1. Vascular Surgery
Michael Ricci, MD

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

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

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

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

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

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

8. Treatment of PVD
Interventions

9. Treatment of PVD
Bypass Surgery

10. 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

11. 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
UE Vein Harvest (List separately in addition to code for primary)
Harvest of two segments of vein for distal bypass
Harvest of three or more segments of vein for distal bypass
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)
Placement of a distal AV fistula during lower extremity bypass surgery as a means to increase patency of a disadvantaged graft
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

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

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

14. Aneurysm Treatment
“Open” Surgery

15. Aneurysm Treatment
Endovascular Surgery

16. Aneurysm Treatment
Endovascular Surgery

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

18. Acute Venous Thrombosis

19. Chronic Venous Disease
Venous Insufficiency
Pain, edema
Ulceration

20. Chronic Venous Disease
Varicose veins

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

22. Venous Treatment
Varicose Vein Stripping
Radiofrequency Ablation

23. Questions?