Vascular Surgery Michael Ricci, MD

What is Vascular Surgery? Diagnosis & treatment of diseases of the circulatory system

What do we treat? Atherosclerosis Aneurysms Venous Disease Hemorrhage Gangrene Stroke Aneurysms Venous Disease Acute Chronic Hemorrhage

How do we treat? Surgery Percutaneous Interventional Procedures Conventional “open” procedures Endovascular procedures Percutaneous Interventional Procedures X-ray Ultrasound Medical

Atherosclerosis Traditional risk factors Smoking, Diabetes, Hypertension, High Cholesterol, Age, Male Produces symptoms by obstruction or embolus.

Peripheral Vascular Disease Claudication Pain with walking Limb Threatening Tissue loss Gangrene Ulceration

Treatment of PVD Medical Surgical Percutaneous Interventions Stop smoking, exercise, Pletal Surgical Bypass Percutaneous Interventions

Treatment of PVD Interventions

Treatment of PVD Bypass Surgery

Bypass Surgery Where…to where? Conduit? Special conditions? 35556 Bypass graft, with vein; femoral-popliteal 35583 In-situ vein bypass; femoral-popliteal 35656 Bypass graft, with other than vein; femoral-popliteal

Bypass Surgery 35556 Bypass graft, with vein; femoral-popliteal 35583 In-situ vein bypass; femoral-popliteal 35656 Bypass graft, with other than vein; femoral-popliteal 35500 UE Vein Harvest (List separately in addition to code for primary) 35682 Harvest of two segments of vein for distal bypass 35683 Harvest of three or more segments of vein for distal bypass 35685 Placement of a vein patch or cuff at the distal anastomosis of a synthetic bypass graft. This code can be used only with 3 main bypass graft codes (35656, 35666, and 35671) 35686 Placement of a distal AV fistula during lower extremity bypass surgery as a means to increase patency of a disadvantaged graft 35681 Composite 35700 Reoperation, femoral-popliteal or femoral (popliteal)-anterior tibial, posterior tibial, peroneal artery or other distal vessels, more than one month after original operation

Carotid Atherosclerosis Symptoms from emboli Standard of Care is Carotid Endarterectomy Evolving treatment to include carotid stent placement

Aneurysms 5% of population have AAA Increases with age 4:1 male:female ratio 15,000 deaths / year in US from ruptured AAA

Aneurysm Treatment “Open” Surgery

Aneurysm Treatment Endovascular Surgery

Aneurysm Treatment Endovascular Surgery

Venous Disease Acute Venous Thrombosis Venous Insufficiency Deep Venous Thrombosis (DVT) Superficial Thrombosis (Phlebitis) Venous Insufficiency Varicose Veins

Acute Venous Thrombosis

Chronic Venous Disease Venous Insufficiency Pain, edema Ulceration

Chronic Venous Disease Varicose veins

Venous Ulcer Treatment Compression Surgical Debridement Skin grafts Apligraft Sclerotherapy Venous Surgery

Venous Treatment Varicose Vein Stripping Radiofrequency Ablation

Questions?