Open Vascular Surgery

Arterial grafting is performed to bypass a blocked or diseased part of an artery in order to restore proper blood flow and reduce the risk of serious complications. During this procedure, part of a blood vessel from another area of the body is used to prevent blood from passing through narrowed vessels affected by a wide range of vascular conditions to ensure that oxygen-rich blood can successfully reach the heart. The graft used in this procedure is often taken from a healthy artery in the chest, leg or arm.

This procedure is usually performed under general anesthesia and may take several hours, depending on the number of arteries being bypassed. A hospital stay is often required after this procedure and patients will be given specific post-operative instructions in order to promote proper healing and effective heart function.

A carotid endarterectomy begins with an incision in the neck, exposing the narrowed carotid artery. At this point, a shunt may be used to direct blood flow away from the area being operated on. Then, the surgeon opens the artery and removes the plaque, usually in one piece. In some cases, a vein from the leg is grafted onto the carotid artery to widen it. The shunt is then removed and all incisions are closed.

Recovery from Carotid Endarterectomy

A hospital stay of 1 to 3 days is usually required after a carotid endarterectomy. Day-to-day activities can be continued about a week after surgery, as long as they don’t involve strenuous physical labor. Neck aches may last for about 2 weeks after surgery; therefore, it is important for you not to turn your head too fast during the recovery period.

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An aneurysm is an abnormal bulge in the wall of an artery. They can occur in the brain, intestine, neck, spleen, legs, or heart. Aneurysms usually develop wherever pressure is strongest, i.e., in areas where blood vessels divide and branch off to other parts of the body. Aneurysms are extremely risky: if the aneurysm bursts, it can cause life-threatening internal hemorrhaging.

Aneurysms can be caused by illness or injury, but some people are genetically predisposed to aneurysms due to the poor elasticity of their arteries. Other factors include: plaque buildup, cigarette smoking, high blood pressure, and blood infections.

Treatment of Aneurysms

Once an aneurysm is identified, effective treatments include: rupture prevention with early diagnosis and monitoring with medication, in which appropriate adjustments to treatment are made if anything changes, such as enlargement of the aneurysm. The other is aneurysm repair, in which surgery is performed if it is believed the aneurysm is near bursting. The outlook on surgical intervention is generally excellent if the aneurysm is caught in time.

There are two common approaches to aneurysm repair: traditional “open” or surgical repair, and “stent graft” or endovascular repair. During open aneurysm repair, the weakened part of your artery will be replaced with a tube-like replacement which will allow the blood to pass easily through it. Endovascular stent graft is performed within the artery using thin tubes called catheters which are threaded through incisions in the groin area and through your blood vessels. This procedure is considered less invasive. Surgery time depends on several factors including area of the aneurysm, size, and type.

Risks

As with any surgical procedure, there are risks associated with aneurysm repair surgery. However, greater risk lies in ignoring problems that could be symptomatic of an aneurysm or deeper health issue. Patients should actively discuss symptoms and concerns with their healthcare provider. If surgery or treatment has been decided on, personal health or life issues (i.e. smoking, diet, and exercise) that could be factors in the success of their surgeries must be discussed with their healthcare providers.

An aneurysm is a localized, balloon-like expansion in a blood vessel, caused by weak vessel walls. The abdominal aorta refers to the part of the aorta (the artery that carries oxygen-rich blood from the heart to the legs) between the diaphragm and the legs. Hence, when a bulge occurs in the abdominal aorta, it is called an abdominal aortic aneurysm. Most aortic aneurysms occur in the abdomen, and most abdominal aortic aneurysms occur beneath the kidneys and may continue into the iliac (leg) arteries.

Surgery is recommended for arteries at great risk for rupture: those over six centimeters wide, and those four to six centimeters wide in patients otherwise in good health. Surgery is performed immediately on arteries that threaten imminent rupture or have already ruptured, although success is far less likely once the vessel has burst.

Traditional surgery involves making an incision to open the abdomen, then removing the aneurysm and replacing the excised vessel piece with a synthetic tube. Recent minimally invasive laparoscopic techniques require only small incisions, typically made in the femoral artery in the thigh, through which a thin tube with a camera is inserted so the surgeon can “see” inside the patient’s body without the need for open surgery.

In laparoscopic surgery, a stent graft is inserted into one of the small incisions and guided up to the weak area of the artery with a catheter. Stent grafts are six-inch-long metal-mesh cylinders containing synthetic Dacron tubes. Once inside the artery they expand to fill the vessel, providing a strong new vessel wall and permitting uninterrupted blood flow. The aneurysm then generally shrinks around the stent graft as time passes.

Laparoscopic surgery offers reduced risk of complications, but as with any surgery, there is risk of bleeding and infection. Additionally, surgery may result in:

• Aortic rupture or dissection
• Hypovolemic shock
• Arterial embolism (blood clot)
• Insufficient circulation
• Kidney damage or failure
• Myocardial infarction
• Stroke

Short for hemodialysis, dialysis is the most common treatment for chronic kidney failure. Healthy kidneys effectively remove excess fluid, minerals and waste from the blood to keep it clean and prevent disease. When the kidneys fail, they can no longer filter wastes from the blood. Dialysis does the kidneys’ job for them: blood is removed from a vein in the patient’s arm or leg, circulated through a filtering machine, and returned to the body through an artery.

Because veins tend to have weak blood flow, doctors often connect one of the patient’s nearby arteries to the vein being accessed for dialysis. This increases blood flow and strengthens the vein, which in turn allows more blood to flow. The vein’s increased strength and capacity helps create a durable access site and provide ample blood flow for patients undergoing long-term dialysis.

Vascular Access

Dialysis treatments are usually administered three times a week for three to five hours. When beginning treatment, it is important for patients to determine the most appropriate point of vascular access with their doctor, which is the site on the body where blood is removed and returned during dialysis. This area is usually prepared a few weeks before dialysis begins to allow for more efficient removal and replacement of your blood with fewer complications.

There are three basic kinds of vascular access for dialysis treatments, including: arteriovenous (AV) fistula, AV graft and venous catheter. Your doctor will determine which type of access is most appropriate for you based on a thorough evaluation of your condition.

Arteriovenous Fistula

An AV (arteriovenous) fistula is the surgical connection of an artery to a vein to create a stable access site and provide ample blood flow for patients undergoing long-term dialysis treatments. They are created during a minor outpatient procedure that is performed under local anesthesia.
Although they typically take three to six months to mature, fistulas are considered the “gold standard” option for dialysis access. Doctors prefer to use fistulas over alternative methods such as artificial grafts and catheters because fistulas tend to be more durable and have a lower risk of complications.

Arteriovenous Grafts

If you have small veins that won’t develop properly into a fistula, you can get a vascular access that connects an artery to a vein using a synthetic tube, or graft, implanted under the skin in your arm. The graft becomes an artificial vein that can be used repeatedly for needle placement and blood access during hemodialysis. A graft doesn’t need to develop as a fistula does, so it can be used sooner after placement, often within 2 or 3 weeks.

Venous Catheters for Temporary Access

If your kidney disease has progressed quickly, you may not have time to get a permanent vascular access before you start hemodialysis treatments. You may need to use a venous catheter as a temporary access. Catheters are not ideal for permanent access.
Complications
As with any type of treatment, there are certain risks associated with all three types of vascular access, including infection, blood clotting, and low blood flow. These complications are considered minor and tend to occur most often in venous catheters. Your doctor may prescribe medications to correct these problems or may need to remove the access point with additional surgery.

Our doctors have many years of experience performing dialysis access procedures, and take certain precautions to reduce the risk of complications.