Vascular Surgery/Endovascular Surgery
After the age of 50, most people experience some form of vascular problem. For some it may be little more than an elevated cholesterol level. For many, however, there are complications such as cardiac disease, hypertension, diabetes, kidney disease or lipid disorders.
The Division of Vascular Surgery performs procedures on the abdominal and thoracic aorta, and reconstructive procedures for pathologic condition affecting the mesenteric, cerebrovascular and extremity arteries. Access procedures for renal failure and procedures for varicose veins and venous disease are also performed.
What is Vascular Disease?
Simply stated, vascular disease can be defined as hardening of the arteries. While many people associate this process with heart disease, a build up of damaging plaque in blood vessels in other parts of the body can cause a variety of life or limb threatening illnesses: strokes, renal failure, gangrene and abdominal aortic aneurysms - one of the most common causes of death in people over 60. Vascular disease also encompasses a variety of painful and disabling disorders that affect the veins; leg ulcers, varicose veins and "bad veins" due to incompetent valves.
Making the Diagnosis
Noninvasive Diagnostic Testing
Onsite laboratory testing offers specialized, painless diagnostic testing to identify abnormalities created by vascular disorders. These tests include carotid ultrasound for the neck arteries, arterial ultrasound for aneurysms, arterial Doppler for leg arteries, ultrasound of arteries to the kidney, ultrasound for obstruction in grafts or fistulas created for hemodialysis, assessment of leg bypass grafts, and vein ultra-sound for phlebitis.
Angiography is taking images to study blood flow in the arteries. The resulting picture can be used to examine almost any artery, including those in the legs, kidneys, head and lungs. Magnetic resonance angiography and CT scanning are utilized. These exams are performed by experienced vascular/interventional radiologists to accurately diagnose the level and degree of disease. When necessary, standard angiography is performed through use of an injection of contrast dye.
More than 2,000 procedures are performed annually by the nationally recognized vascular surgeons at Long Island Jewish Medical Center and North Shore University Hospital. These include the entire range of reconstructive vascular procedures to relieve the effects of blocked blood vessels. The surgeons at both North Shore University Hospital and Long Island Jewish Medical Center also treat aneurysms of the aorta and other blood vessels. They perform vascular access procedures for both long term intravenous treatments and access for hemodialysis. Minimally invasive endovascular techniques are used whenever possible to improve both short and long term recovery.
The carotid artery is an artery in the neck which provides a significant portion of the blood supply to the brain. There is one on each side of the neck. Blockages of this artery and its branches can lead to strokes. Carotid endarterectomy is an operation performed to remove the blockage, which is composed mostly of calcified plaque. The indications for this operation are specific, and patients are fully evaluated to determine if they are candidates for endarterectomy. Endovascular techniques (angioplasty and stenting) are available when indicated.
Peripheral Arterial Bypass
Blockages of the arteries in the abdomen, pelvis and legs can result in pain in the legs when walking or at rest. Such blockages can produce sores in the legs and feet, prevent the healing of wounds and can result in the loss of a limb. Sometimes, in order to restore blood flow it is necessary to bypass the blockage with a procedure that uses a synthetic tube or the patient's own veins to bring blood from the arteries above a blockage to those below the blockage.
Minimally Invasive Techniques for Aortic Aneurysm
The vascular surgeons have expertise in the latest approaches to aortic aneurysm surgery. These include a minimal incision technique which allows repair of the aneurysm through a smaller incision than is used in the standard open approach.
These surgeons also offer endovascular aneurysm repair. This is another minimally invasive method of performing aneurysm repairs. For more information, go to Minimally Invasive Techniques for Aortic Aneurysm Surgery.
Minimally invasive techniques are rapidly evolving, allowing less invasive treatment of vascular and nonvascular diseases. Patients are treated by using small caliber catheters or devices introduced into their blood vessels via catheter. This includes balloon angioplasty (inflation of a balloon within a blood vessel) to create a wider channel for increased blood flow, the use of expandable metal tubes, known as stents, placed within the vessel to maintain the widened channel, and thrombolytic therapy, which is medication injected through a catheter to dissolve blood clots.
Vascular Access Service
In cases of chronic disease or inadequate veins, vascular access in often recommended. This procedure involves insertion of an intravenous catheter to allow easy access for antibiotics, nutritional supplements or chemotherapy. Various techniques for establishing access for patients who need hemodialysis are also provided.
Diabetic Foot Care Center
Diabetic patients have great susceptibility to infection, which may particularly effect the feet with dire results. The Diabetic Foot Center offers a multidisciplinary approach to treatment and prevention. The Center is staffed by podiatrists, who coordinate with other diabetic specialists including endocrinologists, neurologists, plastic surgeons and orthotic specialists to provide complete management of limb-threatening wounds and infections. This multidisciplinary approach affords the best possible care for the prevention of serious complications.
