THE KEYS TO OUR SUCCESS

Vein Problems
The most common problems of the veins are: Varicose veins are veins near the surface of the skin, usually in the legs, that have become swollen and can be felt through the skin. These bulging, bluish veins are often found on the inside of the calf or thigh. Chronic venous insufficiency (CVI) results when the veins in the legs no longer pump blood back to the heart effectively. Deep vein thrombosis (DVT) occurs when a blood clot, or thrombus, develops in the large veins in the lower extremities or pelvis.

Angioplasty & Stent Placement
During an angioplasty, your vascular surgeon inflates a small balloon inside a narrowed blood vessel. A stent is a wire mesh stainless steel tube that holds an artery open and keeps it from closing again. It becomes a permanent part of your artery.

Endovascular Treatment of Peripheral Vascular Disease
Atherosclerosis is a condition in which fatty material collects along the walls of arteries. Endovascular revascularizatio is a surgical procedure for the provision of a new, additional, or augmented blood supply to a body part or organ. Peripheral vascular disease (PVD), also known as peripheral artery disease (PAD) or peripheral artery occlusive disease (PAOD), includes all diseases caused by the obstruction of large arteries in the arms and legs.

Peripheral Angiography
Peripheral angiography is an outpatient diagnostic study for patients who may have blocked blood vessels in their legs and lower body. Utilizing an iodine-based dye that is injected to make arteries (which aren't detectable by X-rays) visible when mixed with blood, doctors can have a "map" of a patient's blood vessels to determine if there's disease or blockage and where the problem is located.

Vena Caval Filter Placement
Inferior vena cava (IVC) filter placement is surgery to place a filter into your inferior vena cava, a large blood vessel found in your abdomen. It begins at your abdomen, and continues up to your heart, inside your chest. The IVC brings blood from the lower parts of your body back to your heart. During the procedure, a catheter (thin plastic tube) is inserted into the blood vessels in your neck or groin. A doppler ultrasound or fluoroscope (x-ray) is used to guide the catheter into your IVC. The IVC filter is inserted through the catheter and into the IVC where it attaches to the walls of the vein. The catheter is pulled out after the procedure and the filter is left in.

Dialysis Access Surgery
Creating the access portal is a minor surgical procedure. During dialysis, physicians use the dialysis access to remove a portion of your blood to circulate it through the dialysis machine so it can remove impurities and regulate fluid and chemical balances. The purified blood is then returned to you, again through the dialysis access. Dialysis access is an entranceway into your bloodstream that lies completely beneath your skin and is easy to use. The access is usually in your arm, but sometimes in the leg, and allows blood to be removed and returned quickly, efficiently, and safely during dialysis.

Iliac & Femoral Angioplasty
Angioplasty most commonly done to treat narrowings in the leg arteries, especially the common iliac and femoral arteries.

Infrainguinal Bypass (Femoral-Popliteral, etc.)
In advanced lower limb blood restriction, infrainguinal (below the groin) or femoral-popliteral (in the legs bypass procedure is the treatment of choice for limb salvage provided there is good distal run off.

Aortobifemoral Bypass
Aortobifemoral bypass surgery is for people who have blocked blood vessels (aorta or iliac arteries) in the abdomen and pelvis. The blockage usually must be causing significant symptoms or be limb-threatening before bypass surgery is considered.

Carotid Endarteretomy
Carotid endarterectomy (CEA) is a surgical procedure used to prevent stroke, by correcting stenosis (the narrowing or constriction of the inner surface) in the common carotid artery. Endarterectomy is the removal of material on the inside of an artery.

Carotid Stenting
Carotid artery stenting (CAS) is a non-surgical, catheter-based procedure which unblocks narrowing of the carotid artery lumen to prevent a stroke.

Aortic Aneurysm Repair
An aneurysm is an enlarged and weakened section of an artery. An aneurysm is a serious health concern, because as it increases in size, it can rupture. Besides rupturing, aneurysms carry another risk. Blood clots can form in an aneurysm and block blood flow to parts of your body. Your vascular surgeon will make an incision in your skin and muscle above the artery with the aneurysm. Once your surgeon exposes the aneurysm site, he or she will clamp the artery above the aneurysm to stop blood from flowing through the area. Your surgeon next opens the aneurysm and removes the clotted blood and plaque deposits. Usually, your surgeon will not completely remove your aneurysm. Instead, he or she may cut through the wall of the artery and open it like a butterfly. He or she may then insert a graft that is the same size and shape of your healthy artery. Your surgeon will attach one end of this graft just above where the aneurysm begins and the other end below the end of the aneurysm. In some cases, your surgeon may remove the aneurysm and replace it with a piece of a vein from your leg, or a man-made graft, if necessary.

Dorsal Sympathectomy for Hyperhydrosis
Dorsal Sympathectomy is a surgical procedure where certain portions of the sympathetic nerve trunk are destroyed. Hyperhidrosis is the condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature.

