Since physicians do not know the exact cause of atherosclerosis,
therapy is directed at risk factor reduction, such as quitting smoking, lowering
cholesterol and embarking upon a regular exercise program. Once atherosclerosis
develops and progresses, other treatments become necessary.
What kinds of problems do vascular surgeons treat? The most common problem treated by vascular surgeons is atherosclerosis,
or hardening of the arteries. The disease affects virtually every artery within
the body, but seems to have a particular preference for certain sites, which
means it generally results in a limited number of types of clinical problems.
When the disease is in the coronary arteries the heart becomes affected. Narrowing
in the carotid arteries in the neck affect the brain and can cause stroke. Similarly,
atherosclerosis in the leg arteries can cause different problems of varying
degrees in the legs. Another condition that is well managed by having a vascular
surgical procedure is an anuerysm of a major internal artery, such as the aorta,
or anuerysm of an extremity such as thise that occur behind the knee.
Do vascular surgeons recommend a surgical procedure
to treat all vascular problems? Not all, but operations performed by our Vascular Surgeons have a very
good sucess rate and safety record. Some are treated with medications and are
followed with non-invasive tests. If there is no evidence of progression, some
problems are monitored, and left alone. Where conditions require intervention,
a number of new and innovative techniques are available. Manipulation within
arteries using specially designed balloons and catheters can often restore circulation
or the integrity of a vessel wall without a surgical procedure or hospital stay.
What kinds of procedures or operations are used
to treat vascular diseases? Severe arterial diseases are treated by vascular
radiology procedures or by surgery. Balloon angioplasty -- in which a balloon is
inserted with a catheter, then inflated, deflated and removed -- may be used for
short areas of blood vessel narrowing. Dye is injected afterward to determine if
the artery has opened sufficiently. If not, the procedure is repeated. Another
procedure called athrectomy utilizes a catheter with a high-speed cutting blade
to remove plaque.
Possible surgical techniques used to improve circulation include:
Endarterectomy -- involves opening the
diseased artery, removing the plaque, and closing the artery with sutures.
Trombectomy/Embolectomy -- involves
removing a blood clot using a small catheter with a balloon at the end of it.
The artery opening is closed with sutures.
Bypass -- involves use of a vein or a synthetic
graft to bypass an area of narrowing or blockage, or to replace the weakened
walls of an aneurysm.
How is intermittent claudication treated? This recurrent muscular leg pain is temporarily alleviated by rest,
and without specific therapy, but in a number of advanced cases the problems
persist. Continued walking and the elimination of typical risk factors such
as smoking and a high cholesterol diet should cause sufficient improvement so
that surgical therapy will not be necessary. A small percentage of patients,
however, will develop gangrene and may require amputation of part or all of
a leg.
Some drugs have been approved for use in this condition, but they are not as
yet particularly helpful or cost-effective. In progressive or severely disabling
cases, it may be possible, if patients are carefully selected, to successfully
dilate a narrowed blood vessel using a special balloon catheter. Endovascular
grafts may be appropriate for other patients. For the majority of patients who
require correction of intermittent claudication, however, some form of surgical
bypass will be necessary.
How are varicose veins treated? If varicose veins are extensive and extend above the knee, some form
of surgery might be warranted. This may include stripping out the entire diseased
segment, tying off the dilated vein in the groin, and/or making numerous small
incisions in the leg to remove the damaged vein.
How are leg ulcers treated? This problem can generally be treated with periodic leg elevation,
properly fitted elastic stockings, and scrupulous care of the skin of the lower
legs.
How is renal vascular hypertension treated? When left untreated, renal vascular hypertension may progress into
ischemic nephropathy or renal failure. After proper screening and diagnostic
imaging studies, narrowed renal arteries can be corrected by one of two means.
The first is through a procedure called percutaneous transluminal angioplasty
where the lesion does not involve the origin of the blood vessel and is limited
in length. The other option is surgical reconstruction, either by means of thromboendarterectomy
or aortorenal bypass procedures.
How is mesenteric ischemia treated? Once the diagnosis of mesenteric ischemia is obtained by arteriography,
it can be treated by a surgical intervention called aortovisceral bypass grafting.
Prosthetic conduits can be used to bypass the atherosclerotic lesions of the
celiac as well as superior mesenteric artery.
