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09/04/2010 |
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| Practice Resources |
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Vascular Institute of Georgia is devoted to the early diagnosis and treatment of vascular diseases. Vascular disease refers to disturbances of blood flow outside of the heart and throughout the body.
Our physicians provide comprehensive vascular evaluations and care. This may include clinical consultations, medical, surgical and endovascular interventions. |
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Services
Vascular Institute of Georgia is pleased to offer the following services:
- Abdominal aortic aneurysm management and treatment including traditional open repair as well as the latest procedures in endovascular stent graft repair
- Diagnostic and therapeutic interventions which include balloon angioplasty and/or stent placement
- Carotid artery repair, including both endarterectomy and stenting
- Renal artery repair including balloon angioplasty and stent placement
- Evaluation for hemodialysis vascular access
- Deep and superficial vein thrombosis treatment
- Varicose Vein intervention to include endovenous laser treatment, high-ligation and sclerotherapy
- Diagnosis and management of various other vascular disorders
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Conditions Treated
Read more about our services and conditions treated:
Angioplasty
Angioplasty may be recommended to widen a narrowed artery or to open a small blockage by pressing the plaque against the artery wall. Angioplasty usually takes one to two hours to perform. Before the procedure actually begins, an intravenous line may be started in your arm. The skin where the catheters (thin, flexible tubes) are inserted will be numbed. You will be awake, but you are given medications to help you relax.
A catheter with a small balloon on the tip is inserted into the artery to widen the passageway. The doctor guides the balloon into position by watching an image of your artery on a video monitor. Then a thin guide wire is passed through the catheter into the artery. Next, a balloon-tipped catheter is inserted into the artery, threaded over the guide wire, and moved to the spot where the artery begins to narrow.
The balloon is then inflated and deflated several times to crack the plaque and press it against the artery wall. This may cause the artery to expand slightly. The balloon is deflated and the catheters are removed when the blockage has been opened. The artery is now wider and blood can flow again.
Several other procedures use catheters and special drugs or devices to improve blood flow in severely damaged arteries. Thrombolytic drugs may be used to dissolve a small clot. A thrombectomy may be done to remove a clot from an artery. Following angioplasty, small metal frames called stents may be placed inside the artery to hold the walls open. |
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Bypass Surgery
When symptoms worsen and the blockage cannot be treated with angioplasty, bypass surgery may be recommended. This surgery, which requires a hospital stay, can treat blocked arteries in the abdomen or the leg. Using a graft, a path around the artery blockage is created. Blood flows through this new passage, bypassing the blockage entirely.
The incision sites depend on the type of graft and the location of the blockage. During the surgery, a graft is stitched into the artery above and below the blockage, creating a new passage for blood flow. The blocked section of artery is usually not removed.
Abdominal Bypass
- Surgery to bypass a blocked abdominal artery may last three to five hours. In most cases, a synthetic graft is used. Immediately after surgery, patients are observed in a special care unit and placed on a heart monitor and may be placed on a breathing machine.
For the first month after surgery, don't lift anything you have to strain to pick up. This means no household chores, such as vacuuming, lawn mowing, or carrying groceries, and no driving for two weeks.
- Leg Bypass
Surgery to bypass blocked leg arteries may last two to four hours. A large vein, or a synthetic graft may be used for the bypass. Swelling for two to four months after leg bypass surgery is not unusual. Walking is encouraged beginning shortly after the surgery. Patient should avoid prolonged standing or sitting with the feet dependent. |
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Aortic Aneurysm
An aneurysm is most commonly a result of an accumulation of fatty deposits on the vessel wall but may also relate to heredity, trauma or other disease that weakens the vessel wall. Over time, the vessel wall loses its elasticity, and the force of normal blood pressure in the aneurysm can lead to the rupture of the vessel. When an aneurysm forms in the part of the aorta (one of the body''s main blood vessels) that extends through the abdomen, it is called an abdominal aortic aneurysm.
Most people do not experience any symptoms. During a routine physical examination, your doctor may notice or feel a pulsating mass in the middle or lower part of your abdomen. Many aneurysms are identified when x-rays are performed for other reasons.