Lung Volume Reduction Surgery for Emphysema
Lung volume reduction surgery (LVRS) is a procedure which removes approximately 20-35% of the poorly functioning, space occupying lung tissue from each lung. By reducing the lung size, the remaining lung and surrounding muscles (intercostals and diaphragm) are able to work more efficiently. This makes breathing easier and helps patients achieve greater quality of life. Emphysema is a breakdown in the walls of the air sacs of the lung causing them to become abnormally enlarged.

Resection of Mediastinal Tumors, Thymectomy
Mediastinal tumor resection is surgery to remove tumors in the area of the chest cavity that separates the lungs. A thymectomy is the surgical excision of the thymus, a lymphoid organ just anterior to the heart within the rib cage.

VATS or Subxyphoid Pericardial Window, Pericardiectomy
Subxyphoid Pericardial Window is a surgical construction of an opening or window in the pericardium, a double-walled sac that contains the heart and the roots of the great vessels. A pericardiectomy is the surgical removal of part or most of the pericardium.

VATS Lung Biopsy
A minimally invasive technique, video-assisted thoracoscopic surgery (VATS) can be used to biopsy lung and mediastinal lesions. VATS may be performed on selected patients in place of open lung biopsy. While the patient is under general anesthetia, the surgeon makes several small incisions in the his or her chest wall. A thorascope, a thin, hollow, lighted tube with a tiny video camera mounted on it, is inserted through one of the small incisions. The other incisions allow the surgeon to insert special instruments to retrieve tissue for biopsy.

VATS Drainage & Decortication for Empyema
An empyema is a collection of pus within a naturally existing anatomical cavity, such as the lung pleura. When it thickens, it can usually be treated with Video Assisted Thoracic Surgery. Once the fluid becomes thick and loculated, a formal thoracic surgical procedure called a thoracotomy with decortication is required. This involves opening the chest, taking out the fluid, peeling the thick rind of infectious material off the lung, and then inserting a chest drain to help clear the infection.

VATS Pleurodesis for Spontaneous Pneumothorax or Malignant Effusion
Video Assisted Thoracic Surgery (VATS) Pleurodesis is a medical procedure in which the pleural space is artificially obliterated. Surgical pleurodesis is performed via thoracotomy or thoracoscopy. This involves mechanically irritating the parietal pleura, often with a rough pad. Moreover surgical removal of parietal pleura is an effective way of achieving stable pleurodesis. Pneumothorax is a medical condition and potential emergency wherein air or gas is present in the chest. Malignant effusion is excess cancerous fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during inhalation.

Combined Chestwall Resection & Reconstruction
Chest wall resection, with or without removal of adjacent lung tissue, can be treated without surgery. Chest wall reconstruction may require placement of prosthetic materials and rotation of muscle flaps to create cosmetically acceptable and functional results.

Comprehensive Cancer Staging
The stage of a cancer is a descriptor (usually numbers I to IV) of how much the cancer has spread. The stage often takes into account the size of a tumor, how deeply it has penetrated, whether it has invaded adjacent organs, how many lymph nodes it has metastasized to (if any), and whether it has spread to distant organs. Staging of cancer is important because the stage at diagnosis is the most powerful predictor of survival, and treatments are often changed based on the stage.

Combined-modality Therapy for Advanced Thoracic Malignancies
The intense combined modality treatment of stage III disease (both small cell and non-small cell lung cancers). Two or more types of treatments are used to supplement each other. For instance, surgery, radiation, chemotherapy, hormonal or immunothearpy may be used alternatively or together for maximum effectiveness.

Cervical Mediastinoscopy, Anterior Mediastinotmy
A procedure in which a mediastinoscope is used to examine the organs in the area between the lungs and nearby lymph nodes. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. The mediastinoscope is inserted into the chest through an incision above the breastbone. This procedure is usually done to get a tissue sample from the lymph nodes on the right side of the chest.

Lobectomy, Pneumonectomy, Sleeve Lobectomy
A lobectomy is the removal of a lobe, or section, of the lung. Pneumonectomy is the surgical removal of a lung. A sleeve lobectomy is surgery to remove a lung tumor in a lobe of the lung and a part of the main bronchus (airway). The ends of the bronchus are rejoined and any remaining lobes are reattached to the bronchus. This surgery is done to save part of the lung.

Video-assisted Thoracic Surgery (VATS) for Pulmonary Resection
Pulmonary resection is the removal of the tumor and neighboring lymph nodes. An operative procedure known as video assisted thoracoscopic surgery (VATS) is minimally invasive. During VATS, a lung is collapsed and the thoracoscope and surgical instruments are inserted into the thorax through any of three to four small incisions in the chest wall.

Transmyocardial Laser Revascularization
This surgery uses a laser beam to improve blood flow to the heart. It is not common but may be done to reach areas of the heart where bypass grafting does not work as well.

Redo Bypass Surgery
A redo by pass surgery is the same except that it is being done after one by-pass surgery has already been performed in the past. The difference is that a redo by-pass surgery is harder. Now there are lesser places to connect the artery -- old grafts that you have used cannot be used again, one has to come up with new grafts. Performing a redo by-pass surgery requires far more skill. It is a more challenging and demanding surgery when it is a second time.

