MDNews - Mid Hudson

are all board certified, have academic affiliations and are part of the largest vascular group in the country. Focusing on quality outcomes, "The three physicians who conduct the Center for Vascular Excellence care at HealthAlliance. However, our scope goes beyond performing the procedures. Our goal is to promote vascular health and awareness in the community, as well." we're able to provide the highest level of comprehensive vascular Dr. Saltzberg performs thrombin injection for percutaneous treatment of a pseudoaneurysm. — Stephanie Saltzberg, M.D., FACS, vascular surgeon at the Center of Vascular Excellence If a patient is not diagnosed and treated for PAD, he or she may develop critical limb ischemia and, in extremely neglected cases, gangrene. Part of the Center of Vascular Excellence's modus operandi is educating the community to recognize the risk factors and symptoms of vascular disease. Physicians may conduct a simple diagnostic test called the ankle brachial index (ABI) on at-risk patients to detect a blocked artery in the legs. Specialists at the Center of Vascular Excellence offer both open and endovascular interventional procedures to treat PAD when exercise, smoking cessation or cholesterol reduction fail. In elderly patients with PAD, Dr. Hnath notes, significant comorbidities are sometimes present, making open surgery a risk. In these cases, minimally invasive endovascular approaches are employed. According to Dr. Hnath, advances in endovascular technology allow surgeons at the center to access small arteries, such as tibial arteries, in multiple ways. The first plan of action, Dr. Hnath says, is to use angioplasty and stenting to unclog the blocked vessel. Because the rate of restenosis, the renarrowing of the blood vessel after stenting, is higher in the endovascular approach than in open surgery, patients may require future interventions more frequently than if they had bypass surgery. For patients whose angioplasty and stenting procedures fail to clear the affected artery, an atherectomy may be performed. Andreas Spirig, M.D., FACS, board-certified general and vascular surgeon at the Center of Vascular Excellence, notes stents do not work in all parts of the leg, particularly near joints, because the device does not withstand a great deal of flexion. "Flexion used to be a limiting factor for minimally invasive treatment," says Dr. Spirig. "However, through a simple needle stick, we place atherectomy devices into the artery. These are like small drills that can remove or cut out the plaque from the inside Andreas Spirig, M.D., FACS, vascular surgeon at the Center of Vascular Excellence, reviews a prior study. of the artery. This is a procedure we frequently perform, to the benefit of patients." Some cases do not prove amenable to successful endovascular intervention. Dr. Spirig says that in these cases, and in younger patients, surgical bypass is the best option. The primary criteria for surgical bypass are good health and a suitable vein with which to construct the bypass vessel. Artificial vessels can be used, but Dr. Spirig points to durability issues and higher complication rates associated with artificial vessels that make using one of the patient's own veins ideal. Whereas angioplasty and stenting open a clogged vessel to create an open path for blood to circulate, bypass detours the blockage altogether. Surgeons attach the artificial or natural vessel above and below the blockage, allowing blood to circulate around the obstruction. The SVS notes that bypass is very effective for extensively blocked arteries. MDNEWS.COM ■ MD NEWS Mid Hudson | 9

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