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Medical Services and Treatments

By incorporating interventional radiology with traditional surgery, the vascular surgeons provide a broad spectrum of open surgery and endovascular (minimally invasive) procedures to treat a wide range of diseases involving the peripheral arteries and veins. Through the use of grafts or using the patient’s own arteries or veins, it may be possible to bypass a diseased blood vessel to restore normal blood flow to the affected area. Common examples are provided below. On occasion, amputation (surgical removal of a part of the body) is sometimes necessary. Underlying reasons for a patient to require an amputation include poor circulation or gangrene.

Aneurysm repair

An aneurysm is an out-pouching or abnormal bulge in a blood vessel caused by weakening of the wall of the vessel. Aneurysms most often occur in the aorta, the largest artery in the body. The aorta carries blood from the heart and is located in both the abdomen and thorax (chest). It is necessary to repair aneurysms to prevent them from rupturing. Repairs can be done with an open (surgical) or endovascular technique. The vascular surgeons also repair aneurysms in the blood vessels of the extremities, kidneys, liver, spleen and other abdominal areas.

Angioplasty

Angioplasty is a technique where veins and arteries are manually widened to improve blood flow. There are two ways to perform angioplasty. The first method involves the use of a balloon-like instrument. It is inserted into the affected artery or vein and it is inflated to open the vessel. A second technique is to surgically repair the affected vessel.

Aorta-femoral bypass

When the aorta becomes blocked (from atherosclerotic plaque, for example), it is often necessary to bypass the blockage. The femoral artery in the groin is often used to accomplish this, to achieve improvement in blood flow.

Axilla-femoral bypass

In this procedure, the axillary artery of the arm is used to supply blood to the femoral arteries in the groin.

Carotid bypass and endarterectomy

The carotid artery is the large blood vessel in the neck that supplies blood to the brain. If blockage occurs in this area there are two treatment options: a bypass or an endarterectomy, the surgical removal of the diseased tissue causing the blockage.

Deep vein thrombosis (DVT)

See Thrombosis.

Dialysis fistulas / grafts

Dialysis is the process of cleansing of the blood for patients with end stage kidney disease. To perform dialysis, blood must be transported outside of the body to a machine. In order to access the blood, grafts and fistulas are surgically created.

Femoral-femoral bypass

In this type of bypass, blood flow is rerouted from the femoral arteries in the groin to the popliteal arteries above or below the knee.

Femoral-popliteal bypass

In this type of bypass, blood flow is rerouted from the femoral arteries in the groin to the popliteal arteries above or below the knee.

Iliac artery bypass

At the end of the aorta in the abdomen, the aorta splits and forms two iliac arteries. If an iliac artery becomes blocked, bypass surgery is performed. The femoral arteries in the groin are sometimes utilized to perform this surgery.

Mesenteric vessel bypass

Mesenteric arteries supply blood to the small intestine (superior mesenteric artery) and to the large intestine (inferior mesenteric artery). When mesenteric vessels become blocked, bypass surgery is performed to treat the problem.

Subclavian artery bypass and reconstruction

The subclavian artery supplies blood to the arms and head. It is located in the chest (thorax). When the subclavian vessels become blocked or diseased, bypass or reconstructive surgery is performed.

Thrombosis

Thrombosis is the technical term for the formation of blood clots in arteries and veins. Deep vein thrombosis (DVT) may occur after surgery or after long periods of sedentary activity.

Varicose veins

Varicose veins occur in the legs and may become raised and noticeable. The varicose veins are often uncomfortable and aesthetically displeasing to the patient. Injection into the vein, called sclerotherapy, is a common treatment. The veins also can be “stripped” or removed surgically.

Vena caval filters

To prevent a blood clot (embolism) from moving from the blood vessels into the heart and lungs, a filter may be inserted into the large vessels. The permanent or removable filters trap emboli before they cause serious damage.

Diagnostic Procedures and Evaluations

The patient will undergo a complete history and physical examination. Screening studies may be performed and include duplex scan, segmental vascular studies, computed tomography (CT) scan and magnetic resonance angiography (MRA). When the evaluation is complete, the vascular surgeon will discuss the diagnosis and treatment choices, including the risks and benefits of any proposed procedure. This may be followed by endovascular therapy or open vascular surgery.

What to expect

Patient-focused care should be expected. The vascular surgeon will go over the evaluation results and proposed treatment. Since patients may differ significantly in their general health status, it is not possible to state specific expectations. The vascular surgeon will review the proposed procedure and may obtain additional medical consultation to ensure the patient is suitable candidate for surgery.

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