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Category: Carotid Endarterectomy

Carotid Endarterectomy

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Carotid endarterectomy is a surgical procedure that involves removing plaque buildup from the carotid arteries, which are located in the neck and supply blood to the brain. This blog post aims to provide you with a comprehensive understanding of carotid endarterectomy, including its purpose, procedure, and why you might need one.

What is Carotid Artery Disease?

Before delving into carotid endarterectomy, it’s essential to grasp the concept of carotid artery disease. Over time, the carotid arteries can become narrowed due to the accumulation of fatty deposits called plaques. This condition, known as atherosclerosis, restricts blood flow to the brain, potentially leading to a stroke or transient ischemic attack (TIA), often referred to as a mini-stroke.

Purpose of Carotid Endarterectomy:

Carotid endarterectomy aims to reduce the risk of stroke by removing the plaque buildup from the carotid arteries. By restoring normal blood flow, the procedure helps prevent the development of vascular surgeon in the or.a full-blown stroke or TIA.

Indications for Carotid Endarterectomy:

Significant carotid artery narrowing: Typically, a stenosis of 70% or more is considered significant, but the decision to undergo surgery depends on several factors, including your overall health and the presence of symptoms.
Experienced a recent TIA or minor stroke: If you’ve had a transient ischemic attack or a minor stroke, carotid endarterectomy may be recommended to prevent further, more severe strokes.
Asymptomatic with high-grade stenosis: In some cases, carotid endarterectomy may be considered for individuals without symptoms but with high-grade carotid stenosis (greater than 80%) due to the increased risk of future strokes.

The Carotid Endarterectomy Procedure:

Here’s a general overview of what you can expect during a carotid endarterectomy procedure:

Anesthesia: You will be given either general anesthesia (where you’re asleep) or local anesthesia (where only the neck is numbed).

Incision: A small incision is made in the neck over the affected carotid artery.

Artery Access: The vascular surgeon carefully opens the carotid artery to access the plaque inside.

Plaque Removal: The plaque is removed from the artery, aiming to restore normal blood flow.

Closure: The artery is then closed, and the incision in the neck is stitched or stapled.

Recovery: After the procedure, you will be closely monitored in the hospital for a day or two before being discharged. The recovery period may vary, but most individuals can resume their normal activities within a few weeks.

Carotid endarterectomy is a well-established procedure aimed at reducing the risk of stroke in individuals with significant carotid artery disease. By removing plaque buildup from the carotid arteries, the procedure helps restore normal blood flow to the brain, potentially preventing future strokes. If you’ve been recommended to undergo carotid endarterectomy, it’s crucial to discuss any concerns or questions you may have with your healthcare provider. Remember, the decision to undergo the procedure should be made based on a careful assessment of your individual medical condition and the risks and benefits involved.

Why do I need a vascular surgeon?

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Why do I need a vascular surgeon?

 

Vascular Disease:

If you have been diagnosed with vascular diseases such as peripheral artery disease (PAD), deep vein thrombosis (DVT), varicose veins, aneurysms, or carotid artery disease, a vascular surgeon specializes in the treatment of these conditions.

Circulation Problems:

If you experience symptoms related to poor blood circulation, such as leg pain or cramping during walking or at rest, non-healing wounds or ulcers, or coldness in your extremities, a vascular surgeon can evaluate and provide appropriate treatment options.

Vascular Trauma:

In cases of traumatic injuries that involve blood vessels, such as a severe laceration or damage to arteries or veins, a vascular surgeon can perform surgical procedures to repair and restore blood flow.

Aortic Aneurysm:

If you have an abdominal or thoracic aortic aneurysm, which is a weakened and bulging area in the aorta, the main blood vessel in your body, a vascular surgeon may perform surgery to repair or replace the affected segment to prevent the risk of rupture.

Endovascular Procedures:

Vascular surgeons are trained in minimally invasive endovascular techniques, such as angioplasty, stenting, and embolization, to treat various vascular conditions. These procedures involve using catheters and imaging guidance to access and treat the affected blood vessels from within.

Vascular Access:

If you require long-term dialysis, a vascular surgeon can create and manage vascular access points, such as arteriovenous fistulas or grafts, to allow repeated access to your blood vessels.

With many years of extensive vascular experience, Western Vascular Institute’s providers are able to provide unparalleled diagnosis & management for all venous & vascular diseases as well as exceptional patient care.

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What is Vascular Surgery?

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What is Vascular Surgery?

Vascular surgery is a surgical specialty that deals with diseases of the blood vessels. It is a relatively new specialty, having been founded in the early 1970s. The first residency program was started at the University of Minnesota in 1973.

The specialty of vascular surgery is divided into two main branches: open surgery and endovascular surgery.

Open surgery is the traditional form of surgery, where the surgeon makes a large incision in the patient’s body in order to access the blood vessels. Endovascular surgery is a newer form of surgery that uses tiny instruments and a camera to access the blood vessels through small incisions.

