WHAT IS “ENDOVASCULAR” SURGERY?

As a vascular surgeon, I perform two very different types of surgery: Open Surgery and Endovascular Surgery.

  • Open surgery is just as you might think!  It involves making an incision with a scalpel and using various tools like forceps, scissors, electrocautery, and needle drivers to expose and then repair specific structures.  Since the beginning of surgery itself, all surgeons, not just vascular surgeons, have been practicing open surgery.
  • Endovascular surgery is a recent development that only began in the 1990s.  Motivated by the desire to perform minimally invasive and less harmful interventions on the most sick and highest risk patients, pioneers in vascular surgery developed endovascular techniques.

Though the concept is simple, endovascular surgery now allows vascular surgeons to solve a multitude of problems with blood vessels very differently than they have in the past. Using advanced minimally invasive surgical techniques, vascular surgeons can treat many forms of vascular disease without the need to “cut-open” their patients to treat extraordinarily complex and in some cases life threatening diseases.

Endovascular surgical techniques utilize ultrasound (sound waves) to place the tip of a hollow needle into a blood vessel.  Once these hollow needles have been placed through the needle, we place a very stiff wire that allows us to advance large tubes called catheters into the vessel.  Catheters have many different functions depending on the situation and are used to re-establish blood flow in vessels that are diseased and or blocked.

For peripheral vascular disease, there are blockages in the legs of a patient that prevent blood flow from reaching the foot.  For peripheral vascular disease we can use balloons on the end of the catheter that are inflated to open a blockage.  If balloons do not work, then we can put a self-expanding metal mesh tube on the end of a catheter and then deploy it inside the blockage, thereby keeping it open.  There is also a technology called atherectomy which literally means cutting out plaque.  The atherectomy device has a cutting edge that sands down the plaque and then a suction function that removes all the debris.

For aneurysms, which are dilations of a blood vessel that can rupture, we use stent grafts, which are self-expanding metal mesh tubes that are lined with an impermeable fabric.  We place the stent graft above and below the aneurysm, thereby sealing it from the pressure created by the heart and preventing rupture.

At the end of these endovascular cases, the patient only has one or two 1 mm in size punctures over the arteries that were accessed.  Contrast this to the classic open surgeries where patients could have incisions up to 10 to 20 cm!  As a contemporary vascular surgeon, I take pride and joy in being able to offer both types of surgical interventions to my patients.  If you or your loved one may be suffering from vascular disease, please do not hesitate to call our office at 408-376-3626 to schedule an appointment today!

WHY DIABETES IS BAD FOR YOUR FEET

Everyone knows that diabetes, otherwise known as high blood sugar, is bad for you.  What most people don’t realize, however, is just how many people in the US have diabetes and the impact diabetes has on their feet. In 2021 the CDC released the following info graphic:

 

As a vascular surgeon the primary issue I see in patients with diabetes is foot infection.  But how does diabetes specifically make it more likely for patients to develop foot infections?  My hope in writing this blog today is to give patients a complete understanding of what happens to the feet of people with diabetes.

High concentrations of sugar in the blood lead to what physicians call an inflammatory state in the arteries, or blood vessels that take blood from the heart to the rest of the body.  The inflammatory state results in scarring and narrowing in the arteries.  However, only smaller blood vessels such as the ones in the eyes, toes/feet, and kidneys are affected significantly.  In the feet, the scarring affects both arteries that supply the feet and toes themselves as well as the arteries that supply the nerves.

With a lack of blood flow to the nerves of the feet, patients lose sensation in their toes and feet.  Thus, when a patient has an accidental injury like a scratch or a bruise, no pain is registered, and the area continues to be traumatized and unable to heal.  In addition, the muscles of the foot lose their ability to contract, and they then relax into positions that create bony prominences that erode through the skin and cause ulcers.  Finally, the nerve damage also results in the loss of natural oils in the skin that then makes the skin dry and prone to cracking.  This cracking then increases the chance of ulceration and foot infection.

As you can see, diabetes is very bad for the foot!  If you are diabetic and see an ulcer on your foot or have either pain or numbness, do not hesitate to call our office at 408 376-3626 to schedule an appointment today! Visit our website at www.southbayvascular.com to learn more. We Can Help!