Multiple Arterial Bypasses
Sometimes several arteries are blocked, and several bypasses are needed. If, for example, there were blockages in all three coronary arteries and one branch, a person would get four bypasses. This is called quadruple bypass surgery. People who need several bypasses aren't necessarily at higher risk than those who need just one. It is not the number of bypasses that dictates a patient's risk. The risk is more dependent on the general condition of the patient, whether the patient has other conditions, such as kidney disease or diabetes, and the condition of the heart muscle itself. So if the patient's condition is good, the number of bypasses may mean a longer surgery but not significantly greater risk.

Ischemic Heart Disease
Ischaemic heart disease occurs when the heart is not sufficiently supplied with blood causing damage to the heart muscle. Subsequently the heart muscle functions ineffectively. The restriction of blood flow is initiated by the deposits of fat that build up within the coronary arteries which progressively results in the narrowing of the arteries.

Pacemaker & Defibrillator Placement
Pacemaker:
A pacemaker is a surgically implanted electronic device that regulates a cardiac arrhythmia.
Defribrillator:
Defibrillation is a process in which an electrical device called a defibrillator sends an electric shock to the heart to stop an arrhythmia resulting in the return of a productive heart rhythm.

Management of Thoracic Trauma (Heart, Lungs, Aorta ...)
Chest trauma (or thoracic trauma) is a serious injury of the chest. Thoracic trauma is a common cause of significant disability and mortality, the leading cause of death from physical trauma after head and spinal cord injury.

Repair of Adult Congenital Heart Lesions
Classification best describes lesions by the amount of pulmonary blood flow (increased or decreased pulmonary blood flow) or the presence of an obstruction to blood flow. Surgical procedures include arterial switch, Damus-Kaye-Stansel procedure, Fontan procedure, Ross procedure, shunt procedure, and venous switch or intra-atrial baffle.

Repair of Thoracic Aortic Aneurysm or Aortic Dissection
Aortic dissection is a rare, but potentially fatal, condition in which blood passes through the inner lining and between the layers of the aorta. The dissecting aorta usually does not burst, but has an abnormal second channel within it. In surgery, damaged sections of the aorta are removed and a synthetic graft is often used to reconstruct the damaged vessel.

Surgical Management of Endocarditis
The endocardium is the inner lining of the heart muscle, which also covers the heart valves. When the endocardium becomes damaged, bacteria from the blood stream can become lodged on the heart valves or heart lining. The resulting infection is known as endocarditis. Surgical cases of congestive heart failure, recurring emboli, infection that doesn't respond to treatment, poorly functioning heart valves, and endocarditis involving prosthetic (artificial) valves. The most common surgical treatment involves cutting away (debriding) damaged tissue and replacing the damaged valve.

Surgical Treatment of Atrial Fibrillation (Maze Procedure)
The maze procedure is a surgical treatment for atrial fibrillation. The surgeon can use small incisions, radio waves, freezing, or microwave or ultrasound energy to create scar tissue. The scar tissue, which does not conduct electrical activity, blocks the abnormal electrical signals causing the arrhythmia. The scar tissue directs electric signals through a controlled path, or maze, to the lower heart chambers (ventricles).

Mitral & Tricuspid Valve Repair
Mitral:
Mitral valve repair is an open heart procedure performed by cardiothoracic surgeons to treat narrowing or leakage of the mitral valve. The mitral valve is the "inflow valve" for the left side of the heart. Blood flows from the lungs, where it picks up oxygen, and into the left atrium. When it opens, the mitral valve allows blood to flow from the left atrium to the heart's main pumping chamber called the left ventricle. It then closes to keep blood from leaking back into the lungs when the ventricle contracts (squeezes) to push blood out to the body.
Tricuspid:
Tricuspid valve repair surgery involves repairing a damaged or malfunctioning tricuspid valve, which lies between the right atrium and right ventricle, to make the valve open and close properly.

Valve Replacement (Mechanical & Bioprosthetic)
There are two main types of prosthetic heart valves. Tissue (bioprosthetic) valves made primarily from animal tissue [i.e., bovine pericardium (the sac surrounding a cow's heart), a pig's aortic (porcine) valve or human valves from cadavers] and mechanical valves created from synthetic (man-made) materials.

Endoscopic Saphenous Vein Procurement for CABG
The saphenous vein, which runs inside the leg from the ankle to the groin, can be harvested for use in coronary artery bypass graft surgery as a detour around arterial blockages. Removal of this large vein will not adversely affect the leg, although swelling can occur. There are two ways to harvest the vein. Endoscopic harvesting is the most commonly used approach because it is minimally invasive compared with traditional open harvesting, which requires a long incision. Endoscopic harvesting reduces postoperative pain and infection and shortens the hospital stay.

Coronary Artery Bypass Grafting (CABG)
During a coronary artery bypass graft (CABG), blood flow is rerouted through a new artery or vein that is grafted around diseased sections of your coronary arteries to increase blood flow to the heart muscle tissue.