The vascular surgery program and overall vascular services continue to grow in both volume and in complexity. Surgeons on the medical staff treat a multitude of vascular cases including abdominal aortic programs and thoracic aortic conditions. A vast degree of experience and sub-specialization is present within the vascular surgeons on the medical staff, as many procedures performed at Baylor Hamilton Heart and Vascular Hospital are not widely performed elsewhere. Referrals to the medical staff stem from other vascular surgeons and physicians across the country.
Baylor Hamilton Heart and Vascular Hospital was proud to mark the 50th anniversary of the Vascular Surgery Fellowship in fiscal year 2015. More than 100 fellows have graduated from the program and gone on to provide outstanding care to patients around the world.
Quality and service excellence have always been hallmarks of the vascular specialists on the Baylor Hamilton Heart and Vascular Hospital medical staff, in addition to a commitment to offering advanced treatment options that are not always widely available.
Recently available at Baylor Hamilton Heart and Vascular Hospital as a result of specialty training by vascular surgeons on the medical staff is Transcarotid Artery Revascularization – also known as TCAR for short. This is an endovascular technique to treat blockages in the carotid artery that could cause stroke. A small incision is made just above the collar bone to expose the common carotid artery. A soft, flexible sheath is placed directly into the carotid artery and connected to a system that will reverse the flow of blood away from the brain to protect against fragments of plaque that may come loose during the procedure. The blood is filtered and returned through a second sheath placed in the femoral vein in the patient’s thigh. A stent is then placed. This procedure is known at TCAR and may be performed under local anesthesia.
Transcarotid artery revascularization (TCAR) may have an advantages, says John Eidt, MD, co-medical director of vascular surgery at Baylor Dallas. "TCAR combines the safety and reliability of open carotid endarterectomy with the minimally invasive features of carotid stenting. We are very enthusiastic about this technology."
In FY2015, Baylor Hamilton Heart and Vascular Hospital became one of only a handful of trial sites performing endovascular abdominal aortic aneurysm repairs with a groundbreaking fenestrated aortic stent graft. The new graft allows vascular surgeons on the medical staff to perform minimally invasive abdominal aortic aneurysm repair on a greater number of patients.
"The biggest limitation on being able to repair aneurysms with stent grafts has been the location of the aneurysm in proximity to major branch arteries," explains Gregory Pearl, MD, medical director of Vascular Services. "With the fenestrated procedure, we are able to treat many of those patients with a stent graft, whereas before, the only option was to do a major open operation."
Minimally invasive endovascular repair offers a range of potential benefits:
More than 77 total elective endovascular abdominal aortic aneurysm repairs were completed in FY2015.
In addition to new endovascular repair trials, Baylor Hamilton Heart and Vascular Hospital also is home to a new trial using stem cells to treat arterial occlusions in the lower extremities. “This trial is exploring a new treatment for patients who have no other options beyond amputation,” says Dr. Pearl.
The slim space between the collarbone and first rib is called the thoracic outlet. Blood vessels, nerves, and muscles that extend from the back to the arms pass through the thoracic outlet. If this space is too slim, the blood vessels and/or nerves may become abnormally compressed, causing shoulder pain. The compression may also cause impaired circulation or tingling and numbness in the hands. This is known as thoracic outlet syndrome.
Symptoms of thoracic outlet syndrome occur when the space between the collarbone and the first rib becomes too narrow. This can occur because of a variety of conditions including:
symptoms you may experience from thoracic outlet syndrome depend upon the specific nerves or blood vessels that are being compressed.
Symptoms if nerves are compressed:
Symptoms if blood vessels are compressed:
Your range of motion in your shoulders may be restricted in addition to the above symptoms.
Your physician will determine your diagnosis by performing a physical exam and inquiring about your health history. Your physician may also order additional tests to confirm your diagnosis, such as an X-ray of the thoracic outlet or an MRI.
Treatment for thoracic outlet syndrome commonly involves lifestyle changes and medications to aid in reducing your symptoms. Physical therapy is also recommended in order to strengthen muscles in your shoulders in efforts to improve support or the collarbone. Over the counter medication such as ibuprofen may be used to help reduce inflammation and pain.
If non-surgical treatment options are not correcting or relieving your symptoms of thoracic outlet syndrome, your physician may recommend surgery. This would involve your doctor removing an extra rib (if you have one), redirecting blood vessels around the area, or removing part of your first rib, known as a first rib resection.
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