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Jeffrey Hnath, M.D., vascular surgeon and Director of the Center of Vascular Excellence, and Stephanie Saltzberg, M.D., FACS, vascular surgeon at the Center of Vascular Excellence, perform a peripheral intervention. Pictured here, they insert a stent and post-dilate it with a balloon. 15,000 cases. When symptoms develop, it is imperative that physicians refer the patient for treatment. Symptoms of AAA may include: + pulsing, like a heartbeat, in the abdomen + precipitating rupture, or a sudden, extreme pain in the abdomen or lower back + more rarely, pain, discoloration or sores may develop on the feet TAA may cause congestive heart failure if located close to the heart. Depending on the location and size of the aneurysm, TAA may present in various other ways, including: + jaw, neck, back or chest pain + difficulty breathing + coughing or hoarseness TAA and AAA are primarily treated through either an open or endovascular approach. Physicians at the Center of Vascular Excellence are equipped to repair aortic aneurysms in the manner most appropriate for each patient. Dr. Hnath notes two criteria for endovascular intervention: anatomical and patient preference. Dr. Hnath points out that the majority of procedures used to treat aortic aneurysms are conducted endovascularly, and whenever a patient meets the criteria, specialists at the Center of Vascular Excellence push for that approach. For an endovascular stent to be effective, there must be approximately 1 centi- meter of normal aorta — "landing zones," according to Dr. Hnath — available on either side of the aneurysm upon which to place a stent. Along with the necessary landing zones, the other anatomical indication for endovascular stenting is the size of the aneurysm itself. In the abdomen, the aorta is normally approximately 2 centimeters in diameter. The SVS recommends the use of a graft once an aneu- rysm expands the vessel to more than one and a half to two times its normal size. Dr. Hnath notes that anatomical features of the aneurysm itself can make it A PARTNER IN HEMODIALYSIS CARE EXPERTS AT THE Center of Vascular Excellence are often called to perform hemodialysis access procedures. Jeffrey Hnath, M.D., board-certified general and vascular surgeon at the Center of Vascular Excellence, and his colleagues employ both arteriovenous (AV) fistulas and AV grafts to enhance blood flow in patients preparing for hemodialysis. To create an AV fistula, Dr. Hnath connects a vein to an artery — typically in a patient's arm. This technique causes the vein to dilate, strengthened by the blood flowing into it from the artery, thus allowing nurses to more effi- ciently access the vessel for hemodialysis. For patients whose veins will not form a fistula, surgeons use an artificial AV graft — plastic tubing placed under the skin — to connect the two blood vessels. While the time it takes for the fistula to mature — and blood flow to strengthen the vessel — typically is three to six months, an AV graft may be accessed within weeks of placement. According to Dr. Hnath, the Center of Vascular Excellence's specialists maintain a close relationship with HealthAlliance's dialysis center, swiftly acting should a complication or other medical need arise. The vascular team also attends monthly meetings with the dialysis center staff to help plan care for patients. MDNEWS.COM ■ MD NEWS Mid Hudson | 7 PHOTOS © DON DEMPSEY, WHITE LIGHT PHOTOGRAPHY