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emerging treatment capabilities. Traditional methods called for vein stripping, a painful vein extrication process in which vascular surgeons placed a plastic rod through one incision in a main superficial vein and pulled it out through another. This process often resulted in one month of lost work time, restricted activities and a number of side effects, including leg numbness and infection. Those days are over. Dr. Saltzberg explains that microphlebectomy and injection "It's unique to have a medical center like Vassar Brothers that is able to provide leading-edge technology and expertise in a community setting. The interventions we perform are often limited to tertiary care centers, but we have the resources, support and technology to perform almost any procedure locally." — Andreas Spirig, MD, FACS, Chair of the Department of Surgery at Vassar Brothers Medical Center sclerotherapy allow for minimally invasive methods for removing problematic and aesthetically displeasing veins, and new office-based procedures using radiofrequency ablation or laser energy to essentially melt varicose veins shut are significantly improved treatment options. "These techniques effectively close the vein and avoid the complications associated with vein stripping," she says. "Patients have no restrictions on their activities, and they get up after the procedure and walk out of our office. It's a revolution in varicose vein care — what was once done in the operating room can now be done in an office. It's easier, just as effective and reduces complications." Accessing Improved Dialysis In addition to the numerous emergent and preventive treatments for the spectrum of vascular diseases, vascular surgeons provide important support for patients suffering from chronic kidney disease. For optimal dialysis, Vassar Brothers' vascular surgeons use a technique to maximize the amount of blood cleansed during each session. "To perform successful dialysis, the machine needs to draw blood from the body at a high rate and then deliver it back at a likewise high rate," Dr. Shah explains. "Additionally, blood must be drawn from one place far enough from where it is returned to minimize the amount of recirculation." Catheters provide fast dialysis access, but long-term access reduces morbidity and mortality rates associated with catheters. Dr. Shah notes that Vassar Brothers' vascular surgeons evaluate patients for long-term dialysis access placement and can proceed with a procedure to place an arteriovenous (AV) fistula or graft, or they can place a catheter in emergent cases. In patients' nondominant arm, Dr. Shah connects superficial veins to an artery or attaches a prosthetic material between an artery and a deep vein to create what is essentially a fast lane for blood flow that can be directly accessed with a needle. These connections reduce the risk of infection, thrombosis and other complications long- term dialysis patients face. Although AV fistulas and grafts reduce complications associated with catheteriza- tion, the technique requires close vigilance. Dr. Shah notes that the most common chal- lenge is central venous stenosis, also known as venous outflow stenosis. Patients may also develop swelling, arterial steal syndrome — also known as hand ischemia — thrombosis or infection. Regular evaluations enable Dr. Shah to perform physical exams and closely monitor the AV fistula or graft for complications or decreased function. If a physical examination or patient report reveals potential complications, ultrasound testing is used to find evidence of what may be causing bleeding and low f low rates. If a problem is identified, minimally invasive fistulagrams — a test similar to angiography — detail the blood flow and pinpoint where circulatory impediments are. Then, vascular surgeons employ endovascular techniques, such as atherectomy balloon angioplasty, coils, stenting or thrombolysis, to optimize vascularization. In those cases in which endovascular treatment is not an option, an open surgical repair is performed. Because of the high level of multidisci- plinary expertise at VBMC, the vascular department is capable of performing any necessary intervention or collaborating with other departments to provide a one-stop shop for vascular care. But even though patients benefit from the comprehensive care within the medical center, outside physicians must make expeditious referrals for optimal treatment. Global Approach Vascular Services at VBMC empha- sizes a broad network of collaboration. Dr. Saltzberg notes that the charge to promote vascular health permeates every aspect of patient care. "Part of our focus is promoting vas- cular health and awareness," she says. "This requires us to provide more than simple surgical fixes. We pride ourselves on promoting vascular health and medical optimization. As vascular surgeons, while we are technicians, we also have to take a more comprehensive global approach to each patient to provide the highest levels of care." For more information about Vassar Brothers Medical Center's Vascular Surgery Department, visit health-quest.org/vbmcvascular. ■ PHOTOS © DON DEMPSEY, WHITE LIGHT PHOTOGRAPHY Dr. Spirig views patient monitors in an operating room. COV ER FE AT UR E 1 0 | Mid Hudson MD NEWS ■ M D N E W S . CO M

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