vascular procedures

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& Minimally Invasive Procedures & Surgeries

Lower extremity angioplasty/ stenting - a less invasive alternative to lower extremity bypass surgery for the treatment peripheral arterial disease. Lower extremity arterial disease is caused by damage to the inner wall of the artery from atherosclerosis or hardening of the artery. Symptoms of lower extremity arterial disease is pain in the hip, pain in the thigh/ calf with walking. If arterial insufficiency progresses and is left untreated, this can ultimately lead to gangrene and loss of the extremity. A diagnosis is made not only by objective/ subjective assessment but also by ultrasound and angiogram/ MRA of the extremity.

If the blockage is not that extensive, angioplasty with stent placement can be performed to re-establish blood flow. An open bypass may be necessary if the blockage is too extensive for angioplasty. Stenosis of right superficial femoral artery. Less invasive vein ablation - a minimally invasive treatment for venous insufficiency/ vericose veins. These poorly functioning veins cause venous pooling and decreased blood return from legs back to the heart. During this outpatient procedure, the interventional radiologist advances fine catheters within the greater saphenous vein. Once in the vein radiofrequency or laser energy is applied thus sealing off the vein. Once the diseased vessel is closed, alternate healthy veins take over to carry blood from the leg, re-establishing normal flow.

Renal Artery Angioplasty - a less invasive procedure to improve blood flow to the kidneys which may be caused by atherosclerosis. This reduced perfusion (renal artery disease) can lead to hypertension and eventually renal failure if not treated. The location and extent of the lesion is diagnosed by performing a renal artery angiogram. If the blockage is extensive then angioplasty and stenting is done to re-perfuse the kidney. Mesenteric artery angiogram - seen below, is done to assess for any acute bleeding or blockage in any of the abdominal vasculature. If a blockage is present, it can cause bowel to become necrotic and die.

Endovascular Stent Grafting - less invasive procedure for the treatment of an abdominal aortic aneurysm and more recently thoracic aortic aneurysms. The vascular surgeon along with an interventional radiologist perform this procedure under direct radiographic visualization. Access is gained through the femoral artery in the groin and specialized catheters, guide wires and instrumentation is placed within the vessel to the area of the aneurysm. This less invasive approach to aneurysm repair is a good alternative for patients who are to ill to undergo an extensive open surgery. If you are an appropriate candidate, an endovascular approach can offer the patient numerous potential benefits such as: smaller, less painful scars, less anesthesia, faster recovery, less risk for infection and a shorter hospital stay. With aortic stent grafting,the majority of patients have minimal discomfort and are able to resume their normal activity within 2-3 weeks of the repair.

Although the endovascular approach is less invasive, it is still a surgical procedure that involves a certain level of risk. Consult your health care provider to see if endovascular repair is appropriate for you. Long-term complications are not yet known due to its relative infancy as a surgical alternative for abdominal aortic aneurysm repair. Frequent CT scans are advised to check the stent graft for potential leaks between the graft and the wall of the aorta.

CT imaging of stent graft

3D imaging of hypogastric, femoral
arteries to evaluate degree of
stenosis.

Imaging on renal vasculature to
evaluate stenosis

More less invasive vascular procedures

Synthetic venous grafts are commonly placed in the arms and legs to allow access to the circulation for hemodialysis for kidney failure patients. These synthetic access devices regularly develop a narrowing of the inside of the graft where they are sewn into the vein. This narrowing can cause the graft to clot with blood and consequently patients cannot have their usual dialysis treatment. In a majority of the cases, the blood flow within the graft can be restored without surgery using a small tool placed directly into the synthetic graft through a needle stick. After the clot has been removed, an angiogram will show possible areas of narrowing that can be dilated with a specialized balloon. Open surgical repair of the graft may be necessary if the graft starts to clot more frequently or the narrowing does not respond to angioplasty or ballooning of the graft.

Both instances are medical emergencies if diagnosed. If active bleeding is seen, the area that is bleeding can be embolized, or stopped with specialized coils. Mesenteric artery angioplasty and stenting is a newer method for opening a mesenteric artery and restoring blood flow to the bowel to prevent death of the tissue. It can sometimes be performed at the time of the angiogram.