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Success through Surgery: Weighing the options of intervention
Omar P. Haqqani, MD
Midland Daily News
April 9, 2017
Last week, we discussed the many options of treatment available for newly diagnosed conditions affecting the vascular system. In certain cases, however, surgical intervention is necessary to combat progress of conditions, as well as worsening effects.
Because each condition is unique and require different methods of surgical intervention to repair damage, there are numerous variations of surgery available to each particular case, assuring successful mediation.
When treating either abdominal or thoracic aortic aneurysm, for example, each condition has two different options for repair: Traditional and endovascular.
In a traditional open repair of an aortic aneurysm, the aneurysm first has to be visualized through a large cut into the abdomen. Once open, a cylinder-shaped tube known as a graft is sewn into the aneurysm in order to repair it. The area affected by the aorta is ultimately relined with a sleeve of material to strengthen it, preventing rupture.
An endovascular approach to repair is much less invasive, involving a small incision along the groin. Using long, thin tubes inside the body called catheters, a graft is placed into the aneurysm utilizing x-ray guidance. Like the traditional repair, the ultimate purpose of endovascular repair is to prevent rupture of the aneurysm.
However, like with any condition, not every surgical procedure is as simple as black and white. Often times, a recommended surgery will be based off a number of contributing factors before proceeding.
When treating peripheral vascular disease, multiple surgical options are available, with recommendation based on the location and extent of the condition’s damage.
Through an angioplasty, a balloon-tipped catheter is inserted into the blood vessel affected by plaque build-up through the use of imaging guidance. Stenting, a process involving a small wire mesh tube that is often jointly used with angioplasty, helps to keep the blood vessel open.
Once the opening is secured, atherectomy helps to clean out the inner lining of the artery through the use of a devise that shaves or vaporizes the plaque.
However, depending on the area of the blockage, a bypass surgery may be necessary to clear the blockage. After an incision is made into the leg, arm, or groin, a graft is inserted to help reroute blood flow around the blockage, sewn above or below the blockage.
In a similar procedure, an endarterectomy may be recommended, where an incision is made into the arm or leg, and plaque is removed from the artery’s inner lining. After the artery is opened again, blood flow can be restored.
An endarterectomy is also recommended in cases of stroke to remove blockages impeding blood flow, and angioplasty and stenting can be useful in aiding those afflicted with May-Thurner syndrome.
Unlike peripheral vascular disease, where the procedure is defined through different means of removing a blockage or clearing plaque from a blood vessel, some conditions have multiple options for surgical intervention that all stem from a similar method.
Thoracic outlet syndrome is an example of this condition, with three approaches to its surgical treatment: Transaxillary, supraclavicular, and infraclavicular.
The goal of all three approaches is to relive compression caused by the condition – the different between the three, however, is the method of entry used to alleviate compression.
Transaxillary requires access through a patient’s chest to access the first rib. Once the muscles in front of the rib are divided, a portion of the rib is removed to relieve compression.
Supraclavicular’s access stems from an incision made under the patient’s neck to expose the brachia plexus region. After signs of trauma are assessed, the compression of the affected blood vessel is repaired.
Infraclavicular is a more invasive method compared to the prior two approaches, as the incision to repair the affected veins is made under the collarbone and across the chest.
While many surgical options are readily available, it is important to first consult either your medical doctor or vascular surgeon to first weigh your options, analyzing the many available procedures and selecting an operation that fits your particular needs.
Though surgery may seem like a difficult road ahead, advances in surgical procedures have allowed for low risk interventions with high success rates for vascular recovery.
To learn more about the surgical options for vascular conditions, log on to vascularhealthclinics.org.
Dr. Omar P. Haqqani is the chief of Vascular and Endovascular Surgery at Vascular Health Clinics in Midland.
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