MDNews - Mid Hudson

COVER FEATURE Dr. Hnath and Dr. Saltzberg review images of a procedure. impossible to place a stent endovascularly. For example, the angulation of proximal aneurysms — those closer to the heart — may prohibit a graft from being placed in the area. For aneurysms in the distal area — those further from the heart — the blood vessel must be large enough to pass a catheter and graft through. Dr. Hnath notes that many women, in particular, have smaller vessels in this area, which necessitates an open procedure. To endovascularly decompress the pressure caused by an aneurysm, surgeons thread a catheter into the aorta from the femoral artery via an incision in the groin. Guided by X-ray imaging throughout the procedure, a surgeon moves the catheter into the affected area of the aorta and places the stent. Once the stent is in place, it works to not only relieve the built-up proximal and distal force in the aorta, but also strengthen the vessel. According to Dr. Hnath, the technique used for open surgical grafting and stenting at the Center of Vascular Excellence is less invasive than those utilized at many vascular centers around the country. Using a retroperitoneal approach to cause less cardiac and pulmonary stress on the patient, the aorta is exposed and clamped below the renal arteries. Surgeons then sew the graft to the aorta both proximally and distally. This procedure requires close follow-up in the subsequent months; however, the long-term benefits are noteworthy. According to Dr. Hnath, after initial postsurgical management and follow-up, there is no fixed requirement for long-term obser- vation because of the graft's durability. Biannually, Dr. Hnath sees patients for ultrasounds to ensure no complications have presented — an occurrence that, Dr. Hnath notes, is rare. Differences between the two procedures are primarily seen in recovery times and follow-up requirements. Open surgery requires much more attentive postsurgical observation, and 8 | Mid Hudson MD NEWS ■ MDNEWS.COM the typical hospital stay after open surgical aortic aneurysm repair is between four and seven days. After an endovascular procedure, Dr. Hnath says, the majority of patients return home the next day. He notes that full recovery from open surgery takes between four and eight weeks, whereas recovery time from the endovascular procedure is virtually nil, save for the healing of the incisions in the patient's groin. A reversal in necessary follow-up is seen long term. Two times per year, a patient who underwent endovascular repair needs to have combination ultrasound and computed axial tomography (CAT) scans to ensure the graft has not migrated, says Dr. Hnath. There is also a chance that endovascular patients may need follow-up outpatient procedures to replace stents or for coil embolization, a procedure in which surgeons repair leaks in the blood vessel. "We find it is very important for patients to commit to continuous follow-up," Dr. Hnath says. "If they don't want to follow up, we generally do not recommend the endovascular aneurysm repair." Peripheral Clearance Peripheral arterial disease (PAD) occurs when extremities do not get enough blood and oxygen due to an arterial blockage. PAD can occur in any artery but is most commonly seen in the legs. Although it is typically asymptomatic, PAD can be accompanied by a set of symptoms in the form of intermittent claudication (IC). The SVS approximates 50% of patients will have arterial blockages extensive enough to experience the discomfort or pain in the legs associated with IC, a symptom that flares during activity and subsides when at rest.

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