Varicose veins, spider veins as well as other venous problems can cause significant pain and/or unsightly marks.The vascular surgeons at both North Shore University Hospital and Long Island Jewish Medical Center offer comprehensive care of these problems with surgical and non-surgical options.
Continuing education for vascular patients comprehensive disease management program. In addition, Institute staff provide community education programs and periodic free screenings to detect carotid artery disease, abdominal aortic aneurysms and peripheral arterial disease.
Basic Science and Clinical Research Programs
All vascular surgeons are involved in ongoing clinical research programs which are central to developing new and improved methods of understanding, detecting and treating vascular disease.
To Make an Appointment
To schedule an appointment, please phone (516) 233-3701. Our team of Vascular Surgeons are available 24 hours a day.
The aorta is the largest blood vessel in the body. Originating from the heart, it is the major artery that delivers blood throughout the body through various branches. In some patients, the wall of this artery may become weak and the artery will get bigger like a balloon. This is what is called an aneurysm. The most common place for this to occur is in the abdomen between the kidney vessels and where the aorta divides into two at the pelvis to give the blood supply to the legs.
Unfortunately, there are little or no symptoms from abdominal aortic aneurysms (AAA), even when they get quite large. They are most often found incidentally on a physical exam or on a test like an ultrasound, MRI or a CAT scan done for another reason. The danger of an AAA is that it may rupture or burst. This event will most often result in death (80-90%). AAA is the 13th leading cause of death in the Unites states. Some famous people have died of this, like Joe DiMaggio, Lucille Ball and Albert Einstein. The risk of rupture increases with increasing size.
Once an AAA gets bigger than 5 centimeters in size, the risk of rupture starts rising rapidly. Above 7 centimeters, the risk of rupture is very high. Surgery is performed on AAA to fix it before it ruptures. On the whole, the chances of making through a surgery to fix an AAA that is not ruptured are 93-95%. An AAA is completely cured by surgery.
The standard open repair of aortic aneurysm has long been demonstrated to be consistent and durable. Once the aneurysm is repaired, the concern for rupture is alleviated and no routine x-ray follow up is required. The standard operation for aortic aneurysm surgery involves a large incision (about 12-14 inches long) from the bottom of the breastbone to the bottom of the abdomen. At L.I.J., techniques which are less invasive, have been developed. Laparoscopically-assisted aortic aneurysm repairs were first reported by our institution in 1997. Since then we have also developed the minimal incision technique.
Minimal Incision Technique
Minimal incision technique was developed to keep the benefits previously seen with laparoscopically - assisted aortic aneurysm repair but to reduce the operative time and the need for multiple small incisions associated with laparoscopic surgery. The approach to the surgery is also through an incision in the middle of the abdomen but it is a much smaller incision than the standard surgery with the usual length around 4-5 inches.
One or two small half-inch incisions may be used for the placement of surgical instruments, which prevent bleeding during the aneurysm repair if needed, but the majority of times this may be done through the original incision. The aneurysm is then repaired in the same way as with the standard open technique, which involves sewing in a Dacron graft to replace the aneurysmal aorta. This acts as a new pipe through which the blood can flow. This graft is permanent and will stay in for the rest of your life. The materials that are used for the graft do not cause a reaction and your body will not reject it.
Our studies have shown that patients undergoing the minimal incision technique recover faster from the surgery in terms of length of stay in the intensive care unit, time to resuming a full diet, and time to discharge. They also had less post-operative pain due to the smaller incision. They also tend to get back to normal activities sooner.
Endovascular Aneurysm Repair
Endovascular aneurysm repair is a technique that involves fixing the aneurysm from within. The procedure consists of performing two small groin incisions through which a graft is inserted into the aorta. The graft is held in position by stents similar to those used to open blockages in blood vessels. This graft effectively excludes the aneurysm from the flow of blood, which is now directed through the graft, (see illustrations of before and after endovascular grafting).
The obvious advantage to these grafts is that an abdominal incision is avoided and this allows patients to recover faster. The majority of patients can go home 24 to 48 hours after surgery. Patients return to normal activities much sooner than with open repairs. In some cases this procedure can be done without general anesthesia.
Not all patients will be candidates for this procedure depending on their anatomy and other factors. If you have an aneurysm and want to find out if you are a candidate for this technique or one of the other techniques, call to make an appointment for an evaluation.
Our surgical staff has many years of experience in performing even the most advanced vascular and endovascular operations. We have presented our successes at numerous national and international conferences. Our staff consists of:
- Dr. Gary Giangola — System Chief, Vascular Surgery, Vice Chairman
- Dr. K. V. Krishnasastry — Chief, Vascular Surgery, North Shore University Hospital
- Alisha Oropallo — Director, Comprehensive Wound Healing Ctr & Hyperbaric
- Dr. Mark Kissin
- Dr. Richard Schutzer
- Dr. Mihai Rosca