If you have a blood vessel problem, you might not
know what type of specialist you should see to have it
taken care of. But you really don’t need to know if you
live in Moore, Richmond, Montgomery or one of the
other nearby counties.
|Vascular surgeons Clinton Atkinson, M.D.; Joel Berman, M.D.; and Robert Albrecht, M.D.
That’s because all of the medical and surgical
specialties that deal with the circulatory system are
represented by physicians at FirstHealth Moore
Regional Hospital. As a group, they are experienced in dealing
with virtually every circulatory problem.
“We have a community of speciali sts who work together
and support each other,” says Clinton Atkinson, M.D., of
Pinehurst Surgical. “The idea is to get the right doctor with
the right skills at the right time to provide whatever treatment
is most appropriate for any given patient.”
Dr. Atkinson is a vascular surgeon, which means he
specializes in treating conditions affecting the peripheral
vascular system—all of the blood vessels outside the heart and
Interventional cardiologists, interventional radiologists and
cardiothoracic surgeons at Moore Regional also treat patients
with peripheral vascular conditions.
The most common vascular disease is atherosclerosis, which
is the build-up of fatty plaque inside the arteries that restricts
blood flow and sometimes blocks it completely.
Other vascular disorders include aneurysms, which are
bulges caused by the weakening of a vessel wall; embolisms,
which are blood clots that block vessels; and bleeding vessels.
Some vascular conditions can be treated conservatively with
lifestyle changes such as diet and exercise, and some conditions
respond well to medication. Still others require surgery—to
bypass a blocked section of a vessel or to repair an aneurysm,
Now, many vascular disorders are also treated
with minimally invasive procedures that involve less
pain, shorter hospital stays and faster recovery than
People with diabetes often have poor circulation in
their legs because the disease accelerates the build-up of
plaque in their arteries. The goal of treatment is to restore
adequate blood flow to prevent serious problems such as
infections and gangrene, which can lead to amputation.
Physicians have several procedures they can use to clear
clogged arteries including laser treatments and balloon
angioplasty. This involves inflating a tiny balloon inside
a clogged artery to restore blood flow by pressing the
plaque against the artery wall. Then a stent—a wire mesh
scaffold—is inserted into the artery to keep it open.
“There are many new, exciting developments in
this field,” says Steven Filby, M.D., an interventional
cardiologist with Pinehurst Medical Clinic. “On the
horizon are drug-coated balloons and stents. The
medication is transferred to the blood vessel wall to keep
the section that is being unclogged from re-narrowing
in the future. This technology has been used in coronary
arteries with great success.”
In some cases, blocked arteries can be treated with
devices that shave plaque off artery walls to restore
“These procedures are minimally invasive, and many
patients go home the same day,” Dr. Filby says. “That is a
real advantage over traditional open surgical procedures.”
One of the newest devices available to physicians who treat
vascular problems at Moore Regional is called the Jetstream.
“It combines two technologies,” Dr. Atkinson says. “One
is an artherectomy, which means it removes plaque from
the artery walls. The other is a thrombectomy; it removes
fresh clots and other debris.”
Sometimes, health problems that aren’t caused by
diseased blood vessels can be effectively treated with vascular
procedures. One of these conditions involves fibroids, noncancerous
growths that sometimes develop on the muscular
walls of the uterus. Fibroids need to be treated only if they
are causing symptoms. The most common symptom is an
unusually heavy and prolonged menstrual period.
“Bleeding can be so severe that the patient becomes anemic
and requires a transfusion,” says Samuel Wahl, M.D., an
interventional radiologist with Pinehurst Radiology.
|Cardiothoracic surgeons Peter Ellman, M.D., and John Streitman, M.D.
The standard treatment for fibroids is a hysterectomy—the
surgical removal of the uterus—or, in some cases, the removal
of the fibroid. As an alternative, Dr. Wahl offers a procedure
called uterine fibroid embolization (UFE) in which tiny beads
are injected into arteries that supply blood to the fibroids. The
beads clog the arteries, stopping the flow of blood and causing
the fibroids to shrink. The rest of the uterus is not affected.
According to Dr. Wahl, the minimally invasive UFE
procedure has several advantages.
“It is less risky than conventional surgical treatment, the
complication rates are extremely low, and patients have less
pain and a much shorter recovery time,” he says. “It is a
wonderful procedure, because it is very safe and effective and it
spares the uterus.”
Cardiothoracic surgeons are the specialists
who most often repair aneurysms and other
problems of the aorta, the main vessel that
carries blood from the heart to the arteries
that, in turn, supply the rest of the
body. The aorta extends up from
the heart a short distance (the
ascending aorta) and then curves
back down (the descending
aorta) through the chest and
abdomen. Because all of the
body’s vital organs depend
on a steady flow of blood
through the aorta, any aortic problem—particularly an
aneurysm—can pose a serious risk.
“Aneurysms of the aorta can have a number of different
causes,” says Peter Ellman, M.D., a cardiothoracic surgeon
with the FirstHealth Cardiovascular & Thoracic Center.
“When these aneurysms get too large, they can rupture, which
is a life-threatening situation.”
