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Vascular & Endovascular Surgery

The vascular system is comprised of the heart and the network of arteries and veins supplying all of the organs and tissues of the body, as well as the upper and lower extremities. Arteries carry oxygen-rich blood from the heart to the organs and extremities. The blood returns through the veins to the heart. There are a number of diseases and conditions affecting the arteries-the most common of which is atherosclerosis. This condition can result in narrowing of the arteries (blockage) or even total occlusion. Depending upon the part of the body being supplied, these narrowings or occlusions can result in significant problems for the individual. For instance, if the carotid artery (blood supply to the brain) is affected, a stroke can occur. If the blockage is in an artery supplying the leg, it can result in pain or fatigue while walking.

There are a number of risk factors for vascular problems, and modification and correction of these is essential to successful treatment. This list includes smoking, high blood pressure, diabetes, high cholesterol, and a family history of arterial problems. If you have one or more of these risk factors you should discuss the possibility of vascular disease with your physician.

Successful treatment of vascular problems ideally involves a multi-disciplinary approach. This may involve primary physicians, interventional radiologists, cardiologists, podiatrists, infection specialists, neurologists, and vascular specialists. The vascular team at Central Florida Regional Hospital can provide patients with state of the art minimally invasive, as well as traditional surgical solutions if necessary. Several common vascular problems are discussed below.

Stenosis, or narrowing of the carotid artery in the neck, is a common vascular condition that can lead to stroke. With appropriate diagnosis and treatment, stroke can be prevented. Carotid artery disease can be diagnosed with a simple, non-invasive ultrasound test. At the discretion of your physician, additional tests such as CT or MRI scans may be necessary. If a significant narrowing is discovered, it can be corrected by an operation known as carotid endarterectomy, during which the artery is opened and the plaque (the material blocking the artery) is removed. In some patients, the problem can be corrected with a stent. This involves placing a metal “scaffold” inside the artery to open the channel for blood flow. This is a minimally invasive technique using a catheter placed in the artery at the top of the thigh, through which the stent is passed upward into the carotid artery. The best method of correction of carotid disease for each individual patient is decided by the vascular team.
Narrowing or occlusion of the arteries supplying the legs can result in pain or fatigue which limits one’s ability to walk. Under the worst circumstances, PAD can even lead to amputation. Diagnosis begins with a history and thorough physical examination, which includes checking pulses in the legs and feet. Non-invasive ultrasound can be used to confirm the diagnosis. Referral to a vascular specialist is essential to determine if treatment is required. Some patients with PAD can be treated with medication and risk factor modification. Others with more advanced symptoms may require intervention of some type. Fortunately, Central Florida Regional Hospital offers all of the most advanced and up to date minimally invasive therapies for PAD. Included in this list are balloon angioplasty, stent placement, laser treatment, and atherectomy, which uses a catheter to cut through or remove the blockage. Some patients with more extensive artery blockage may require surgical bypass, wherein a conduit is used to go around, or “bypass” the blocked segment. The bypass conduit can be a segment of vein from the patient’s own leg or it can be an artificial arterial substitute.
An aneurysm is an abnormally enlarged artery, and any artery in the body can be affected. The aorta is the largest artery in the body. It arises from the heart and supplies every organ as well as all four extremities by way of its numerous branches as it courses through the chest and abdomen. The segment of the aorta within the abdomen is the most common site for an aortic aneurysm. The danger of this condition lies in the fact that the aneurysm can grow over time and ultimately rupture, leading to fatal bleeding. Fortunately, aneurysms can be discovered and treated, preventing such a catastrophe from occurring. Physical examination, ultrasound, CT scans and MRI scans can all lead to aneurysm discovery and treatment to prevent rupture and death. In the past, repair of an aneurysm required a very extensive open surgical operation. This involved opening the abdomen and replacing the enlarged segment of the aorta with an artificial arterial substitute. However, our team now treats over 90% of aneurysm patients with a minimally invasive procedure. Instead of opening the abdomen, stents are placed from the arteries at the top of the thighs through catheters and into the aorta. This relines the inside of the aorta, preventing it from rupturing. Most patients are back home in 1-2 days.