The surgeons at the Division of Vascular and Endovascular Surgery at Mount Sinai Beth Israel offer minimally invasive endovascular and open surgery treatment options for patients suffering from various diseases of the legs including: peripheral vascular disease (PVD), venous insufficiency and varicose and spider veins.
The arteries (vessels carrying oxygen-rich blood away from the heart to all parts of the body) can develop waxy deposits on their walls called plaque, that narrow or block the vessels. Sometimes veins (blood vessels bringing blood back to the heart) can also become narrowed or blocked from blood clots. When a blood vessel of either type becomes narrow or blocked, less blood flows to part of the body. This can cause serious problems; if it occurs in arteries bringing blood to the brain, heart, kidneys or legs. The loss of blood to the legs can cause limb loss or death.
When is it needed? Balloon angioplasty uses a tiny inflatable balloon to open up the artery for improved blood flow in arteries narrowed by plaque.
What happens? Through a small incision in the groin, a catheter (long plastic tube) carrying a tiny balloon carried on its tip, is guided to the blocked artery. When the balloon inflates, it pushes plaque back against the walls of the artery, expanding the diameter inside the blood vessel and increasing blood flow.
When is it needed? The arteries or veins have narrowing or blockages due to plaque or blood clots. To keep the blood flowing, a tiny metal tube called a stent is guided to the blockage, then left behind to keep the vessel open.
What happens? Through a small incision in the groin, a catheter (long plastic tube) guides the stent (a tiny metal mesh tube) to the problem area, where it remains permanently. The stent props open the artery, preventing it from collapsing or being closed again by plaque.
When is it needed? Over time, cholesterol and other debris can build up on artery walls. When this happens, arteries can become narrowed or blocked, reducing the amount of blood, oxygen and nutrients flowing through them to all parts of the body. Atherectomy (or Roto Rooter) is a procedure used to remove the cholesterol and fibrous tissue blocking arteries. Most atherectomy procedures are performed in the legs to treat symptoms of a peripheral vascular disease (PVD).
What happens? Through a tiny incision, a catheter (long, soft plastic tube) is inserted into the blood vessels and guided to the area of blockage. Attached to the catheter is a device that cuts and shaves the plaque and tissue blocking the blood vessel. The procedure is often used as the first treatment and sometimes to widen arteries that have closed or become blocked again following a balloon angioplasty and treatment with stents.
When is it needed? The cryoplasty procedure is very similar to angioplasty, which involves a catheter guiding a tiny inflatable balloon into a blocked artery to reopen it and improve blood flow.
What happens? During cryoplasty, once the balloon reaches the site of the blockage, the catheter fills it with liquid nitrous oxide which instantly evaporates into a gas, causing the balloon to inflate and freeze the surrounding tissue. Cooling the area to 14° F promotes the opening of the artery and makes it less likely the blockage in that area will recur.
When is it needed? Laser atherectomy is also very similar to angioplasty. But in this case, instead of a balloon-tipped catheter, the catheter has a laser at its tip. Laser energy destroys the built-up plaque that is narrowing the artery.
What happens? Through a tiny incision, the laser-tipped catheter is guided to the blockage. There, it destroys the plaque, layer by layer, by vaporizing it into gaseous particles. The laser can be used alone or combined with balloon angioplasty. If teamed up with balloon angioplasty, the balloon is used first to breakup the hard plaque.
When is it used? When plaque buildup occurs in the arteries of the legs and feet, less blood reaches those muscles and tissues. This can lead to serious problems, even gangrene. This surgical option is used when minimally invasive options have failed or disease is so far progressed that minimally invasive surgery is not possible.
What happens? Like any other bypass surgery, this procedure involves creating a bypass, or detour around the blocked leg or foot artery so blood resumes its normal flow. The surgeon attaches (grafts) a vein to either end of the blocked blood vessel. Whether it's made of a healthy natural vein or artery, or man-made, the graft lets blood bypass the diseased vessel and flow normally to the legs and feet through the graft vessel.
When is it needed? This technique is used for treating varicose veins and venous reflux that involves the deeper veins of the leg. It is done in the doctor's office using local anesthesia.
What happens? The doctor puts a small tube called a catheter into the problem vein, then inserts a small laser fiber into the catheter. A device at the tip of the probe heats up the inside of the vein and seals it off. Healthy veins around the closed vein take over the normal flow of blood. Symptoms from the varicose vein will improve almost immediately. Usually veins on the surface of the skin connected to the treated varicose vein will also shrink after treatment. This is an outpatient procedure and patients can return to work the same day.
When is it needed? This is the most common treatment for both small varicose and spider veins. The technique does not require anesthesia and can be done in the doctor's office. The person can return to normal activity right away.
What happens? The doctor injects a liquid chemical into the vein, which causes the vein walls to swell, stick together, and seal shut. This stops blood from flowing, and the vein turns into scar tissue. The vein will fade in a few weeks. Sometimes, the same vein needs to be treated more than once. In this case, treatments are done every four to six weeks.
When is it needed? This treatment is used when varicose veins are especially large or severe, or when valves in large veins of the groin are also leaking, or when varicose veins have not responded to other treatments.
What happens? Because several short incisions are made in the skin along the leg, the procedure is done under general or spinal anesthesia. First, the problem vein is tied off (ligated) with a small stitch to block the flow of blood. If only one valve is damaged, the ligated vein may be left in place. But if many valves are damaged, the vein is removed (stripped). Usually, other veins in the leg take over the work of the removed vein or veins. Patients can go home the same day.
When is it needed? When a person has venous insufficiency, ulcers (sores) or wounds can develop on the skin of the lower legs. These ulcers can quickly become infected or even gangrenous.
What happens? During debridement, doctors surgically remove all dead and infected tissue and bone from a non-healing ulcer. This promotes faster and better healing. The procedure is also used when a patient with a venous ulcer shows signs of infection, including fever, elevated white blood count, and draining from the ulcer.