Vascular Surgery Wavelengths
Two young doctors unravel a few mysteries behind the cath lab.

 
Dr. Kaviani, what changes have you seen in vascular surgery? What about in interventional cardiology, Dr. Chhabra?

Amir Kaviani (AK): In vascular surgery during the past decade, less invasive approaches have allowed for smaller, less painful incisions, shorter hospital stays, and are often associated with faster, less complicated postoperative recovery.

For example, an aneurysm is a degenerative condition involving the wall of a blood vessel which, over time, leads to a widening of the vessel lumen [space within the vessel], making it prone to rupturing and possible loss of life. In the past, aortic aneurysm repairs were always performed through a large incision and the degenerated segment was replaced with a prosthetic material. Now, grafts can be deployed from within the vessel lumen. When this procedure can be performed safely, the device can usually be deployed through two small incisions overlying the groin arteries rather than a large abdominal incision.

Ankush Chhabra (AC): We’re seeing the same kind of changes. Standard interventional cardiology involved opening up blocked arteries in the heart, but it has now moved way beyond where it was 10 years ago. We’re moving into the field of bioabsorbable stents that dissolve after a certain period of time.

 
There are also clinical trials for percutaneous [through the skin] aortic valve replacement for certain eligible patients with aortic stenosis [constriction] who traditionally had to undergo open heart surgery. Minimally invasive techniques are already being used to repair the most common congenital defect, which is a hole in the heart. With open heart surgery, patients had a four-or-five-day hospital stay, and now they are usually discharged within five hours.

What about non-coronary vascular surgery?

AK: We do a lot of lower extremity interventions in patients who have peripheral vascular disease; the arteries in their legs are pretty severely blocked. If people are developing pain in their legs or calves when they’re walking and the pain goes away when they stop, that’s probably related to low blood flow to the legs, and they might want to get themselves checked out. The good news is, before we’d have to bypass an artery and now we only need to insert a stent. Also, we used to have to strip varicose veins, but now we eliminate the vein that isn’t working properly by making a very small pinprick type incision, going up with a catheter and then ablating the vein from the inside out.   Continue »

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