Both Dr. Ellman and John Streitman, M.D., also a
cardiothoracic surgeon with the FirstHealth Cardiovascular &
Thoracic Center, can repair an aneurysm at any point along
the ascending or descending aorta.
Repair of aneurysms, particularly of the ascending aorta,
usually involves open surgery where the aorta is replaced with
an artificial conduit that is made of a material called Dacron.
In some cases, such as those involving the descending aorta,
repair can be done less invasively using endovascular (through
the blood vessels) techniques and stent grafts.
“We offer procedures that traditionally would require
the patient to be transferred to a major referral center,”
Dr. Streitman says. “We are able to provide academic-level
care, which relieves patients of the stress of traveling to a big
academic medical center to be taken care of.”
Like other vascular disease specialists, cardiothoracic
surgeons at Moore Regional also treat diseased carotid
arteries, which supply blood to the brain, as
well as blocked arteries in the legs.
Deep vein thrombosis
Veins, the vessels that return blood to
the heart after circulating through the
body, are also susceptible to problems
requiring treatment. One of the
most common and most serious
is deep vein thrombosis—
blood clots in the larger veins
such as the inferior vena cava,
which carries blood from the
intestines and legs.
“We treat deep vein
thrombosis with clot-busting techniques using catheters, along with medications that help
dissolve the clots,” Dr. Filby says. “Breaking up these clots early
helps restore normal vein function and prevents lifelong swelling.
We also can place a filter in the vein, which helps prevent clots from
embolizing (traveling) to the lungs.”
Most of the time, vein and artery problems are first detected by
patients’ primary care physicians or the specialists they are already
seeing, such as cardiologists or gynecologists. Typically, these
physicians refer the patient for further diagnostic testing.
Based on the test results, physicians can determine the most
appropriate treatment and which type of medical or surgical
specialist should be called on to provide it.
Samuel Wahl, M.D., and
Steven Filby, M.D.
When physicians at a hospital outside the
FirstHealth system needed assistance with
an unusual vascular situation, they called
upon an interventional radiologist at FirstHealth
Moore Regional Hospital for help. Using a catheter
that is typically used in neuroradiological (nervous
system) procedures, David Furie, M.D., of Pinehurst
Radiology Associates, was able to retrieve a broken
piece of medical equipment from a patient’s heart.
“There were certainly risks involved, but we
managed them appropriately and, as a result, we had a good
outcome,” Dr. Furie says.
|David Furie, M.D.
The episode began when personnel at the regional hospital
tried to remove a chemotherapy port from a patient
and noticed that a 6-inch plastic catheter had broken
off and disappeared. Rather than subject the patient
to extensive exploratory surgery to locate the piece, a
physician at the hospital suggested calling Dr. Furie at
With his patient sedated but awake on an
angiography table, Dr. Furie expected to locate
the missing piece in a vein, either the subclavian or
jugular, but instead found it lodged inside the heart.
In his first attempt to retrieve it, Dr. Furie tried to lasso the
piece with a traditional interventional vascular snare, also called
a gooseneck snare. When that didn’t work, he improvised and
used a neuroradiology catheter to deliver the gooseneck snare—
inserting it through the groin and into the right femoral vein before
moving it through the inferior vena cava into the right atria and then
the right ventricle— to grab the errant piece and pull it through the
patient’s heart and out of his body.
While risks were possible, including the potential for a fatal heart
rhythm, Dr. Furie says, “The patient did well, and we avoided the need
for open surgery.”
The procedure took about 30 minutes, and was conducted much like
a typical angiogram (a test used to examine blood vessels in key parts of
In fact, Dr. Furie says, “We were talking to the patient the whole time.”
Many times, leg pain gets ignored as a
normal sign of aging. However, chronic
leg pain can be a symptom of something
much more serious.
The most common symptom of Peripheral Artery
Disease, or PA D, is painful cramping in the hips,
thighs or calves when walking, climbing stars or
exercising. Symptoms of severe PA D are leg pain
that doesn’t go away when you stop exercising, foot
or toe wounds that won’t heal or heal very slowly,
a notable decrease in the temperature of the lower
leg or foot (especially when compared to the other
leg or the rest or the body),
and even gangrene.
A test for diagnosing
PA D is now available at
the FirstHealth Family Care
The painless exam
compares the blood
pressure in the feet to
the blood pressure in the
arms to determine how
well the blood is flowing. The test takes only a
few minutes and can be performed as part of a
routine physical exam.
|Bo Kopynec, M.D.
The results can help identify the presence, severity
and location of PA D, providing early detection of the
disease when more treatment options—including
lifestyle changes and non-invasive treatments—are
“This is a diagnostic test that can help us develop
a treatment plan for the patient,” says Bo Kopynec,
M.D., “or, if necessary, refer the patient to a vascular
surgeon for more advanced care.”
Leg pain, cramping, swelling, numbness and skin
discoloration are common complaints that physicians
hear from their patients. About 33 percent of the
estimated 9 million adults with PA D experience
symptoms of such frequency or intensity that they
require medical attention.
For more information about diagnostic testing for
leg pain at the FirstHealth Family Care Center-Ellerbe,
call (800) 213-3284.