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Vascular Care at Sentara
 Procedures for Vascular Disease Treatment
Vascular surgeons at Sentara operate using the latest advances in technology, including minimally invasive surgery (or endovascular) techniques when appropriate. Benefits to patients include reduced trauma to the body, less blood loss, less postoperative pain, fewer complications, a reduced hospital stay and faster recovery times.
Individualized Treatment for Your Condition
You and your physician will determine the best treatment plan for you. Depending upon the associated surgical risk and benefit to you, a more or less invasive treatment will be determined. In both situations, fully understanding the risks and benefits is critical for an optimum outcome. Your physician will discuss what options are best for you.
Minimally Invasive/Endovascular Procedures
A less invasive approach to the treatment of abdominal aortic aneurysms and peripheral vascular disease involves the use of balloon catheters that are usually inserted through one or both groin arteries whereby stents or stent grafts can be placed at the problem area (i.e., abdominal aorta or peripheral arteries). The image of the procedure is visualized on a monitor screen made possible by X-ray equipment that detects injectable dye. This approach is not suited for all individuals.
Minimally Invasive Procedures include:
 Abdominal Aortic Aneurysm Endograft
Carotid Artery Stenting
Lower Extremity Revascularization
Thoracic Aortic Endograft
Surgical Procedures:
Abdominal Aortic Aneurysm Surgery
Amputations
Carotid Endarterectomy
Surgical Bypass
Thoracic Aneurysm Repair
Vascular Access
Minimally Invasive/Endovascular Procedures:
Abdominal Aortic Aneurysm Endograft (endovascular stent grafting for treatment of abdominal aortic aneurysm)
Placement of an abdominal aortic endograft through the arteries that branch off the abdominal aorta reinforces the bulging or weakened artery wall. Usually, a small incision is made in both groin areas. A flexible catheter is threaded through the iliac artery up to the abdominal aorta just below the kidney arteries. The catheter contains a compressed endograft made of synthetic material that is reinforced to keep the endograft open and close to the artery wall. A balloon is inflated at the top of the graft to open and “seat” or “seal” the endograft against the artery wall. The same procedure is done at the bottom of the graft. The limbs of the endograft are usually positioned inside the iliac arteries. The endograft remains in place for life and requires lifetime follow up to measure the status of the graft and reduced size of the aneurysm.
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Carotid Artery Stenting (minimally invasive technique to treat cerebrovascular disease)
A stent is inserted via the groin using an endovascular technique. Once the device reaches the blocked vessel in the neck, a filter collects debris and blood clots to prevent them from going to the brain and resulting in a stroke.
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Thoracic Aortic Endograft
Thoracic aortic aneurysms cause a bulge in a section of the thoracic aorta and result in a weakening of the main artery that carries blood from the heart to the body. As this bulge increases in size, the risk of rupture and internal bleeding also increases.
Every year in the United States, an estimated 15,000 people die because of ruptured aortic aneurysms. But a new minimally invasive life saving procedure for the treatment of thoracic aortic aneurysms (TAA) is now available at Sentara Norfolk General Hospital.
This technologically advanced device—the GORE TAG™ Thoracic Endoprosthesis—is the first and only endovascular device approved by the FDA for treating TAAs. Prior to the approval of the GORE TAG™ device, patients were limited to traditional open-chest surgical repair, a procedure many patients with complex pre-existing conditions could not endure. This minimally invasive procedure represents a safer alternative to open-chest surgery.
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Surgical Procedures:
Amputations
In an amputation, a surgeon removes a limb, or part of a limb, that is no longer useful to you and is causing you great pain, or threatens your health because of extensive infection. Most commonly, a surgeon removes your toe, foot, leg, or arm. Physicians consider amputation a last resort.
Although amputations may be required for other reasons, such as severe injury or the presence of a tumor, the most common reason you may need an amputation is if you have peripheral arterial disease (PAD) due to atherosclerosis (hardening of the arteries).
Carotid Endarterectomy (treatment with or without stents for cerebrovascular disease)
Carotid endarterectomy is performed to remove plaque buildup and other debris from the carotid artery. Reopening the blood artery channel helps to prevent stroke. A neck incision is made and clamps are placed above and below the narrowed carotid artery. An incision is made through the blood vessel wall and opened. The solid, waxy plaque buildup is carefully removed. Next, a piece of vein or a synthetic material called a stent may be placed using a long thin tube called a catheter. The stent can be sewn to the opened carotid artery to provide reinforcement. If the artery wall does not require reinforcement, it is stitched closed. Next, the neck incision is closed with sutures that will absorb over time.
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Abdominal Aortic Aneurysm Surgery (for treatment of aneurysm)
Surgical intervention for aneurysmal or occlusive disease involves an aneurysmectomy or bypass of the weakened or narrowed wall of the abdominal aorta. Clamps are placed above and below the aneurysm to prevent bleeding. Next, a long incision is made through the weakened wall of the aneurysm and the contents (blood debris) are removed. A synthetic graft is stitched above and below the aneurysmal aorta. Next, the graft is wrapped for protection by the opened aorta. Finally, the aortic wall is stitched closed to protect the synthetic graft. The size and type of graft chosen to repair the aneurysm will depend upon the size and involvement of the aneurysm. The goal of this surgery is to prevent aneurysm rupture and restore blood flow to the lower extremities.
Surgical Bypass
A vein from the leg or a synthetic graft may be used to bypass the blocked artery. If leg veins have been used for other bypass surgeries, arm veins can also be removed, stitched together, and used to bypass the blockages in the legs. Usually, an incision is made in the groin and above or below the bend in the leg. The arteries are clamped, and the graft material is carefully sewn to the artery in the groin and the leg artery. The bypass material serves as a new blood channel that delivers oxygen and nutrients to the leg tissues. Finally, the skin incisions are closed.
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Thoracic Aneurysm Repair
Thoracic aortic aneurysms cause a bulge in a section of the thoracic aorta and result in a weakening of the main artery that carries blood from the heart to the body. As this bulge increases in size, the risk of rupture and internal bleeding also increases.
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Vascular Access
There are three basic kinds of vascular accesses for hemodialysis: an arteriovenous (AV) fistula, an AV graft, and a venous catheter. A fistula is an opening or connection between any two parts of the body that are usually separate, for example, a hole in the tissue that normally separates the bladder from the bowel. While most kinds of fistula are a problem, an AV fistula is useful because it causes the vein to grow large and strong for easy access to the blood system. The AV fistula is considered the best long-term vascular access for hemodialysis because it provides adequate blood flow for dialysis, lasts a long time, and has a complication rate lower than the other access types. If an AV fistula cannot be created, an AV graft or venous catheter may be needed.
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