Vascular and Endovascular Surgery
Thoracoabdominal Aortic Aneurysm Repair (TAAA)
TAAA repair is an extensive surgery done to fix aneurysms (ballooning) of the aorta that extend from the chest into the abdomen. A catheter, inserted at the start of the procedure to drain spinal fluid, relieves pressure created during surgery and reduces the risk of post-surgical paralysis. Surgical methods used by the Memorial Hermann Heart & Vascular Institute-TMC team since 1992 have dramatically reduced the incidence of paralysis from 15 percent to less than 3 percent.
Endovascular Abdominal Aneurysm Repair (EVAR)
The minimally invasive endovascular abdominal aneurysm repair (EVAR) procedure involves making small incisions in the groin and threading catheter tubes through the femoral arteries and into the aorta. A fabric-covered metal stent is introduced through the artery and fixed in place, relieving pressure on the artery to prevent rupture. Patients remain conscious under local anesthesia during the procedure. Patients who undergo EVAR have lower morbidity rates and shorter recovery times and can usually resume normal activity within a few days after surgery.
Thoracic Endovascular Aortic Repair (TEVAR)
A minimally invasive alternative to open surgical repair of diseases of the thoracic aorta, TEVAR is most commonly used to correct thoracic aneurysmal disease. Using the TEVAR procedure, the vascular surgeon inserts an endograft (fabric covered stent) into the aneurysm as a replacement for the diseased segment of the aorta. Patients benefit from reduced mortality and morbidity, shorter hospitalizations and more rapid recovery.
Open Abdominal Aortic Aneurysm Repair (AAA)
An abdominal aortic aneurysm is a ballooning in the wall of the largest blood vessel in the abdomen. The aneurysm is prone to rupture if it grows larger than two inches in diameter. During this procedure, the abdominal segment of the aorta is replaced with a prosthetic tube graft through an open incision. This procedure requires general anesthesia. The hospitalization period is 5-7 days and full recovery can take a few weeks. The Department’s outcomes are among the best in the country.
Peripheral Arterial Disease (PAD)
Build-up of plaque in blood vessels that supply the arms and legs can cause muscle pain during walking and exercise. These blockages can be treated using minimally invasive techniques. Blockage location is isolated using Doppler ultrasound, CT, CT angiography, MR angiography and, when necessary, angiography. Intervention varies according to diagnosis and may include conservative therapy, endovascular revascularization or open bypass. Balloon angioplasty and stent placement is a common treatment for blockages in larger vessels. Less frequently, deposits are removed by atherectomy using either a laser or a tiny, rotating knife inside a catheter to shave the obstruction from the arterial wall. The procedure is followed by stent placement, if required.
Carotid Artery Disease
Narrowing of this blood vessel in the neck is a major cause of stroke. We perform carotid endarterectomy and stenting to repair blockages of the carotid artery. Endarterectomy to strip atheromatous plaque from the carotid vessels has been shown to reduce the two-year risk of stroke by 80 percent for patients who have severe stenosis of 70-99 percent. For patients who may not be candidates for endarterectomy, angioplasty and stent placement provides a minimally invasive alternative. This procedure is performed using a removable umbrella shaped filter device to avoid plaque particles from embolizing to the brain.
Weakening and enlargement of the veins that return blood from the leg to the heart can occur. This may be due to abnormal valves inside the veins. Valves are one-way flaps that keep blood from moving backward. When the valves are diseased, the blood moves backwards in a phenomenon known as reflux. The abnormal veins can be ablated permanently using a minimally invasive procedure. Using ultrasound, the surgeon positions a catheter into the diseased vein through a small incision. The catheter delivers radiofrequency energy to the vein wall. As the catheter is withdrawn, the vein wall is heated causing collagen in the wall to shrink and the vein to close. Outcomes are positive: 90 percent of treated veins have remained reflux free at two years. Patient benefits include less postoperative pain and bruising, return to normal activity within one day and return to work more than a week earlier than patients who undergo vein stripping.
TOS is caused by compression of nerves or blood vessels, or both, as a result of trauma, disease or congenital deformity in the thoracic outlet between the clavicle and first rib. Treatment begins with exercises to stretch and open the tissues associated with the thoracic outlet. If symptoms persist, surgery is an option. The surgeon makes an incision above the clavicle and removes scalene muscles, along with the first rib, easing pressure on the brachial plexus nerves. About 80 percent of patients experience complete resolution of symptoms; 20 percent report significant improvement.
A patient who has impending kidney failure will need to either have a kidney transplant or be started on dialysis. A kidney specialist (nephrologist) determines a patient’s need for dialysis and may recommend that he/she will need dialysis access. Our team strictly adheres to the DOQI criteria and uses a “fistula first” strategy. All patients undergo pre-operative vein mapping or venography. Dialysis access is tailored to the individual patient to provide each patient with the most durable hemodialysis access. An arteriovenous fistula (AVF) can be created by connecting one of the native veins to an artery. For patients who do not have adequate veins, a prosthetic graft is used to create an arteriovenous graft (AVG).
Need more information on vascular conditions, tests or treatments? Visit the Society for Vascular Surgery’s Patient Resources.