Vascular surgery is a highly specialized field, and there are only a few hundred surgeons in the United States who specialize in it. The majority of vascular surgeons are based in large metropolitan areas, and there are few rural areas that have vascular surgeons.

 Treating a variety of diseases and conditions, including:

Vascular surgery is a life-saving procedure in many cases. For example, an aortic aneurysm is a life-threatening condition that can lead to a ruptured aorta. If the aneurysm is detected early, it can be treated with surgery. It is a highly specialized field, and patients should seek out a vascular surgeon who is experienced in treating the specific condition that they have.

What Causes A Stroke?

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What Causes A Stroke?

 

Type of Stroke:

Ischemic stroke – occurs when blood vessel blockage prevents blood flow to the brain due to a plaque build-up in the carotid arteries.

Hemorrhagic stroke – occurs when the vessel ruptures inside of the brain and bleeds.

Transient Ischemic stroke or TIA – is a temporary blockage or mini-stroke which can cause permanent damage and are a sign of more severe stroke in the future.

Like Peripheral Arterial/Vascular Disease, Carotid Artery Disease is a narrowed blood flow through the vessel. This narrowing or blocked vessel becomes occluded by fatty deposits of plaque built up along the vessel wall leading to atherosclerotic disease. The Carotid artery is the primary source of blood to your brain. Therefore, a narrowing or blockage in the carotid artery is a serious complication and requires thorough and appropriate diagnosis and treatment.

Stroke Symptoms:

Many people with Carotid Artery Disease do not experience symptoms even with quite a bit of arterial blockage. Generally, this condition is found after the patient experiences a stroke or by a routine patient examination.

Stroke Causes:

Generally, Carotid Artery Disease is caused by atherosclerosis, where a build-up of plaque in the arteries reduces the flow of blood or blocks the flow entirely. This lack of blood flow and reduced oxygen supply to the brain can lead to stroke.

Stroke Risk Factors include:

Sedentary lifestyle, Overweight obesity, Diabetes, smoking, high cholesterol levels, high blood pressure, Family history, high fat diet, and age above 75 are all factors.

Stroke Diagnosis:

Diagnosis of Carotid Artery Disease is generally diagnosed through a physical examination and medical history. Your physician will also most likely be looking for a (bruit) swooshing sound in the carotid artery that is indicative of a narrowed artery. A Carotid Artery duplex ultrasound scan will also be performed to assess the flow of blood through the artery as well as the pressure.

Stroke Treatments:

The reason for the treatment of carotid artery disease is to reduce or mitigate the possibility of stroke.

For mild blockage:

Lifestyle changes such as eating a healthier diet, reducing salt intake, exercising regularly, losing weight, and quitting smoking are all ways that patients themselves can manage the disease and reduce the chance of blockage and stroke.

Medication management:

Medications may be given to lower the amount of cholesterol in the blood and lower your blood pressure. Additionally, blood thinner medications may be given to prevent blood clots.

Surgical intervention for stroke prevention:

Carotid endarterectomy – generally performed when there is a blockage of 50% or above accompanied by symptoms such as a stroke.

TCAR – Western Vascular Institute is pioneering the use of a breakthrough technology called TransCarotid Artery Revascularization (TCAR) to treat patients with carotid artery disease who are at risk for open surgery. While any repair of the carotid artery carries some risk of causing a stroke because of the repair itself, TCAR was designed to help minimize that risk by keeping potential stroke-causing fragments away from the brain.

Carotid angioplasty/stenting – This procedure is performed to treat narrowed or occluded carotid arteries. In this procedure, the Vascular Surgeon inserts a wire through the groin and guided via X-ray imaging to the carotid artery. Once there, the balloon is placed to expand the narrowed section, and a stent is left in place afterward to maintain the vessel diameter and allow the blood to flow through the artery.

 

The Joint Commission

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The Joint Commission Certification

The Joint Commission, also known as TJC, is an independent, non-profit organization in the United States that accredits and certifies healthcare organizations and programs. It was founded in 1951 and is recognized as a leader in setting quality and safety standards for healthcare.

The goal of The Joint Commission:

The primary goal of The Joint Commission is to improve the quality and safety of patient care. They achieve this by establishing rigorous standards and conducting thorough evaluations of healthcare organizations to ensure compliance. Accreditation by The Joint Commission is voluntary but highly valued and widely recognized as a mark of quality in the healthcare industry.

The accreditation process:

The accreditation process involves an in-depth review of various aspects of an organization’s operations, including patient care, infection control, medication management, leadership, and performance improvement. Surveyors from The Joint Commission visit healthcare facilities to assess compliance with the standards. If an organization meets the standards, they are awarded accreditation, which is typically valid for a specific period.

The Joint Commission certification:

In addition to accreditation, The Joint Commission offers various certification programs for specific areas of healthcare, such as disease-specific care, primary stroke centers, and advanced certification in healthcare quality.

