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FirstHealth of the Carolinas
Vascular Care By Dick Broom and Susan Shinn

Vascular care

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
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 brain.

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, for example.

Now, many vascular disorders are also treated with minimally invasive procedures that involve less pain, shorter hospital stays and faster recovery than conventional surgery.

Interventional options
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 blood flow.

“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.”

Fibroid treatment
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
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 interventions
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.

Interventional radiologist
Samuel Wahl, M.D., and
interventional cardiologist
Steven Filby, M.D.
Interventional radiologist performs unusual procedure

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.
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 Moore Regional.

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 the body).

In fact, Dr. Furie says, “We were talking to the patient the whole time.”

Test for leg pain available at Ellerbe Family Care CenterMany 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 Center–Ellerbe.

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.
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 available.

“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.