A new addition to Northeast Georgia Medical Center’s (NGMC) Surgical Services is the endovascular suite, a specialized room which offers the imaging capabilities of a catheterization laboratory melded with an operating room (OR). The suite was added with the construction of the North Patient Tower and offers a new approach to the treatment of vascular disease.
"The endovascular suite is 100 percent dedicated to the treatment of peripheral vascular disease," says Michael Lebow, MD, a vascular surgeon with Premier Vascular Center, a division of Northeast Georgia Surgical Associates, and NGMC’s medical director of the endovascular suite. A relatively new approach to treating vascular disease, "the room enables vascular surgeons to perform advanced endovascular procedures that require both open surgical and image guided techniques simultaneously," Dr. Lebow adds. "Previously, such technology has been limited to university hospitals, so to have this suite at NGMC is a great advantage to the community."
Treating Vascular Disease
Peripheral artery disease (PAD) is a condition similar to coronary artery disease, except it affects other vessels in the body—such as those in the legs or kidneys—rather than those of the heart. Symptoms associated with vascular disease include poor circulation from narrowings in the arteries and other conditions that can lead to strokes and aneurysms.
According to the American Heart Association, more than 8 million Americans have PAD, and nearly 75 percent of these do not have any symptoms. In addition, most people with PAD have a higher risk of death from heart attack and stroke. While many people with PAD can be treated with lifestyle changes, medications or both, in some cases, angioplasty or surgery may be necessary.
If advanced treatment is needed, the endovascular suite can be used for vascular interventions that require surgical exposures and catheter-based interventions simultaneously. Procedures that can be performed in the suite include carotid, renal and peripherial artery angioplasty and stenting, the treatment of thoracic and abdominal aortic aneurysms and the treatment of aortic dissection. The endovascular suite may also be used for treatment of traumatic injuries such as thoracic tears—an injury that can result from the impact in a motor vehicle or motorcycle crash.
The Suite Benefits
In addition to now having a dedicated room for vascular procedures, surgeons at NGMC can perform more complex vascular cases than were possible before the room was created.
For example, a patient of Dr. Lebow’s recently had to undergo a repair for an aortic aneurysm located just millimeters from her renal arteries. "This case was more complex because the aneurysm, called a saccular aneurysm, had created a pouch, rather than the typical circumfrential swelling, and I was concerned that the proximity to the renal arteries could cause a failure of the graft to seal in place and not completely exclude the aneurysm," he says. "We were able to exclude the aneurysm with a stent graft with no leaking; however, being in the endo suite gave us quick access to the necessary supplies should we have needed to fix a leak."
In cases such as this example, the suite combines the best of both worlds: cutting-edge imaging technology and the sterile environment of an OR. Because these technologies are combined in one area, procedures can take place in the same room, at the same table, without having to move the patient. For patients, the new suite means they spend less time in surgery and the hospital and return home more quickly.
Additionally, in certain cases, the suite allows a less invasive treatment approach. For example, Dan Procter, Sr., MD, a vascular surgeon with Surgical Specialists of Georgia, recently had a patient with a severe blockage in her leg that required immediate treatment. Before the suite opened, the treatment would have been an open procedure in the OR, and the patient would have been in the hospital for up to a week; however, Dr. Procter was able to treat the patient without surgery in the endovascular suite using percutaneous angioplasty (a minimally invasive technique of mechanically widening a narrowed or obstructed blood vessel), and the patient went home the following day.
The staffing of the endovascular suite is perhaps the most important aspect of the room. Because vascular surgery combines multiple modalities of care, the staff is cross-trained to meet the demands that arise in the suite.
"We have assembled a ‘vascular dream team’," says Dr. Lebow. "We have team members from each discipline—cardiology, surgery and interventional radiology—and they have merged to provide an unprecedented level of care and services." The endovascular team has added a new service to NGMC, as well—a 24-hour, 7-day-a-week call team for emergent vascular cases. "We added the new call team because they have been specially trained to work in the suite on vascular cases," says Daniel Tarte, manager of the endovascular suite at NGMC. "For example, if a patient comes in with a ‘cold foot’—meaning they have lost circulation to their lower leg—the team will be called in, along with the physician, for an emergency procedure.
The addition of 24-hour call, along with the suite itself, means that complex cases that may have had to go to Atlanta-area hospitals previously can now be treated at NGMC. "Offering this cutting-edge technology is another way we have increased the level of care and are helping our patients stay closer to home," says Dr. Lebow.