Vascular Surgery Procedures

Doctors with the Vascular Surgical Program at Overlake specialize in treatment of blood vessel disease (arteries and veins) and treat conditions that affect blood flow to many different parts of the body. These highly skilled surgeons perform a wide variety of procedures including both complex open surgery and minimally invasive endovascular techniques to offer the full range of vascular care.

Patients from throughout the Pacific Northwest choose the vascular surgery team at Overlake for their expertise and experience in treating everything from complex vascular diseases to more common vascular conditions.

Vascular disease treatments at Overlake

Overlake is home to one of the region’s only hybrid operating rooms, where certain complex vascular procedures take place. This innovative surgical space enables a team of doctors to work together to perform both endovascular and open surgical techniques.

Endovascular interventions can be performed using catheters (thin, flexible tubes) which are threaded through blood vessels. This allows for options for less invasive treatments which may shorten the length of surgery and time under anesthesia which can lead to less postoperative pain and reduce recovery time for you. Advanced vascular disease treatments available at Overlake include:

Endovascular aortic repair

To treat an aortic aneurysm or dissection, your surgeon places an endograft (fabric-covered mesh tube) into the damaged section of the aorta. Once in place, the endograft supports the weakened part of the aorta and creates a passage for blood to flow safely without further weakening the aorta.

Endovascular aortic repair procedures at Overlake include:

• Endovascular Aortic Repair (EVAR)/Thoracic endovascular aortic repair (TEVAR): Your surgeon threads the endograft through a catheter inserted into the femoral artery in the groin. 
• Fenestrated endovascular aortic repair (FEVAR): This treatment is for abdominal aortic aneurysms that are close to the renal (kidney) arteries. The endograft has holes (fenestrations) that allow blood to flow through arteries that branch off of the aorta.

Carotid endarterectomy

Carotid endarterectomy, and carotid angioplasty and stenting, are treatments for carotid artery disease. This condition occurs when plaque builds up in the carotid arteries in the neck that carry blood to the brain. These treatments can lower your risk of stroke.

Carotid endarterectomy involves opening up a partially blocked carotid artery to remove plaque and prevent a stroke or stroke recurrence. Most patients receive a cervical block to numb the neck. This approach using regional anesthesia is also beneficial if you need cardiothoracic surgery. By performing the carotid endarterectomy a day or so before the open-heart surgery, you spend less time under anesthesia in the operating room. Your risk of stroke during the surgery drops.

Angioplasty and stenting involves threading a catheter with a balloon device on the tip through a blood vessel. The balloon inflates to open a blocked artery. The surgeon then places a stent (mesh tube) in the artery to keep blood flowing well to the brain.

Revascularization procedures for limb salvage

The vascular surgeons at Overlake have an exceptionally high success rate saving limbs through complex revascularization procedures. For 9 in 10 patients, they’re able to restore adequate blood flow to the legs, helping to avoid unnecessary amputations. This brings much-needed hope to people at risk of limb loss due to peripheral artery disease, diabetes, or venous stasis ulcers.

Limb salvage procedures require exceptional skill. The vascular surgeons at Overlake specialize in:

• Endovascular angioplasty and stenting: Your surgeon punctures one of the arteries in your leg or your arm and then threads a wire through the blood vessels to the area of disease. A catheter with a balloon device on the tip can then be used to open the area of blockage. If needed, a stent can be placed so that the artery remains open. Since these procedures are done through small holes, most patients can go home the same day.
• Bypass surgery: Your surgeon creates a new pathway for blood to travel around an area where your natural artery is blocked. This is done by connecting a tube (bypass graft) to your artery above and below the blockage so that blood can flow past the area of disease. One of your own veins may be used to make the bypass graft, or your surgeon may use a synthetic tube.

Vena cava filter placement and removal

People who have deep vein thrombosis (DVT) who cannot be fully treated with blood thinners may need a vena cava filter. Your surgeon uses a catheter to place this device in the vena cava, which is the body’s largest vein. This device catches large clots, preventing them from traveling to the lungs where they could cause a life-threatening pulmonary embolism (PE).

In most cases, it is recommended to have the filter removed after it is no longer needed. While some older filters are difficult to remove since they can be more firmly attached to the vena cava, the filters which are placed at Overlake are designed to be easier to remove. The vascular surgeons at Overlake typically perform filter removal through a small incision in the neck. This can be done as an outpatient so you can go home after your procedure and will not need a hospital stay.

Median arcuate ligament release

Overlake is proud to offer care from physicians with the expertise to treat median arcuate ligament syndrome (MALS) using minimally invasive laparoscopic techniques. 
MALS is a rare condition in which a band of connective tissue in the chest compresses the celiac artery and nerves (the celiac plexus). This may cause symptoms which include chronic abdominal pain, nausea, vomiting and weight loss.

Surgical treatment at Overlake takes place laparoscopically through small incisions. For you, this minimally invasive approach means a shorter hospital stay and faster recovery time with less pain and lower risk of infection.

During the procedure, your surgeon separates the ligament and divides the nerves in the celiac plexus. This takes pressure off of the nerves and celiac artery, helping to restore blood flow and relieving pain and other GI symptoms. 

Renal artery angioplasty and stenting

The surgeons at Overlake perform renal artery angioplasty and stenting to treat narrowing in the arteries to the kidneys. If there is not enough blood flow to the kidneys, this may cause high blood pressure or organ damage. Most blockages are from buildup of cholesterol but other less common diseases like fibromuscular dysplasia may also be a cause. 

For the procedure, your surgeon places a catheter with a balloon on the tip through the renal artery. The balloon is inflated to open the artery, and if necessary, the surgeon may place a stent inside the artery to help keep it open and increase the blood flow to the kidney. 

Vascular access procedures at Overlake

Dialysis access 

For people with kidney failure who need dialysis to filter toxins from the blood, the vascular surgeons perform surgical procedures to create an arteriovenous (AV) fistula or place an AV graft. The procedure directly connects an artery and vein in the arm (fistula) or uses a tube to make the connection (graft). After your arm heals from surgery, blood flow will increase through the fistula or graft so that it can be used for dialysis. 
If dialysis is needed right away, your surgeon may place a catheter in a vein in the neck or upper chest which can be used immediately. This catheter is often temporary until a fistula or graft heals.

Fistulas are the preferred dialysis access method because there’s less risk of complications like infections and blood clots. Due to body structure or previous treatments, it can be challenging to create an AV fistula in certain people. The vascular surgeons at Overlake have an excellent track record of successfully creating AV fistulas. 

Placement of intravascular ports

The vascular surgeons also place ports for people who need long-term IV treatments like chemotherapy. Ports may also be helpful if you have a condition that requires frequent blood draws.

Your surgeon places this quarter-sized disc underneath the skin on the chest or arm. The port is connected to a catheter that the surgeon inserts into a large vein in your neck or under your collarbone. When you need an IV treatment or blood draw, a provider uses a needle to access the port. Having this reliable access allows your blood to be drawn without multiple needle sticks and prevents damage and irritation to the small veins in your arms.