The Joint Commission & Patient Saftey:

The Joint Commission plays a crucial role in promoting patient safety and quality improvement in healthcare organizations. Their standards and accreditation process help organizations identify areas for improvement, implement evidence-based practices, and continuously enhance the quality of care provided to patients.

It’s important to note that while The Joint Commission sets standards and evaluates healthcare organizations, they do not have regulatory authority. Their focus is on voluntary accreditation and continuous improvement rather than enforcing compliance through legal means.

Western Vascular Institute is a Joint Commission Accredited vascular-surgery-center garnering the gold seal of approval. These certifications demonstrate a higher level of expertise and specialization in particular areas of care.

Vascular Ultrasound

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Vascular ultrasound

Vascular ultrasound, also known as duplex ultrasonography or Doppler ultrasound, is a non-invasive imaging technique used to evaluate blood vessels and blood flow in the body.

During this study, a small handheld device called a transducer is used to emit high-frequency sound waves into the body. These sound waves bounce back off the blood vessels and are detected by the transducer, which converts them into images that can be viewed on a monitor.

Vascular ultrasound is commonly used to diagnose and monitor various vascular conditions, including:

 

Peripheral artery disease (PAD):

Evaluating blood flow and detecting blockages or narrowing in the arteries of the legs, arms, or neck.

Deep vein thrombosis (DVT):

Detecting blood clots in the deep veins, usually in the legs.

Carotid artery disease:

Assessing the carotid arteries in the neck to detect plaques or other abnormalities that may increase the risk of stroke.

Abdominal aortic aneurysm (AAA):

Evaluating the aorta in the abdomen for the presence of an abnormal bulge or enlargement that could potentially rupture.

Venous insufficiency:

Assessing the veins and valves in the legs to identify valve dysfunction or venous reflux, which can lead to conditions like varicose veins.

Vascular ultrasound is a safe and painless procedure that does not involve radiation. It provides real-time images and can be used to measure blood flow velocity and direction using the Doppler effect, which allows the assessment of blood flow characteristics such as speed and turbulence.

The results of a vascular ultrasound can help vascular surgeons make accurate diagnoses, develop appropriate treatment plans, and monitor the effectiveness of interventions over time.

What is Atherosclerosis?

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Atherosclerosis – is a disease process that leads to the hardening or clogging of arteries. The build-up over time of substances such as fat, cholesterol, & calcium, collectively called plaque, narrows the artery and restricts the amount of blood able to pass through the arteries, and provides oxygen-rich blood to the body. This stenosis or narrowing of the artery can lead to serious problems such as stroke, amputation, heart attack, and death.

 

What is Carotid Artery Disease?

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What is Carotid Artery Disease? Dr. Dawn Olsen Vascular Surgeon and Kailin George physician liaison discuss the signs, symptoms, causes, & treatments of carotid artery disease. Additionally, as seen below are some photos taken from a recent TCAR or Trans Carotid Artery Revascularization procedure performed by Dr. Dawn Olsen on a patient in the hospital. It can be clearly recognized where the carotid artery had become nearly occluded prior to the procedure and post-procedure including stenting the artery had become nice and open allowing for optimal blood flow to the brain. Also of note is the photo where plaque filtered out through the TCAR device can be seen in abundance.

Introducing Dr. David J. Paolini

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Dr. David J. Paolini vascular surgeon in Arizona.
Dr. David J. Paolini Vascular Surgeon with Western Vascular Institute. Board Certified Vascular Surgeon

Dr. David Paolini is a Vascular Surgeon with over 15 years of Vascular Surgery experience.  Dr. Paolini recently joined Western Vascular Institute as one of our acclaimed vascular surgeons from the Jobst vascular center in Toledo, Ohio. Dr. Paolini has had a passion for medicine and physics from a young age, feeling that Vascular Surgery is the perfect combination of the two scientific areas. Dr. Paolini completed his medical school training from Temple University (One of the best Medical Schools in the united states) in 1999 and after that moved to New Mexico to begin his residency at the University of New Mexico Health Sciences Center Department of Surgery. After completing a 5-year surgical residency Dr. Paolini then moved to Toledo, Ohio to complete a Vascular Surgery specific fellowship at the prestigious Jobst Vascular Center. Dr. Paolini quickly gained accolades as one of the most innovative and competent vascular surgeons in the area as well as being heavily invested in Vascular Surgery research and publications. Dr. Paolini’s care philosophy is “ to take care of patients like you would want your kids’ taken care of ”. As a father of two wonderful children and supported by his beautiful wife Dr. Paolini is poised to join the ranks of the great caring vascular surgeons here at Western Vascular Institute. Dr. Paolini’s previous patients have described dr. Paolini as being kind, compassionate, & honest. We are excited to have Dr. Paolini as part Western Vascular Institute. Dr. Paolini is now accepting new patients in the Mesa and Payson office locations. For an appointment with Dr. Paolini please contact one of our new patient coordinators at (480) 668-5000 ext. 332