Endovascular Services

Vascular procedures are delicate operations involving your arteries and veins. That’s why it’s important to have a vascular specialist perform these procedures when you need treatment. Peoria Surgical Group’s physicians have extensive experience in vascular and endovascular surgical techniques, and provide quality care.

Abdominal Aortic Aneurysm (AAA) Surgery

Definition/Overview

An Abdominal Aortic Aneurysm (AAA) is an enlargement or weakened bulging area of the aorta (the main artery that caries blood away from the heart). As it enlarges, it can rupture and cause death. Depending on the patient’s general health, the size of the aneurysm and the rate of growth, surgery may be recommended.

Procedure

The traditional method of repairing an abdominal aortic aneurysm is open repair, which is performed under general anesthesia. The surgeon begins with a large incision to the abdomen. Blood flow is temporarily stopped above and below the aneurysm. The aneurysm is opened and repaired by sewing a synthetic tube known as a graft in the bed of the enlarged aorta.

After the procedure, you will be monitored closely in the intensive care unit (ICU). You may have a tube in your throat until you are stable enough to breathe on your own. After this tube is removed, you will be asked to cough and take deep breaths. Though this will be painful, it is crucial so as not to develop pneumonia. You will be given pain medication as needed. When your physician determines you are ready, you will be moved to a post-surgical nursing unit where you will gradually start walking and taking in solid foods. You may be in the hospital for 4 to 7 days, but depending on your circumstances, recovery may be 6 weeks to 3 months.

Angioplasty

Definition/Overview

Angioplasty is a minimally invasive procedure performed to open blocked arteries. It is used when blood flow in one or more of your coronary arteries is restricted. This restriction, if left untreated, can lead to chest pain, possible heart attack or stroke.

Procedure

Angioplasty takes 1 to 2 hours and is performed at a hospital or surgical center. Though you will be awake during the procedure, you will receive medication to help you relax.

The site where the catheter will be inserted is numbed, and imaging techniques are used to guide a balloon- tipped catheter into the artery to be treated. Once there, the balloon on the end of the catheter is inflated to break down the plaque and/or push it against the artery wall. Then the balloon is deflated.

This is repeated several times until satisfactory results are achieved. At this point, the catheters are removed and blood flows freely through the artery.

During the procedure, the IV sedative may make you relaxed and sleepy. You may feel slight pressure when the catheter is inserted and mild discomfort when the balloon is inflated. This should lessen as the balloon is deflated. You will remain in recovery for several hours during which time your catheter site will be checked for bleeding or swelling, and your vitals will be monitored. Your physician may prescribe medication prevent blood clots. After you return home, you will be instructed not to lift heavy objects or exercise strenuously for 24 hours. You should avoid smoking on a permanent basis.

Angioplasty with Vascular Stenting

Definition/Overview

This procedure is performed to widen a narrowed or blocked artery. Angioplasty takes 1 to 2 hours and is performed at a hospital or surgical center. Though you will be awake during the procedure, you will receive medication to help you relax.

Procedure

The site where the catheter will be inserted is numbed, and imaging techniques are used to guide a balloon- tipped catheter into the artery to be treated. Once there, the balloon on the end of the catheter is inflated to break down the plaque and/or push it against the artery wall. Then the balloon is deflated.

This is repeated several times until satisfactory results are achieved. Then a small, wire mesh tube (stent) is permanently placed in the newly opened artery to allow it to remain open. One of two types of stents will be used: a bare stent (wire mesh) or covered stent (with an additional artificial wall). The catheters are removed and blood flows freely through the artery.

During the procedure, the IV sedative may make you relaxed and sleepy. You may feel slight pressure when the catheter is inserted and mild discomfort when the balloon is inflated. This should lessen as the balloon is deflated. You will remain in recovery for several hours during which time your catheter site will be checked for bleeding or swelling, and your vitals will be monitored. Your physician may prescribe medication prevent blood clots. After you return home, you will be instructed not to lift heavy objects or exercise strenuously for 24 hours. You should avoid smoking on a permanent basis. If you have an MRI after your stent placement, make sure you notify the technician that you have a stent.

Carotid Endarterectomy

Definition/Overview

Endarterectomy is the surgical removal of plaque from an artery that has become narrowed or blocked. This procedure is commonly recommended for those who have had a transient ischemic attack (TIA) or a stroke resulting from a narrowing of more than 70% of the carotid artery.

Procedure

During this inpatient procedure, you will either be given general anesthesia or your surgeon will numb the area over the artery and you will remain awake for the surgeon to monitor your brain function (due to the decreased blood supply). Through a small incision in the neck, the affected carotid artery is exposed and opened to allow your surgeon to remove the plaque causing the narrowing. During the repair, blood flow is redirected around the narrowed area using a shunt.

If necessary, a vein patch or synthetic patch may be sewn to the carotid artery opening to widen the artery. After the shunt is removed, the artery and incision are closed. This procedure is typically completed in about 1 to 2 hours. Patients with uncomplicated cases are usually discharged from the hospital 48 hours after surgery.