If your doctor feels there is a risk that the aneurysm will burst, he will recommend treatment. The standard treatment is conventional surgery which is performed to replace the section of the vessel where the aneurysm has formed. The surgical procedure is performed under general anesthesia and takes about three to four hours to complete. The surgeon enters the aneurysm through an icision in the abdomen and replaces the aneurysmal portion of the artery with a synthetic graft.
An alternative treatment is Endovascular stent grafting that is a procedure in which a stent graft (a woven polyester tube covered by a tubular metal web) is placed inside a diseased vessel. This alternative treatment may be used for patients who are not good candidates for or who prefer not to undergo conventional surgery and is now available for many patients.
The stent graft is placed inside the aneurysm using a delivery catheter, which is a long tube-like device. When the delivery catheter is properly positioned inside the aneurysm, the stent graft is released from the delivery catheter into the blood vessel. When the stent graft comes into contact with blood, it expands to a pre-set size. After expansion of the stent graft, the delivery catheter is withdrawn and removed. Depending on the shape and size of your aneurysm, additional stent grafts may be placed to assure that the aneurysm is completely reinforced. Imaging procedures allow the doctor to verify that the stent graft is properly placed within the aneurysm. The procedure typically takes two to four hours to complete.
In clinical trials conducted to evaluate the AneuRx Stent Graft System, (our preferred graft), the stent graph was successfully delivered and deployed in 97.6% of patients. The most common reason that the procedure was not successful was that the patient's blood vessels were too small or the location of the surrounding blood vessels prevented safe delivery and deployment of the device.
To determine whether this treatment is right for you, it is important to have a thorough discussion with your doctor. |
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Diagnostic Vascular Lab
The Noninvasive Vascular Laboratory at the Vascular Institute of Georgia (VIG) provides complete and thorough noninvasive testing for all vascular disorders on an outpatient basis. Noninvasive vascular testing allows for early detection and treatment of vascular diseases such as peripheral arterial occlusive disease of the upper and/or lower extremities, stroke and venous disorders including deep vein thrombosis and venous insufficiency which is associated with varicose veins. The testing performed in the laboratory is painless and noninvasive which means there is no risk to the patient since the procedures do not require entering the body or puncturing the skin. We use state-of-the-art ultrasound imaging and indirect testing equipment.
Our patients enjoy the convenience of having studies performed on the same day of the office visit and discussing exam results with the physician immediately following testing. Additionally, exam results are communicated to referring physicians by telephone and/or facsimile the same day.
Studies performed in our vascular laboratory include:
- Carotid Artery Ultrasound - valuable information gained regarding blockages involving vessels that provide blood supply to the face and brain that may increase the risk of stroke.
- Upper and Lower Extremity Venous Imaging - Deep venous thrombosis, a potentially life-threatening disorder can be detected extremely accurately through ultrasound. Also, varicose vein testing is performed to determine the need for high ligation and/or sclerotherapy.
- Peripheral Arterial Occlusive Disease - Indirect testing with the use of blood pressures allows for screening of blockages in the circulatory system of the upper and lower extremities associated with claudication (pain in the legs when walking), rest pain, non-healing wounds and gangrene.
- Graft Surveillance - Ultrasound imaging of the extremity by-pass grafts and arterio-venous fistulas for dialysis provide early detection and prevention of graft failure.
- Vein Mapping - Ultrasound imaging is used to evaluate the size and adequacy of upper and lower extremity veins for use as an arterial by-pass conduit.
- Renal Artery Ultrasound - Ultrasound is used to search for blockages in the arteries that provide blood supply to the kidneys, a potential cause of high blood pressure.
- Mesenteric Artery Ultrasound - Ultrasound is used to evaluate the arteries that provide blood supply to the bowel for blockages that may cause pain associated with eating and chronic weight loss.
- Aneurysm Ultrasound - Measurements are obtained of any abnormal dilatation of the major arteries in the abdomen and the extremities that can cause fatal rupture.
