Vascular Surgery

Vascular Surgeons

Ian N. Hamilton, Jr., MD

Michael C. Hartley, MD

What is Vascular Surgery?
Vascular surgery is an important medical field that is, however often confused with cardiology.  Vascular surgery involves the blood vessels – the arteries and veins – outside of the heart.  Endovascular procedures, which may be likened to operating on the arteries and veins from the inside, are less invasive procedures for treating problems that can develop in the blood vessels that cause a portion of the wall of the vessel to bulge or balloon out, or the problem may be a narrowing (also called occlusion or stenosis) of the vessel that is caused by a buildup of plaque.

How Does It Work?
For years, these conditions were repaired with open surgical procedures, whereas many of these new procedures are, instead, now performed through a small catheter.  The important advances in vascular surgery are the use of techniques such as balloon angioplasty and stent placement that have been used in the heart for a number of years.

One of the first endovascular procedures the hospital offered was repair of aneurysms, most notably abdominal aortic aneurysms, with a minimally invasive technique that involves the use of stent grafts, hollow tubes that take the pressure off the weakened area, lessening the risk of rupture.  Carotid artery balloon angioplasty and stent placement have been performed at HMC since April 2006 (approved by FDA earlier the same year).

Advances
Other advanced minimally invasive procedures available to HMC patients include rotational and directional atherectomy, in which a burr or cutter is used to remove plague in the legs and restore blood flow.  Atherectomy with or without angioplasty and/or stent placement allows reopening of blocked arteries and frequently obviates the need for otherwise needed bypass surgery.  In addition, the AngioJet system, a catheter system that makes use of jet pump mechanics to suck clots out of arteries, is another advanced treatment option.

Evaluating patients with sophisticated non-invasive diagnostic testing such as a 64-slice CT scanner, a GE Innova Endovascular Lab imaging system and intravascular ultrasound (IVUS), the surgeon can determine which patients are candidates for these procedures.  While not every patient is a candidate for an endovascular procedure yet, as the technology evolves, it will become available to an even wider range of patients.

The IVUS machine makes evaluating patients’ arteries much safer and more accurate.  It is a very small catheter that is put into an artery to allow the surgeon to look from the inside out with a 360 degree field of vision.  It gives information about plaque that conventional ultrasound and angiography does not offer.  It can determine the characteristics of the plaque, how old the clot is and determine if it is best treated with clot-dissolving medicine, atherectomy, a balloon or a stent.

Education / Screening
In an effort to increase public awareness of vascular health; an educational / screening program called, “Dare to C.A.R.E.” is offered to help detect vascular disease.  

To Find Out More
Podcasts for Patients and Families
Vascular Conditions, Tests, Treatments