TCV : VASCULAR DISEASE CENTER - TCV SURGERY

• As the population has "aged", the number of patients with vascular disease has increased.
• The introduction of non-invasive diagnostic tests has helped identify many patients with asymptomatic, but possibly life-threatening, situations. For example, most asymptomatic abdominal aortic aneurysms are discovered on CAT scans or sonograms conducted for other reasons.
• Large studies, such as the ACAS (Asymptomatic Carotid Artery Study), have documented the benefit of prophylactic interventions in patients with various vascular disorders.
• Patients have become increasingly aware - through media coverage - of the range of therapeutic options.

Historically, vascular disease was managed by vascular surgeons. However, in light of the above, the study and management of vascular disease has become multidisciplinary, no longer adequately addressed by one specialty. Today, in order to handle the varied needs of patients with vascular disorders effectively and efficiently, collaboration among surgeons, interventional radiologists, wound care experts, and other specialists and subspecialists is necessary.

Winthrop-University Hospital, a major tertiary care and teaching institution, has developed a Vascular Disease Center with all the components required of a successful, multidisciplinary vascular disease program. The goal is to provide vascular disorder patients with comprehensive care rendered by a cohesive team of exceptionally proficient and experienced professionals, who coordinate the utilization of their distinctive skills and always bear in mind the critical role of the patient's primary physician.

In the Vascular Disease Center at Winthrop, the management of patients has been "streamlined" and coordinated so that duplication of procedures and tests is reduced, a "patient-friendly" environment is maintained, and patient outcome and satisfaction are increased.

Division of Vascular Surgery

Vascular Surgery is the cornerstone in the management of vascular disease. Surgeons in the Division of Vascular Surgery at Winthrop perform about 500 major vascular reconstructive procedures per year. These include peripheral reconstructive procedures to salvage legs threatened with amputation because of severe obstructive vascular disease, resection of abdominal aortic aneurysms and operations to relieve narrowing of carotid arteries.

Working closely with the renal experts in Winthrop's Dialysis Center, the vascular surgeons have also developed expertise in placing and managing devices for vascular access for hemodialysis.

In addition, conferences for Winthrop surgeons, as well as surgeons from other hospitals, are held regularly to provide updates on new techniques and concepts in vascular disease.

Non-Invasive Vascular Laboratory

The Non-Invasive Vascular Laboratory at Winthrop aids in the diagnosis, management and long-term follow-up of patients with vascular disease without repeating invasive tests.

The Vascular Lab was the first such hospital-based facility on Long Island to be fully accredited by the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL). Accreditation attests to the quality of work performed, signifying proficiency in cerebrovascular, as well as peripheral arterial and venous, examinations.

In this facility for inpatients and outpatients, about 4,000 examinations are performed annually. Recognized as among the most skilled and accurate in the region, the expert and experienced staff includes Registered Vascular Technologists and Cardiovascular Nurses with advanced training.

Routine studies include:

• Carotid duplex scanning
• Venous duplex screening
• Various arterial testing modalities

In addition, transcranial doppler studies are performed, as are studies of renal arteries.

Vascular and Interventional Radiology

Vascular and Interventional Radiology have become integral to the management of patients with vascular disorders.

Vascular Radiology clearly defines the detailed anatomic extent of vascular disease. With the specialized studies performed by vascular radiologists, more accurate therapeutic decisions can be made. These studies can be conducted either invasively or through use of magnetic resonance angiography.

Interventional Radiology utilizes catheter intervention to correct vascular disorders. This includes balloon angioplasty, the use of stents, and the embolization of bleeding vessels and abnormal communication between arteries and veins. Winthrop is one of the few hospitals in the region with expertise in the use of stents to treat bleeding esophageal varices.

Endovascular Surgery utilizes digital X-ray technology with video and monitoring equipment to access and repair abdominal aortic aneurysms. Through a single point of entry into the vascular system, the aneurysm is repaired within the blood vessel. The procedure is less invasive than conventional surgery, discomfort is reduced and the recovery period is shorter.

Wound Treatment Center

Winthrop's Wound Treatment Center specializes in the management of foot problems associated with peripheral vascular disease and diabetes mellitus. Frequently, these problems are difficult to manage and require a multidisciplinary approach. Winthrop's highly trained, skilled and dedicated nurses, surgeons, podiatrists and internists focus on fulfilling the special needs of these patients.

Other patients treated at the Wound Treatment Center include those with lower leg ulcers caused by venous insufficiency. What's more, the Center helps patients select the appliance most appropriate to their conditions, including compression stockings and other devices for reducing leg edema.

Dialysis Center

The successful maintenance of dialysis hemoaccess is often difficult and challenging. The Division of Nephrology and Hypertension collaborates with the Division of Vascular Surgery to make these procedures as free of complications as possible. Nephrologists, renal nurses and surgeons meet regularly to ensure the delivery of the highest level of quality care.

The Dialysis Center at Winthrop is an advanced, nationally known and extremely active unit with many patients traveling far to obtain dialysis treatments at this facility. Three shifts of patients are treated in 35 outpatient dialysis stations; seven stations are utilized in the Hospital's inpatient dialysis unit.

Diabetes Education Center

People with diabetes are at significant risk for lower extremity amputations. Amputation is 15 times more common among diabetes patients than among those without the condition. However, up to 50 percent of amputations can be prevented, if patients, whose feet are at risk, are aggressively identified and treated. Treatment of vascular disorders is significantly enhanced at Winthrop through the incorporation of patient and family education provided by the Hospital's Diabetes Education Center (DEC) into the broad services of the Institute for Vascular Disease.

For diabetes patients, appropriate self-management is vital. They must make daily decisions concerning blood glucose control - including what to eat, how to read a food label, when to test for blood sugar levels. Winthrop's nationally renowned DEC has long been at the forefront of diabetes education, helping patients and their families cope with these and other issues.

The DEC was the first in New York State to be accredited by the American Diabetes Association for meeting the National Standards for Diabetes Education Programs. Since its inception, in 1979, hundreds of adults and children have participated and benefited from the DEC programs.

Division of Rheumatology, Allergy & Immunology
(Connective Tissue Disorders)

Vasculitis, collagen vascular disease and arteritis are increasingly being recognized as causes of vascular insufficiency, especially in younger patients. Newly recognized autoimmune disorders, such as anticardiolipin syndrome, are major causes of vascular occlusive disease. Winthrop rheumatologists are knowledgeable about these disorders and able to recommend appropriate diagnostic tests and therapeutic approaches.

Division of Neurology
(Cerebrovascular Disease & Stroke)

Great progress has been made in understanding the natural history of carotid artery disease. Several studies performed under the supervision of the National Institutes of Health have demonstrated that, under certain circumstances, procedures conducted to remove carotid blockages help reduce the risk of stroke.

The Division of Vascular Surgery and the Division of Neurology have formed a unique "partnership" to evaluate patients in order to determine who would benefit most from carotid endarterectomy. A Winthrop neurologist with expertise in vascular neurology and stroke prevention makes the Hospital one of the few institutions that can provide patients with this type of expertise.

Additional Patient-Support Activities

Community Education - Winthrop sponsors a wide range of free health information/education programs for the community. Programs are targeted for the general population, the elderly and families with young children. Issues addressed include diet; diabetes, including foot care; management of venous disease; and stroke prevention.

Health Screenings - The Hospital conducts health screenings for the community on an ongoing basis. These include vascular screenings to identify patients at risk for vascular problems.

For more information about The Vascular Disease Center at Winthrop-University Hospital, call 516/663-2754.