The laboratory at VIG was established in 1983 and is staffed by 8 full time vascular technologists and 6 board certified vascular surgeons. Our lab has experienced growth each year since its inception and currently performs over 10,000 exams yearly. Most importantly to verify our commitment to quality and our dedication to providing the best possible patient care we are accredited by the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL). ICAVL is a national organization that ensures individual laboratories have met and continues to meet strict criteria for accuracy in testing modalities and continuing education of staff and physicians. While the process of accreditation is voluntary in the state of Georgia, our office feels that it is necessary to ensure that our patients enjoy the very best level of care available in the industry. |
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Arterial Disease
The walls of arterial blood vessels thicken and narrow the lumen (opening) through which the blood is carried to the tissues. This thickening of the arterial walls is most often caused by deposits of fatty materials, such as cholesterol. "Atherosclerosis" is a term commonly used to describe this condition. We say "peripheral" arterial disease because this condition affects the extremities, mainly the feet and legs. Peripheral arterial disease may produce many different symptoms. Some of these symptoms include:
- Cramping-type pains in the legs that occur with walking and stop with rest
- Changes in the skin color or temperature
- Loss of hair on toes, feet, and lower legs
- Changes in the thickness and appearance of toenails
- Abnormal sensations like "pins and needles" in the feet, legs, thighs, or calves.
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Claudication
When you walk or exercise, the tissues need more oxygen. When this need cannot be met, you may experience a cramping pain.
Intermittent claudication is the most common symptom of lower extremity arterial disease. It is a cramping or aching pain in the muscles which occurs during exercise and is promptly relieved by rest. This pain typically is quite reproducible - occurring at a similar time or distance with each attempt at exercise. |
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Help Condition
Peripheral artery disease does not go away. Although angioplasty or bypass surgery may improve blood flow in damaged arteries, they can not cure the disease. Only you have the power to slow the disease process. You can do this by controlling your risk factors.
Smoking is the single most important risk factor for vascular disease. Chemicals in tobacco injure the artery walls. This narrows the arteries and decreases the blood flow to the tissues, and reduces oxygen in the red blood cells. Smoking may even make red blood cells more rigid. Unless you stop smoking, you can expect little benefit from the other modes of your treatment!
Exercise is great for building better circulation. It may open alternate blood vessel pathways so blood can travel through your legs when the main arteries are blocked, and it improves the efficient use of oxygen in the muscle tissue. By working your muscles and the vessels that feed them, exercise improves your circulation. Patients should try to walk for 30 minutes, four times a week.
Saturated fats should be decreased in the diet since they contribute to the narrowing of the vessels by helping to build fatty deposits on the inner walls. Try these tips to make planning your new diet easier: make sure less than one-third of your daily calories are from fats; eat at least five servings of fruit and vegetables daily. These foods are good sources of vitamins and they are almost fat-free.
Hands and feet require extra attention if you have peripheral vascular disease. Treat nicks, cuts, corns, and fungus infections early. Keep toenails trimmed. Avoid tight-fitting shoes, sitting too long in one position, and protect your feet from extremes in temperature. |
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Varicose Veins and Treatment Options
At the Vascular Institute of Georgia we specialize in the evaluation and treatment of venous disorders including varicose and spider veins. Our physicians will assess your veins with a physical exam and often a venous ultrasound to determine the best treatment options for you.
The goals of our venous treatment program are to relieve symptoms (cramping, aching and tiredness), enhance the normal venous circulation of your legs and to improve the cosmetic appearance of your legs.
The treatment of your varicose veins may include several forms of therapy, including:
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Compression Hose - Elastic stockings can be worn to compress the legs and superficial veins to force blood out of the surface vessels and into the deep veins and back to the heart. The improved circulation improves leg swelling and may reduce the formation of new varicose veins, but does not cure them.
- Sclerotherapy - This office procedure involves injecting a chemical agent into the diseased veins along with compression wraps to help collapse the vessels. After the blood in the treated veins is completely absorbed, the veins disappear.
- High Ligation - Outpatient surgery may occasionally be necessary in the treatment of varicose veins. This procedure is done in the hospital under local anesthesia or sedation. A small incision is made at the groin level and the abnormal superficial vein is located and ligated (separated or "tied" off). With this procedure you will be able to go home immediately and can often return to work the next day.
- EVLT (EndoVenous Laser Treatment) - This treatment uses targeted laser energy to
seal the vein closed. This treatment is quick, minimally invasive, leaves no scar and is
performed within the office. The physician will use ultrasound to guide a thin laser fiber
which is inserted around the knee level to seal faulty veins. The EVLT procedure eliminates the bulging vein at it's source.
Both EVLT and high-ligations are usually followed by sclerotherapy
injections.
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