CLINICAL PROBLEMS

Peripheral Vascular Disease is a broad term which encompasses many diseases of the circulatory system. Vascular Surgery is a specialty area that is dedicated to the treatment of patients with diseases affecting the arteries and veins of the circulatory system.

There are five surgeons at UVM who devote their practices to diseases of the vascular system. All are fully certified by the American Board of Surgery with special qualifications in Vascular Surgery. They are expert in the diagnosis as well as the therapies for peripheral vascular disease. Therapies include minimally invasive or percutaneous techniques (stenting, angioplasty) as well as traditional surgical therapies (bypass, endarterectomy or removal of plaque, and aneurysm repair). They also treat chronic lower extremity ulcers due to diseases of the veins (thrombosis, phlebitis) and varicose veins.

Common Circulatory Abnormalities Seen In the Vascular Surgical Clinics:

• Cerebrovascular (carotid artery) disease - Blockages in the neck arteries that can cause strokes.
  
• Lower extremity occlusive disease (claudication): Blockages in the leg arteries that can lead to serious debilitation, usually seen as pain or aching in the legs with walking.
  
• Aneurysms of the aorta and its branches - Balloon-like expansion of arteries (like a bubble on a tire), which can be life threatening.
  
• Chronic Venous Insufficiency and Varicose Veins - Chronic disorders of the veins of the leg that lead to dilatation of the veins of the leg.  While sometimes these are a cosmetic problem, they can also be painful and sometimes lead to ulcer formation.
  
• Diseases of the thoracic outlet  (arterial, venous, and/or nerve compression) -  These can lead to painful disabilities in the upper extremities.
  
• Other blockages in the arteries of the body which can lead to:
  
  Mesenteric Occlusive disease - abdominal pain and weight loss from blocked intestinal arteries
  
  Renal Artery Hypertension - high blood pressure due to blocked kidney arteries
  
  Dialysis Access - creation of fistulas or shunts for patients on kidney dialysis

For useful information on these and other vascular problems, please see our Related Site.

DIAGNOSING PROBLEMS

Diagnosing the above abnormalities of the peripheral vessels can often be done utilizing non-invasive studies and in particular ultrasound. The Division of Vascular Surgery also maintains a non-invasive vascular laboratory in their clinic. This lab is complete with several ultrasounds and other instruments necessary to evaluate the peripheral circulation in a non-invasive fashion. 

Several of our surgeons are Registered Vascular Technologists. Our division not only utilizes these non-invasive means but is a regional and national leader in advocating and regulating the use of these types of diagnostic methods.

TREATING THE PROBLEMS

Treating patients with Peripheral Vascular Disease often involves many different types of technologies. Some of the therapies offered by the section of vascular surgery are as follows:

• Aneurysm Repair – Achieved by the traditional open repair as well as the new method of endovascular repair (aortic stent graft).
  
• Lower Extremity Revascularization - Improving circulation using both angioplasty and stenting as well as surgical bypass
  
• Carotid Endarterectomy - To prevent stroke by clearing blocked arteries.
  
• Varicose Vein Therapy - Including sclerotherapy, the new “closure” radiofrequency ablation method as well as ligation and stripping.
  
• Dialysis access - Creation of fistulas for the purposes of dialysis.

TEACHING

The Division of Vascular surgery is dedicated to teaching physicians in training and students in understanding vascular diseases and their prevention and treatment. Residents and students rotate on the service to better understand patients affected by peripheral vascular disease.

ONGOING RESEARCH

The division of vascular surgery is one of the founding members of the Vascular Study Group of Northern New England. The mission statement of this group is to improve the quality of care of the vascular patient. This research progra, has been successful in affecting change at the clinical level improving the care of patients at our hospital. More traditional research endeavors include:

• Work with both clinical and administrative data sets in identifying quality factors in vascular patients
  
• Use of technology (telemedicine) in improving clinical care in the regional area
  
• Participation in clinical programs examining the efficacy of new instrumentation designed for minimally invasive treatments of arterial and venous disease
  
• Investigating the effects of chronic venous insufficiency and the development of venous ulcers

The section is involved in a peer review process by which each surgeon’s therapeutic results are evaluated on a regular basis to ensure safety and quality in their individual practice. They are also required to undergo re-credentialing on a regular basis as deemed appropriate by the American College of Surgeons. The recredentialing process involves  Continuing Medical Education credits as well as periodic written testing. All surgeons are board eligible or certified in the practice of vascular surgery.

Andrew C. Stanley, MD
Associate Professor and Chief
Division of Vascular Surgery
University of Vermont College of Medicine

TO SCHEDULE AN APPOINTMENT CONTACT 802-847-4548

Office hours are Monday-Friday, 8:00a.m. to 5:00p.m.

The office is located at:

Fletcher Allen Health Care
Main Pavillion 5
111 Colchester Avenue
Burlington, VT   05401