How are aneurysms treated? Once an aneurysm forms, it tends to enlarge until it ruptures or causes
other symptoms that require treatment -- although among older patients whose
aneurysms do not appear to be enlarging, this may not be the case. Aneurysms
in the abdominal aorta are usually repaired when they are wider than about 2
1/2 inches, and if it is smaller than that when first detected it can be closely
followed with ultrasound scans. During this period of "watchful waiting,"
a patient is advised to quit smoking, control blood pressure and improve overall
fitness with an exercise program. No medication has as yet proven effective
in reducing an aneurysm's growth rate.
Does aneurysm repair always require a major operation? Although they cannot be treated medically, a new graft to re-route
the flow of blood is under development that would be inserted within the artery
with a specialized catheter. This procedure, in its developmental stages, is
offered only in selected locations. It is available at Henry Ford Health System
facilities.
What kind of surgery would be needed
to repair an aneurysm? It is called an aortic aneurysmectomy and bypass, and it is performed
to repair the aneurysm and divert the blood across the weak part of the aorta
before it becomes problematic. A cut is made in the abdominal wall to expose
the aorta and clamp it above the aneurysm to stop the flow of blood to the lower
part of the body. The aneurysm may be repaired by cutting it, opening it up,
removing the material in it, sewing a graft (or patch of tissue) onto the artery,
and folding the shell of the aneurysm over the graft. Or, the surgeon may remove
it entirely and cover the hole in the artery with a graft. If it needs to be
bypassed, a tube will be attached above the aneurysm from the aorta to the arteries
in the legs.
How is carotid artery occlusive disease treated? Without symptoms, treatment may consist of regular checkups and the
use of medications that thin the blood or prevent clotting. If symptoms develop
and the blockage in the artery can be located, surgery -- called a carotid endarterectomy
-- may be required to remove it.
The blockage usually consists of pieces of fat and/or other cells, called plaque.
A cut is made in the artery to remove the blockage. When the artery is blocked,
blood flow to the brain is decreased. If left untreated, the patient is at risk
of a stroke.
What if a patient has had a stroke?
If a patient suffers a CVA (cerebrovascular accident), or stroke,
certain brain cells will have died. Though brain cells cannot regenerate, surrounding
areas of the brain can assume some of the functions of the dead cells; thus,
it is possible for the patient to recover lost function following a stroke.
If a stroke is suspected, a CT scan should be ordered to confirm the diagnosis
and measure the extent of damage. A stroke can result from many causes and surgical
correction will be necessary in only a small percentage of cases.
Since it is difficult to restore function following a stroke, early detection
of this threat is critical.
What are the risks of surgical repair? Risks related to surgery depend on the hospital's expertise ,
the surgeon's skill, and the overall health of the patient. Patients without
health problems and, especially without any history or signs of heart
disease, generally do quite well. Those with known coronary artery disease
should have a thorough cardiological evaluation before surgery. Risks associated
with anesthesia, and possible kidney or nerve damage, loss of sexual function,
heightened blood pressure, and repeated or additional operations should all
be fully discussed with the doctor.
How does one prepare for surgery? Follow the doctor's specific instructions. Generally, a light
meal is allowed the night before the surgery, with no eating or drinking after
midnight and into the morning of the surgery. Plan for care and recovery time
following the operation by allowing time for rest and arranging for others to
help with day-to-day chores and obligations.
What happens after the procedure? The patient is moved to an intensive care unit until stabilized, and
then moved to a regular room. Depending on the surgery, the patient may have
a tube inserted down the nose into the stomach to help release fluid and air
from the gastrointestinal tract for 2 or 3 days while the intestines recover.
Some medications may be necessary to keep the blood from clotting following
surgery.
What is the usual recovery time? That depends on the specific procedure in question, but the average
hospital stay is in the range of [1-7 days], depending on the patient's
overall condition. In some cases, patients can return to a fairly normal lifestyle
within a few weeks, but strenuous activity should ordinarily be avoided for
a period of up to 4 to 6 weeks. The doctor will specify how much activity is
acceptable, and when a follow-up exam is advisable.
Who pays for surgery? Henry Ford Health System accepts all insurance plans. We have treated
patients covered by all major commercial insurance carriers, HMOs (including
Health Alliance Plan and Selectcare), and Medicare and Medicaid.
