is a standard surgical theatre equipped with advanced medical imaging devices that would normally be used in a cardiac catheterization laboratory. Our advanced equipment includes a movable image intensifier (C-Arm used for taking X-rays), a movable gantry (operating table that can be used for X-ray fluoroscopy), a power injector for injecting contrast, and monitors and support systems that allow for complex X-ray imaging. This hybrid operating room has revolutionized the treatment of vascular disease.

This hybrid operating room is a powerful new tool for our management of patients with vascular disease. Because it has all of the capabilities of a standard operating room, nearly any open vascular surgery case can be performed, plus, with the addition of advanced X-ray imaging, as well as other tools such as intravascular ultrasound, the Carson Surgical team can perform complex vascular repairs and reconstructions with minimally invasive methods that were never before possible. 

Once the aneurysm is repaired, patients are placed into a surveillance program to monitor the repair. It is very important to maintain ultrasound follow up of the repair. Occasionally, these grafts do require some maintenance. If identified early through continued surveillance, maintenance can usually be done endovascularly as a quick outpatient procedure.

Peripheral Vascular Disease

Peripheral Vascular Disease is a term used to describe diseases affecting the arteries.  The arteries are large muscular tubes that carry blood pumped from the heart throughout the body.  Arteries have three layers, and it is the middle layer (Tunica Media) that is directly affected in peripheral vascular disease.

Peripheral vascular disease can result in blockages in the arteries or abnormal enlargements of arteries (aneurysms). The risk factors for peripheral vascular disease include a family history of the disease, heart disease, aneurysm disease (genetic component), history of known peripheral vascular disease, smoking, and hypertension.  Artery blockages can occur anywhere, but are most commonly found in the lower extremities and in the carotid arteries (the arteries in the neck that take blood to the brain). In each of these areas, there is a unique set of symptoms that occur. 

Advances in technology have given the vascular surgeons at Carson Surgical Group a large compendium of techniques to fix these problems, many of which are minimally invasive.

Lower Extremity Peripheral Vascular Disease

When artery blockages occur in the lower extremities, blood flow is restricted to those areas causing immediate harm. As plaque builds up in the artery, the flow of oxygen and nutrients to the extremities is limited. At rest, it may not be a problem, but when the patient begins to walk, the muscles cannot get enough oxygen, which results in lactic acid build up in the muscles and the patient experiences calf cramps that prevents them from walking further.

Resting for a minute allows the lactic acid to be flushed out as the oxygen supply builds back up. The patient can then go on to walk again, but only to be stopped at the same distance again from the cramps in the calf.

In many patients, these blockages are so severe that the tissues in the lower extremities don’t even have enough oxygen at rest. This results in tissue break down, wounds, and pain at rest. This becomes an emergency; unless blood flow is restored, the patient will require an amputation.

Advances in technology now give the vascular surgeons at Carson Surgical Group many different options for repairing artery blockages due to peripheral vascular disease. Most often, patients can be treated with angioplasty (using a balloon to open up the artery) or stenting (putting a spring in the artery to keep it open). Other options include manually cleaning out the artery (called endarterectomy) or with a surgical bypass around the blockage.

Once the artery is fixed, patients are monitored using our advanced ultrasound surveillance. All patients with vascular disease must be followed with ultrasound. 

It’s important to note, fixing an artery in a patient with peripheral vascular disease does not cure the disease, but fixes the affected artery. Peripheral vascular disease will progress over time and re-intervention may be required. Re-intervention is easier if found early rather than waiting for the symptoms to recur.

Carotid Artery Disease

Carotid arteries are the dominant arteries that carry blood from the heart to the brain, located in the front of the neck on both sides. Risk factors for carotid arteries are the same as those for peripheral vascular disease.

Blockages in the carotid artery can result in a stroke, and unfortunately, carotid artery blockages are often silent until the first stroke event occurs. Symptoms of a stroke include:

• Facial droop

• Inability to speak or understand

• Blindness in one eye

• Loss of function of an arm or leg or both

Screening for carotid artery disease is extremely important as by the time that symptoms occur, it may be too late. This screening for carotid artery disease is done with ultrasound in our Ultrasound Lab.

Repairing A Blocked Carotid Artery 

Repairing a blockage in the carotid artery is most often done with an endarterectomy, where the artery is cleaned out using an open surgical approach. While there are other methods available, such as stenting, carotid endarterectomy remains the standard of care.

As with peripheral vascular disease treatment in the lower extremities, vascular disease in the carotid arteries must be followed with ultrasound in our Ultrasounds Lab after treatment. Plaque can recur and re-intervention may be required in order to prevent a stroke.

Aneurysm Disease

An aneurysm is an abnormal enlargement of an artery. Nearly any artery can develop into an aneurysm, something analogous to blowing up a balloon. The larger the balloon gets the easier it is to blow up; eventually rupturing if it gets large enough. 

While the risk for most aneurysms is the risk of rupture, aneurysms can also develop so much clot inside them that they completely block off the artery, resulting in a sudden lack of blood flow to any structure down-stream of the blocked artery. Usually this occurs in the popliteal arteries (the arteries behind the knees).

Aneurysms are silent (they do not cause any symptoms), so the only way to know if you have an aneurysm is to scan in our Ultrasound Lab.

Risk factors for aneurysms include:

• A family history of aneurysm disease (genetic component)

• History of known peripheral vascular disease

• Smoking

• Hypertension

If you have any of the risk factors for aneurysm disease, you should consider being screened in our Ultrasound Lab by the age 65.