Femoral Endarterectomy

A Femoral endarterectomy is the surgical removal of fatty deposits, called plaque, from the walls of arteries other than those of the heart and brain. The surgery is performed when plaque blocks an artery and obstructs the flow of blood and oxygen to other parts of the body, most commonly the legs but also the arms, kidneys, or intestines. The peripheral arteries most often treated with endarterectomy are those that supply the legs, especially the aortoiliac arteries in the pelvic area. Other arteries that may be treated with endarterectomy include the femoral arteries in the groin, the renal arteries that supply the kidneys, and the superior mesenteric arteries that supply the intestines.

Endarterectomy Surgery

Endarterectomy surgery is performed to treat advanced peripheral arterial disease (PAD). PAD most often occurs as a result of atherosclerosis, a condition characterized by the gradual build up of fats, cholesterol, cellular waste, calcium, and other substances on the inner walls of large and medium-sized arteries. Plaque, the hardened, waxy substance that results from this build up, can cause narrowing (stenosis) of an artery and block the flow of blood and oxygen. Peripheral endarterectomies are performed to reopen blocked arteries and to restore blood flow in the body (revascularization), helping to prevent heart attack, stroke, the amputation of a limb, organ failure, or death.

Endovascular Aneurysm Repair (EVAR)

Definition/Overview

An Abdominal Aortic Aneurysm (AAA) is an enlargement or weakened bulging area of the aorta (the main artery that caries blood away from the heart). As it enlarges, it can rupture and cause death. Depending on the patient’s general health, the size of the aneurysm and the rate of growth, surgery may be recommended.

Procedure

The traditional method of repairing an Abdominal Aortic Aneurysm begins with a large incision to the abdomen. However, a newer — yet widely accepted — procedure involves the placement of a stent graft.

Using a small groin incision and possibly a small abdominal incision, catheters loaded with the tube graft are passed through the groin arteries into the abdomen. The stent graft is deployed under X-ray guidance. The tube graft occludes the aneurysm at the top of the normal aorta and at the bottom of the normal aorta.

Following the procedure, the patient may or may not be taken to the intensive care unit (ICU) or a post anesthesia care unit (PACU). Vitals are monitored and you will eventually be transferred to a regular nursing care unit. You will be given pain medication if you have not had an epidural during surgery to alleviate postoperative pain. Gradually you will be encouraged to walk and take in solid food as tolerated. The initial recovery time is usually 2 to 3 days, with patients returning to normal activities within weeks. Long-term follow up with serial CT scans is required.

Peripheral Artery Bypass

Definition/Overview

This procedure, sometimes referred to as a peripheral vascular bypass or a lower extremity bypass, is performed to treat Peripheral Artery Disease, when the buildup of plaque in an artery has blocked the normal flow of blood that carries oxygen and other nutrients to the lower extremities.

Procedure

This is an open procedure requiring general anesthesia. The surgeon makes an incision to expose the affected artery above the blockage, and another to expose it below the blockage. The arteries are blocked off with vascular clamps, and the surgeon creates a new path for blood to flow around the blocked or narrowed artery.

The new path — or bypass — is created from either another blood vessel from the patient’s leg or from a synthetic (manmade) graft, which is sutured (stitched) into an opening in the side of one artery then into the other. The clamps are removed and the flow of blood is observed to make sure that it bypasses the blocked portion of the affected artery. Recovery instructions will depend on the area where the bypass was performed. The approximate hospital stay is two to four days, and the patient will be given specific instructions on activity restrictions and lifestyle modifications

Wound Care

The skin is a barrier to the outside world protecting the body from infection, radiation, and extremes of temperature. There are many types of wounds that can damage the skin including abrasions, lacerations, rupture injuries, punctures, and penetrating wounds. Many wounds are superficial requiring local first aid including cleansing and dressing. Some wounds are more severe and need medical attention to prevent infection and loss of function, due to damage to underlying structures like bone, muscle, tendon, arteries and nerves. The purpose of medical care for wounds is to prevent complications. While important, cosmetic results are not the primary consideration for wound repair. Animal and human bites should always be seen by a medical professional because of the high rate of infection. Please call 911 if you have either one of these conditions and need immediate help.

Most wounds can be treated at home with routine first aid including thorough washing and dressing to prevent infection. You may be required to visit our offices at Peoria Surgical Group to meet with a physician or physicians assistant to set a plan of action for your wound care.

Some of the following are reasons medical care should be obtained for a wound:

  • If the wound is due to significant force or trauma and other injures are be present.
  • If bleeding cannot be stopped even with persistent pressure and elevation.
  • If there is concern that wound requires repair with sutures (stitches). The size and location of the wound are important considerations. Most facial wounds may need to be repaired for cosmetic reasons, especially if they involve the lip or eye.
  • If the wound is caused by an animal bite. At least 50% of dog bites, 80% of cat bites, and 100% of human bites become infected. There is also a need to consider rabies immunizations if appropriate.
  • If the wound is very dirty and cannot be easily cleaned.
  • If there is evidence of infection including redness, swelling, increased pain, and pus at the wound.
  • If tetanus immunizations are not up to date, then a booster is needed within 48 hours. If the patient has never been immunized, the initial tetanus prevention with immunoglobulin should be given immediately.

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