Is endovascular surgery right for you?

 The trend in surgery today is to use the least-invasive procedures possible. The reasoning is simple: It’s usually better for patients to return home and get back to their normal lives faster than for them to spend long periods recovering in the hospital.  

In the field of vascular surgery, which deals with conditions of the blood vessels, we refer to minimally invasive surgery as endovascular surgery. Endovascular surgery involves small punctures, usually in the groin area, as opposed to the large incisions on the abdomen or chest that open surgery for blood vessels requires.

This type of surgery has seen a huge surge in the past few decades. That’s because it’s often safer and better for patients. But endovascular surgery isn’t the best option in all cases. Below, I’ll discuss when we use endovascular surgery, why it’s beneficial, when the traditional open approach might be better and what’s to come for this area of surgery.  

When we use endovascular surgery

We can use these surgical techniques for virtually the entire range of vascular treatments. These include:

The field of vascular surgery started seeing a surge in less-invasive surgical techniques in the early 1990s. Since then, endovascular surgery has grown from something reserved for simple cases to being used for complex issues today. Our rule of thumb is this: If a vascular surgery can be done with an endovascular technique, that’s probably the way to go.  

A vascular surgeon’s work now consists of about 75 percent endovascular surgery and perhaps 25 percent open surgery. That’s almost the opposite of the way it was just a few decades ago.  Using less-invasive techniques involves a much different skillset for vascular surgeons. I must be able to clearly see the area where I’m operating on an X-ray screen, rather than operating on the patient and looking directly. Advanced imaging technology, like what we use in our Hybrid Suite, can make this easier for vascular surgeons.  

Request an appointment with one of our doctors to learn if endovascular surgery might be an option to treat your vascular condition.

How endovascular surgery benefits patients

The main benefit of endovascular surgery is that it’s less invasive. Open surgery for blood vessels can involve large incisions, major scarring and long recovery periods. But less-invasive techniques are all done through a small puncture or incision, usually in the groin area. We can thread our tools through the blood vessels to access the area where we’re working with the use of catheters—thin, flexible tubes we insert into this small incision.

Many patients who have this type of surgery go home the same day. Some have short stays in the hospital afterward, but it’s a huge improvement over those who have open vascular surgery. Endovascular surgery can make a big difference in patients’ recovery and quality of life.  

#Endovascular surgery can make a big difference in patients’ recovery and quality of life. via @MedStarWHC

A great example is surgery to treat aortic disease. Traditionally, correcting it involved an open surgery with a large incision and long recovery period. Patients were usually in the hospital for seven to 10 days, and they usually took three to four months to fully recover. But with an endovascular surgical procedure, these patients go home the next day, and they’re usually back to themselves within four to five days.

Limitations of less-invasive blood vessel surgery

While there’s been tremendous growth in this area of surgery, it does have a few limitations. One example is if we can’t reach an area through a minimally invasive approach. Because we thread our surgical tools from the groin to the area where we operate, we must make sure we can access the blood vessels we need to treat and that blood continues to flow to the body’s organs and tissues during surgery. With an open approach, we can directly access the area where we need to work, which can be easier in some cases.

A patient’s age and overall health also can factor into the decision on whether to use a less-invasive technique or an open surgical technique. Though endovascular surgeries can be easier on patients, some patients find that the results don’t last as long as the results after open vascular surgery. So we may have to weigh a patient’s particular options when we decide which approach is better. For a 75-year-old who’s a smoker, I probably would choose a less-invasive approach to be easier on the patient. For a 35-year-old who’s in otherwise excellent health, it may make sense to perform an open surgical procedure that will last a lifetime.

New treatments on the horizon

Researchers hope to make endovascular surgery a good option for treating even more cases of blood vessel conditions. It’s a constant process of changes and improvements to make this possible.

As of January 2017, we have initiated a clinical trial for a new device to treat aortic aneurysms in the aortic arch, which is the area of the aorta that curves between the ascending aorta (which carries blood up from the heart) and descending aorta (which carries blood down through the chest and abdomen). The aortic arch has three blood vessels that branch off of it to carry blood to the arms and brain.

Traditionally, we haven’t been able to put a stent (a device used to hold blood vessels open) there, because it would cover those branching arteries. But we’ll be testing a new device that allows us to maintain this circulation with a minimally invasive approach.

We’re also involved in the clinical testing of different balloons used to treat peripheral artery disease. During a procedure called angioplasty, we use a balloon to push arterial blockages aside to improve blood flow. But these blockages may come back over time. We helped test a balloon coated with a medication to prevent blockages from reforming in treated blood vessels.

And we’re about to help test another type of angioplasty balloon called a lithotripsy device. This balloon uses sound waves to break up blockages that have hardened because they have calcium in them, similar to a process used to treat kidney stones.

Endovascular surgery is a great option in many cases. And as technology and techniques continue to improve, I’m looking forward to it being an option for even more conditions and patients.

Sean Hickman’s Second Chance

Sean Hickman’s Second Chance

One Serious Accident 

Sean Hickman has been a Washington, D.C. police officer since the fall of 2005. As a police officer, he was familiar with the facilities at MedSTAR Trauma at MedStar Washington Hospital Center. Every time he responded to a call that required transportation for a patient, that is where he brought them. “It was a safety net that helped the city, and it was a reliable place that we could depend on in taking care of the people we brought in,” he explains.

