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Minimally invasive cardiovascular surgery

Minimally invasive cardiovascular surgery (MICS) is a rather broad term used to describe a cardiovascular procedure that, in theory, minimizes the surgical trauma to an individual patient. At the Cardiovascular and Thoracic Surgeons of North Houston we focus on four broad areas of MICS which include: endovascular treatment of aortic aneurysms, minimally invasive valvular heart surgery, endovascular treatment of peripheral arterial disease and minimally invasive treatment of varicose veins. This article will briefly describe the aforementioned surgical procedures and the tangible patient benefits associated with each procedure.

Endovascular approaches to aortic aneurysms may be used to treat aneurysms in both the chest and the abdomen. The procedures themselves are commonly referred to as a TVAR or EVAR procedures when referring to the thoracic or abdominal area respectively. In both procedures a synthetic aortic graft is deployed from inside the aorta and covers up or excludes the native aortic aneurysm. In short the patient’s native aorta is excluded from the circulatory system and blood is routed through the endovascular graft. By doing so the tensile stressors on the native aortic wall in the area of the aneurysm are reduced and the risk of aneurysm rupture is removed. The procedure is performed through the patient’s femoral artery in the groin and avoids the need for open surgery through the chest or abdomen. Patients who undergo TVAR or EVAR procedures are typically hospitalized for one or two days as opposed to the week long hospitalization associated with open surgical repair. In addition with TVAR/EVAR the need for blood transfusions is reduced and time to full recovery after surgery is significantly shorter than with open surgery.

Minimally invasive approaches can be used when performing valvular heart surgery. Typically they are used when operating on the aortic and mitral valves. While there are several surgical approaches that your surgeon may use they usually involve either a small incision in the sternum or one in the right chest. Using specialized instruments the valves can be repaired or replaced as necessary. Potential patient benefits from these minimally invasive approaches include a more rapid return to work, shorter hospitalization and a decreased need for blood transfusion.

Peripheral arterial disease (PAD) affects millions of Americans annually. It usually presents as pain in the lower extremity associated with walking. In addition patients may notice that they have open sores on the feet or toes that heal slowly. Other signs may include hair loss on the legs and feet. The diagnosis of PAD is typically through an arterial Doppler test of the lower extremities. At the Cardiovascular and Thoracic Surgeons of North Houston we perform both open surgical bypass and peripheral interventions to treat PAD. Peripheral intervention treatment involves placing catheters in the femoral artery in the groin and then cleaning out the affected arteries in the lower extremities using balloons, stents or athrectomy devices. In short this avoids the need for open surgical bypass to improve the blood flow to the affected area and is typically done as an outpatient procedure. As vascular surgeons if a patient requires a combined or hybrid approach to their care we are able to provide both an open and minimally invasive approach to their PAD.

In our practice we also focus on minimally invasive treatment of varicose veins. In the past treating varicose veins often required vein stripping which is a process in the varicose veins in the lower legs are pulled out of the leg using a crochet hook. We are now able to treat varicose veins in an outpatient setting using a small catheter that effectively closes the patient’s greater saphenous vein in the leg. By closing the greater saphenous vein in the leg the patient’s symptoms of swelling, itching, burning and oftentimes restless leg syndrome are treated. The success rate of the procedure is 95-98% and is done as an office based procedure.