Issue link: https://viewer.e-digitaledition.com/i/288126
to evidence-based guidelines to decide if endovascular approaches will be more or less successful than open procedures. For example, if there is a significant but short narrowing in an iliac artery in the pelvis, the data tells us stenting is extremely effective. However, if we find a long, com- pletely occluded arterial segment below the knee, the data tells us we will have a much lower chance of success with endovascular methods and stenting may be ineffective. These patients will most likely need a leg bypass surgery." Some patients need multiple interven- tions — a stent in one arterial segment and a bypass in another. Dr. Shah explains that a combination procedure to place a stent in the occluded iliac artery and create a bypass below the knee can be performed simultaneously and is referred to as a hybrid procedure. Minimally invasive procedures reduce perioperative complications, such as bleed- ing, infection and wound-healing issues, but such interventions must be deployed with care. The location of blockages and size of the arteries play a major role in determining which modality vascular surgeons use for revascularization. Dr. Shah emphasizes that she and her colleagues are always prepared for the necessity of traditional open-leg bypass. "The entire team works to provide maximum efficiency, optimal outcomes and patient satisfaction with the overall experience," she states. While vascular surgeons must be ready to use whatever modality is most appropriate, referring physicians should be similarly prepared to identify patients who are at risk for developing PAD. As the disease can be asymptomatic, Dr. Shah suggests being attuned to its risk factors, including a his- tory of smoking, diabetes, coronary artery disease, hypertension and hyperlipidemia, and a family history of PAD. Males are at higher risk for developing the condition, and the risk increases with age for both genders. Aneurysm Repair Abdominal aortic aneurysms (AAA) and thoracic aortic aneurysms (TAA) are a weakening of the arterial wall, which may result in rupture and/or death. AAA and TAA may develop silently — typically with no symptoms — and are strongly associ- ated with smoking and a familial history. Dr. Spirig explains that small aneurysms can be monitored for changes in size and the development of symptoms. When intervention becomes necessary, vascular surgeons at VBMC perform minimally invasive or open surgical procedures to repair these aneurysms. Endovascular aneurysm repair (EVAR) is a minimally invasive technique to repair an AAA. The procedure mandates state-of-the-art technology and multidis- ciplinary collaboration, ensuring optimal patient outcomes. Frequently only two small incisions and an overnight hospital stay are required. Recovery time is minimal; the patient may return to normal activities within days. Dr. Spirig and Dr. Saltzberg inside a state-of-the-art operating room at VBMC, discussing a strategy for an endovascular aneurysm repair Dr. Shah discusses treatment options with a patient. COV ER FE AT UR E 8 | Mid Hudson MD NEWS ■ M D N E W S . CO M