Vascular Surgery Michael Ricci MD What is Vascular

Vascular Surgery Michael Ricci, MD

What is Vascular Surgery? l Diagnosis & treatment of diseases of the circulatory system

What do we treat? l Atherosclerosis l Gangrene l Stroke l Aneurysms l Venous Disease l Acute l Chronic l Hemorrhage

How do we treat? l Surgery l Conventional “open” procedures l Endovascular procedures l Percutaneous Procedures l X-ray l Ultrasound l Medical Interventional

Atherosclerosis l Traditional factors risk l Smoking, Diabetes, Hypertension, High Cholesterol, Age, Male l Produces symptoms by obstruction or embolus.

Peripheral Vascular Disease l Claudication l Pain l Limb with walking Threatening l Tissue loss l Gangrene l Ulceration

Treatment of PVD l Medical l Stop smoking, exercise, Pletal l Surgical l Bypass l Percutaneous Interventions

Treatment of PVD l Interventions

Treatment of PVD l Bypass Surgery

Bypass Surgery l Where…to where? l Conduit? l Special conditions? 35556 Bypass graft, with vein; femoral-popliteal 35583 In-situ vein bypass; femoral-popliteal 35656 Bypass graft, with other than vein; femoral-popliteal

Bypass Surgery 35556 Bypass graft, with vein; femoral-popliteal 35583 In-situ vein bypass; femoral-popliteal 35656 Bypass graft, with other than vein; femoral-popliteal 35500 35682 35683 35685 35686 35681 35700 UE Vein Harvest (List separately in addition to code for primary) Harvest of two segments of vein for distal bypass Harvest of three or more segments of vein for distal bypass Placement of a vein patch or cuff at the distal anastomosis of a synthetic bypass graft. This code can be used only with 3 main bypass graft codes (35656, 35666, and 35671) Placement of a distal AV fistula during lower extremity bypass surgery as a means to increase patency of a disadvantaged graft Composite Reoperation, femoral-popliteal or femoral (popliteal)-anterior tibial, posterior tibial, peroneal artery or other distal vessels, more than one month after original operation

Carotid Atherosclerosis l Symptoms from emboli l Standard of Care is Carotid Endarterectomy l Evolving treatment to include carotid stent placement

Aneurysms l 5% of population have AAA l Increases with age l 4: 1 male: female ratio l 15, 000 deaths / year in US from ruptured AAA

Aneurysm Treatment l “Open” Surgery

Aneurysm Treatment l Endovascular Surgery

Aneurysm Treatment l Endovascular Surgery

Venous Disease l Acute Venous Thrombosis l Deep Venous Thrombosis (DVT) l Superficial Thrombosis (Phlebitis) l Venous Insufficiency l Varicose Veins

Acute Venous Thrombosis

Chronic Venous Disease l Venous l Pain, Insufficiency edema l Ulceration

Chronic Venous Disease l Varicose veins

Venous Ulcer Treatment l Compression l Surgical Debridement l Skin grafts l Apligraft l Sclerotherapy l Venous Surgery

Venous Treatment l Varicose Vein Stripping l Radiofrequency Ablation

Questions?