MDNews - Mid Hudson

COVER FEATURE TREATMENT FOR A RARE PROBLEM INTERVENTION FOR BLOCKAGES in the renal and mesenteric arteries has, until recently, primarily been approached with open surgery. According to Jeffrey Hnath, M.D., board-certified general and vascular surgeon, within the last 15 years, the paradigm has shifted to a minimally invasive approach using stents and angioplasty balloons. In the HealthAlliance of the Hudson Valley angiography suite, Dr. Hnath reviews endovascular options during a patient consultation. Because endovascular intervention often necessitates future procedures, the durability of a bypass procedure makes this method particularly suitable for younger patients. Often, few or no comorbidities exist in younger patients, so the stress of an open surgical procedure will not stress their bodies as it would older patients. A Safer Treatment for DVT A blood clot located in a vein within a group of muscles, deep vein thrombosis (DVT) may present in a handful of ways, includ- ing painful inflammation of the leg, tenderness in the extremity, leg pain that worsens when walking or standing, discoloration of the skin, or a warm sensation in the leg. Stephanie Saltzberg, M.D., FACS, vascular surgeon at the Center of Vascular Excellence, notes that there is a push to aggres- sively treat DVT with clot-busting medication and/or mechanical thrombectomy devices to prevent life-threatening or disabling conditions. She explains that blood clots used to be treated with blood thinners and compression socks, but because an alarming number of patients developed post-thrombotic syndrome — resulting in elevated levels of morbidity and absenteeism from work — the treatment paradigm has shifted. Physicians at the Center of Vascular Excellence use ultrasound imaging to identify the clot, according to Dr. Saltzberg. From there, the patient is evaluated for a pharmacomechanical throm- bectomy (PMT) procedure. PMT combines clot-busting medicine with mechanical thrombectomy devices to break up blood clots. If DVT is caught early, the chance of pieces of the clot breaking off and causing pulmonary embolism is significantly reduced. Physicians at the Center of Vascular Excellence perform outpatient PMT in the new angiography suite. While the patient is under light sedation, physicians — guided by X-ray images taken by the C-arm imaging equipment — use minimally invasive devices to break up as much of the clot as possible. After a few hours, the patient returns home. There is minimal recovery time, and follow-up ultrasounds are recommended anywhere 10 | Mid Hudson MD NEWS ■ MDNEWS.COM experts at the Center of Vascular Excellence conduct an outpa- tient procedure, during which plaque blockages are treated with little more than a needle stick in the groin. According to Dr. Hnath, using a balloon and a stent to revascularize the obstructed vessel eliminates the need for an incision. "Patients come in and have the procedure, and they go home the same day without an incision," says Dr. Hnath. "The HealthAlliance has given us the hospital staff and recovery areas that allow us to do this." Should the endovascular approach fail or the location of the blockage is in an inaccessible area, then open surgery is employed. from a week to a month afterward, depending on the patient and physician. "If a patient has a vascular problem, the more beneficial it is for us to see him or her early because we provide a component of preventive care," says Dr. Hnath. "Patients should be aware of the problems they have and potential dire complications they face if they don't adhere to certain lifestyle guidelines. The earlier we get these patients referred, the better they do because there's a lower chance they'll need further intervention." For more information about the Center of Vascular Excellence, please visit www.hahv.org/archives/service/vascular-center. ■ Left to right: Charlie Greenberg, R.T.(R); Christy Bauer, R.N., charge nurse; Lowell Fley, R.T.(R), manager; and Sue Kehoe, R.N.

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