While most officers spend their days in patrol cars, Sean found a way to combine two of his greatest loves: his job and his passion for motorcycles. He did his patrols on two wheels instead of four. One day, while responding to a call, Sean was intentionally struck by a hit-and-run driver. He was transported to MedStar Washington Hospital Center. “I was concerned I was going to die,” he says. “Once I got to MedStar, I knew I was going to be okay.”

It wasn’t until after his first surgery that he learned the full extent of his injuries. His whole left side, from the hip down, was essentially shattered.

 An Amazing Second Chance

Over the next three years, Sean underwent 20 surgeries. MedStar Washington Hospital Center’s vascular, trauma, orthopedic, and plastic surgery teams worked together to repair his life-threatening injuries and then save his leg. “Everybody that was in the initial trauma team to everyone thereafter helped to save my life,” he says

Sean returned to his job after one year and 10 months, but he remains at desk duty today. He hopes to recover enough to return to full-time police work.

The progress that Sean has already made allows him to walk short distances today, completely unassisted by crutches or a cane. On July 2, he’ll test his walking ability in front of friends and family as he marries his fiancé who has stood by him throughout his recovery. His injury put their wedding date on hold, but now, he’ll have a second chance to do what would have been impossible three years ago—he’ll walk down the aisle to his bride.

Have any questions?

We are here to help! Contact us for more information about MedSTAR Taruma. Call us at 855-546-1974.

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Life’s Pleasures Restored Post Peripheral Vascular Disease

Debilitating Leg Pain from Peripheral Vascular Disease Gone after Minimally Invasive Surgery

A leisurely walk along a fishing pier on a recent vacation with his wife would not have been possible for Kevin Dougherty earlier this year. That’s because the 62-year-old retiree was experiencing claudication—or too little blood flow—in his right leg, which in turn caused pain and cramping when Kevin walked even very short distances.

A lifelong smoker who had previously undergone a carotid endarterectomy for plaque build-up and blockage in the carotid artery in his neck, Kevin Dougherty knew the underlying cause of his constant leg pain was likely peripheral vascular disease (PVD). The potentially serious but treatable circulation problem occurs when the vessels that supply blood flow to the legs are narrowed. PVD is typically caused by atherosclerosis, or plaque build-up inside the vessel walls.

Kevin, despite living in Bethany Beach, Del., knew exactly who he wanted to treat his condition—Edward Woo, MD, an internationally known surgeon who leads the vascular surgery program at MedStar Heart & Vascular Institute. Kevin met Dr. Woo during a previous procedure, while they were both living in Pennsylvania. In fact, Dr. Woo’s brother repaired Kevin’s congenital heart valve defect years earlier.

After confirming peripheral vascular disease with diagnostic testing, Dr. Woo brought Kevin to MedStar Washington Hospital Center. Here, he placed stents, or thin, wire mesh tubing, to help keep the vessel open in Kevin’s right upper leg. The blockage was reached through a small puncture in the groin area. The same-day procedure in March allowed Kevin to walk out of the hospital with less pain and cramping than when he walked in.

“A lot of people may be experiencing leg pain and not know the cause of it,” explains Dr. Woo. “If you have any concerns, it is important to talk to your doctor or make an appointment to see a vascular specialist. Without treatment, severe PVD can lead to worsening conditions, including dead tissue, gangrene, and even possible amputation
of a limb.”

Kevin is grateful for both Dr. Woo’s care and expertise. “The amount of respect I have for Dr. Woo and his staff is immeasurable,” he says. “He is an amazing doctor, and I would recommend him to anyone.”

“My right leg feels great,” he adds. “Before, I couldn’t even walk a block. Now I can walk a half mile or more, and I try my best to keep up with my six grandchildren.”

MedStar Heart & Vascular Institute currently has a team of experienced vascular surgeons and physicians at MedStar Washington Hospital Center, MedStar Georgetown University Hospital, MedStar Montgomery Medical Center, MedStar Southern Maryland Hospital Center and MedStar St. Mary’s Hospital.

If you or a loved one is experiencing symptoms of peripheral vascular disease (see box at right), schedule an appointment with one of our specialists at 855-546-1974.

Symptoms of Peripheral Vascular Disease (PVD) Include:

  • A change in color or temperature  of the limbs
  • Pain or cramping in the legs when walking or at rest
  • Numbness or tingling sensation
  • A new, long-lasting sore in the foot or leg
  • Diminished pulses in the legs and feet
  • Thickened, opaque toenails

You may be at risk for vascular disease if you:  

  • Are age 50 to 80
  • Smoke
  • Have diabetes, high blood pressure or high cholesterol
  • Have a history, or family history, of heart disease
  • Are obese or physically inactive

To detect the Peripheral Vascular Disease early, MedStar Health has partnered with Dare to C.A.R.E. to offer FREE vascular screenings. Screenings are quick and pain-free, using ultrasound technology. Schedule your screening today, at 410-573-9483 ext. 202 or 203.

 

Have Any Questions?

We're here to help! Contact us for more information about PVD or to schedule an appointment with a specialist. Call us at 855-546-1974.

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