Renal Artery (Kidney)
Revascularization
Indication:
To lower blood pressure
in select patients with very high (diastolic BP > 110) blood pressure and to
preserve renal function (prevent kidney failure requiring dialysis) when the
arteries to the kidneys are found to have narrowings.
Preoperative evaluation: First your
doctor performs a complete history and physical exam. Then the initial study
ordered may be a Renal
artery duplex examination
or a nuclear medicine scan. Ultimately, a renal artery arteriogram is required
to further define the narrowings in the renal arteries.
Procedure: Depending on the patient’s
anatomy and overall health, several options may be considered. The narrowed
renal arteries can be opened with a balloon procedure in carefully selected
cases. In other patients a bypass is a more durable option. A bypass can be
performed from a nearby artery to beyond the narrowed area of the renal artery.
Length of stay:
One to three day
stay in the intensive care unit (ICU) followed by 4 to 6 days in a regular room.
Recovery:
4 to 6 weeks with no
driving for 10-14 days and no heavy lifting (over 15 lbs.) for 6 weeks.
Lower
Extremity Revascularization
Vein Stripping
Indication: To remove large
(greater than 1/8 inch in diameter), symptomatic varicose veins. This surgery is
usually reserved for patients who have failed to respond well to the use of
compression stockings.
Procedure:
Just before going
back for surgery, with the patient standing, the veins to be removed are marked
with ink. After anesthesia is given, small incisions (less than ¼ inch) are
made next to each varicose vein. The veins are then extracted with a small hook,
the excess length excised, and the ends tied off. The incisions are small enough
that they can be closed with "steri-strips" and no sutures are
required.
Length of stay:
Outpatient or
occasionally overnight.
Recovery:
Treated legs should
be elevated initially to minimize swelling and bruising. The recovery is
otherwise rapid.
VNUS
Closure (Radio Frequency
Ablation)
Indication:
To remove large (greater than 1/8 inch in diameter), symptomatic varicose veins.
This is a new method of accomplishing the same end-point as stripping, without
the need for incisions, and with much more rapid recovery.
Procedure:
With the patient anesthetized, a small needle is passed into the saphenous
vein, just above the inside of the knee. A catheter is passed to the top of the
vein, near the groin. Energy is transmitted to the vein wall, through the
catheter, and the vein permanently collapses, thereby ridding the patient of the
varicose veins that are fed by this vein
Length of stay:
Outpatient.
Recovery:
Treated legs should
be elevated initially to minimize swelling and bruising. The recovery is
otherwise rapid.
Further Information: http://www.vnus.com/navigation/patients.htm
Vena Cava Filter
Placement
Indication:
To prevent
pulmonary embolism in the presence of deep venous thrombosis (blood clots in the
large deep veins of the legs that could then travel to the lungs or heart.)
Preoperative evaluation: After
a focused history and physical exam, a venous
duplex examination is reviewed to look for blood clots in the leg veins.
Procedure:
The femoral vein
(large leg vein located in the groin) has a hollow wire, called a catheter,
inserted into it. Dye is injected through the catheter and an x-ray picture of
the inferior vena cava (the largest vein in the body, which leads directly to
the heart) is taken. After the patients anatomy is demonstrated on the x-ray, a
small umbrella shaped metal device (the filter) is placed into the vena cava to
catch any traveling blood clots before they can reach the heart or lungs.
Greenfield Vena Cava Filter
Length of stay:
The skin
puncture site that the catheter was placed through is observed for two hours
after which normal activity may be resumed.
Recovery: There are otherwise
no restrictions and an inpatient stay is not required unless other treatments
are required (for instance the administration of blood thinners).
