And the Beat Goes On
Minimally-Invasive Surgery for Treatment of
Vascular Disease Offers Significant Patient Benefits

Like a well-oiled machine, your arteries and veins carry blood from the heart to the tissues and organs throughout your body and back again. This structure, which includes arteries, veins and the heart, is called the vascular system. And, like a machine, when the rhythm is interrupted, your body may come to a screeching halt.

Problems in the vascular system often begin with plaque build-up. The blockage reduces blood flow to your arms, legs, head, neck and organs. In other cases, an enlarged blood vessel, called an aneurysm, is susceptible to rupture. What is the end result of vascular disease? Debilitating pain, stroke, heart attack or possibly an aneurysm.

Less than a decade ago, the only way to diagnose and fix potentially fatal arterial blockages or aneurysms was through invasive surgical procedures. Today, non-invasive diagnostic approaches and minimally-invasive techniques have revolutionized the management of vascular disease.

Who's Who at
the GBMC Vascular
Surgery Center
Dale Buchbinder, MD
David Coll, MD
Peter Golueke, MD
Mark Gonze, MD
Peter Mackrell, MD
Rajesh Raikar, MD
Wayne Reichman, MD
Roger Schneider, MD

At the GBMC Vascular Surgery Center, board-certified vascular surgeons use traditional and new approaches to provide expert, life-saving care to patients. The Center is one of Maryland's busiest, offering all FDA-approved minimally-invasive treatments for peripheral vascular disease.

Diagnosis and Treatment
Doppler ultrasound has replaced the more cumbersome invasive catheterization dye study (angiogram) to determine where a blockage or weakness is located. "About 90 percent of preliminary screening for vascular diseases such as aneurysms, occlusive disease and venous disease can be performed using CT scans, magnetic resonance and non-invasive ultrasound," says Wayne Reichman, MD , one of a team of GBMC vascular surgery specialists.  

When the problem is diagnosed, most patients can be treated with minimally-invasive surgery. "Seven years ago, 90 percent of patients in my practice had invasive surgery. Now, 60 to 70 percent of patients have minimally-invasive surgery," says Dale Buchbinder, MD , Chairman, Department of Surgery.

Translated, that means patients avoid the neck-to-groin scalpel and suture approach, making for less patient discomfort, less trauma and a faster recovery time. It also means fewer healthcare dollars and less risk of infection. The newer techniques are especially beneficial for older individuals who are at greater risk for complications during a more invasive, open procedure.

The tools of the trade are catheters, balloons and stents. Catheters, small thin tubes, are inserted into a blocked blood vessel through a small incision. Balloons are inserted into these tubes and inflated to push aside the blockage. Once the blockage is removed, the balloon is deflated and removed with the catheter. Stents are metal supports inserted into the blood vessel to hold it open, after balloon angioplasty. The stents are either coated with a protective material or attached to a graft, which is a fabric or plastic tube that entirely replaces the blood vessel.

Leadership
"As a community hospital, GBMC is known for exceptional patient care. It's also the place where other surgeons come to learn," explains Peter Golueke, MD . "We've been doing these minimally-invasive procedures since they became available, giving our patients the benefit of unparalleled expertise and experience." GBMC's reputation is so strong that the hospital is the training ground for surgeons who practice elsewhere.

"Because of our volume, we are the experts," says vascular surgeon David Coll, MD . "Our work is strengthened by the experienced GBMC nursing and support staff and dedicated operating rooms."

Understandably, experience breeds caution. GBMC vascular surgeons are selective in their choice of new surgical approaches, notes Dr. Golueke. "We usually wait until the technique is proven before bringing it out."

  
Although surgeons are enthusiastic, they are equally emphatic about preventing surgery in the first place. "If you are over 50 or have a family history of vascular disease, have a thorough physical to check your aorta (the major blood vessel found in the abdomen) and carotid artery," says Dr. Buchbinder. "We can determine if there is any blockage and fix it before damage is done."

An Overview of Today's Vascular Surgery Procedures

First Step: Prevention
One of the most important steps is to know your risk factors, believes Dr. Coll. "If we can get people to stop smoking, we can save a lot of lives."

Under Your Control

  • High blood pressure
  • Smoking
  • Excessive alcohol intake
  • High cholesterol
  • Inactivity
  • Excess body weight 
  • Heart disease
  • Diabetes

What You Cannot Control

  • Gender (Men have a higher risk)
  • Age 
  • Heredity

The remarkable changes in vascular surgery bode well for patients today and tomorrow, say surgeons at GBMC's Vascular Surgery Center. "Within the next five years, closer to 90 percent of all vascular surgery cases will be performed through minimally-invasive techniques," says Dr. Reichman.

If you are interested in learning more about GBMC's Vascular Surgery Center: Call 443-849-2110 for a physician referral.  Visit www.gbmc.org/vascular  for details on our vascular surgery program.