Advances in vascular surgery now give patients several options for treating aneurysms in the aorta, the large artery that carries blood away from the heart. Mount Sinai has built a reputation as a national leader in treating this life-threatening condition with minimally invasive techniques.

Abdominal aneurysm repair
Today, many patients have the option of minimally invasive aneurysm repair, using a newer procedure called an endovascular stent graft. Using live x-ray pictures, the surgeon guides a fabric-and-metal tube to the site of the aneurysm. This tube is called an endovascular stent graft, or endograft. The graft strengthens the aorta by relining the damaged part. Excluding the weakened area from circulation decreases the risk of rupture.

This procedure relines the weakened part of the aorta with a man-made tube called a graft. The graft strengthens the damaged area and allows blood to pass freely without causing a bulge. Complex cases of thoracic aortic aneurysms may involve heart surgery at the time of aneurysm repair.

Today, many patients have the option of minimally invasive aneurysm repair, using a newer procedure called an endovascular stent graft. Using live x-ray pictures, the surgeon guides a fabric-and-metal tube to the site of the aneurysm. This tube is called an endovascular stent graft, or endograft, and it relines the aorta to provide added strength.

Endovascular stent grafts
Using live x-ray pictures, the surgeon works inside the body with thin plastic tubes called catheters. He or she uses the catheters to guide a fabric-and-metal tube to the site of the aneurysm. This tube is called an endovascular stent graft, or endograft, and it relines the weakened area of the aorta to provide added strength. This minimally invasive procedure for aneurysm repair typically requires a shorter hospital stay and recovery time.

Carotid disease treatment.
The Mount Sinai Division of Vascular Surgery offers different treatments for patients with atherosclerosis, or hardening of the arteries, in the carotid arteries. These therapies help prevent stroke, which can have a devastating and debilitating effect on a person’s quality of life.

The surgeon removes buildup of fatty substances called plaque from inside the carotid artery. The procedure widens the artery opening and improves the flow of blood.

Angioplasty and stenting
Like carotid endarterectomy, this procedure also widens the carotid artery to improve blood flow. The surgeon inserts a thin wire through the narrowed area or blockage and then passes a plastic tube called a catheter over the wire. The surgeon uses the catheter to guide a slender, metal-and-mesh tube called a stent to the area of blockage. The stent is compressed until the surgeon positions and releases it. Then, the stent expands to fit the artery, often with help from the surgeon, using a balloon. This device works like metal scaffolding to hold the artery open.

Peripheral arterial disease (PAD) therapies
The vascular team at Mount Sinai specializes in both conventional vascular surgery and newer, minimally invasive treatments of peripheral arterial disease (PAD). This broad expertise allows us to discuss all therapy options to achieve the best outcome for each patient.

Like carotid endarterectomy, this procedure also widens the carotid artery to improve blood flow. The surgeon inserts a thin wire through the narrowed area or blockage and then passes a plastic tube called a catheter over the wire. The surgeon uses the catheter to guide a slender, metal-and-mesh tube called a stent to the area of blockage. The stent is compressed until the surgeon positions and releases it. Then, the stent expands to fit the artery, often with help from the surgeon, using a balloon. This device works like metal scaffolding to hold the artery open.

Atherectomy
This surgical procedure removes fat, cholesterol, and other substances collectively known as plaque that build up in an artery’s inner lining. The surgeon guides a thin plastic tube called a catheter to the blocked or narrowed area. The catheter often has a rotating shaver at the tip that cuts away the plaque buildup.

The surgeon literally bypasses the blocked area of artery by creating a detour. He or she attaches a tube, either a transplanted vein or a man-made substitute, above and below the blockage. This process creates a new path of blood flow.

Cryotherapy 
This treatment uses extreme cold to remove fatty deposits, or plaque, from inside artery walls. The surgeon guides a thin plastic tube called a catheter to the narrowed or blocked area. He or she then inflates the balloon, which pushes back the plaque and widens the artery opening.

At this point, the surgeon uses a thin, wand-like device called a cryoprobe to administer a freezing substance, often argon gas. The cold destroys the plaque without harming the artery.

Also known as photoangioplasty, this procedure uses a laser to remove fat, cholesterol and other substances collectively known as plaque that build up in an artery’s inner lining. The surgeon guides a thin plastic tube called a catheter to the blocked or narrowed area. Then, he or she uses a tiny laser to dissolve the plaque deposit and widen the artery opening.

Thrombolysis
This procedure uses a special medication to dissolve clots that form in the arteries, which block blood flow. The surgeon guides a thin, plastic tube, called a catheter, to the blocked area. He or she then delivers medication to melt away the clot and to allow blood to flow freely.

Our surgeons specialize in providing vascular access for dialysis patients. Ideally, such access should be prepared weeks or months in advance. We work with nephrologists early in the process to identify the best location and time for placement, even before dialysis is needed, in some cases, to prevent future complications.

Arteriovenous (AV) fistula
This procedure offers the best long-term access for dialysis. It provides adequate blood flow, lasts a long time, and produces fewer complications. To create an AV fistula, the surgeon attaches a vein directly to an artery, usually in the forearm. The increased blood flow makes the vein grow larger and stronger, making it an effective access point for repeat dialysis treatments.

In creating an AV graft, the surgeon attaches a man-made tube to an artery and a vein under the skin in the arm. This tube acts as an artificial vein that can be used repeatedly to provide access during dialysis.

Venous catheter
Some dialysis patients may not have time to create a permanent vascular access before starting dialysis. To provide temporary access, until a permanent one can be placed, the surgeon inserts a thin, plastic tube, called a catheter, into a vein in the neck. This tube has two sections, which allow blood to flow in two directions.

Patients with any type of vascular access, be it AV fistula, AV graft, or venous catheter, may have complications. Mount Sinai surgeons have extensive expertise in treating these conditions to provide effective dialysis access. Common complications include blood clots in the graft or areas of blockages that require stenting.

Venous disease therapies
Mount Sinai vascular surgeons are skilled in performing therapies that address the full range of venous disease, from superficial spider veins to chronic venous stasis, deep vein thrombosis (DVT), and lymphedema.

A full battery of diagnostic tests at the vascular laboratory allows surgeons to distinguish between venous disease and limb-threatening arterial disease. We use several types of ultrasound examinations to study different parts of the circulatory system, both venous and arterial. The vascular laboratory is part of the Cardiovascular Center and Institute for Cardiovascular Health at Mount Sinai.

Angioplasty 
The surgeon inserts a thin, plastic tube called a catheter into the vein. He or she then inflates a balloon at the tip of the catheter. The balloon opens inside the narrowed area and widens the opening.

This outpatient treatment involves inserting a tiny laser ray into the vein. The laser shuts down the vein and relieves pressure. This therapy is especially effective for treating that varicose veins insufficient blood flow cause.

Sclerotherapy
This outpatient treatment improves the appearance of spider veins. The surgeon injects affected veins with a sclerosing solution, which makes them collapse and fade from view. Therapy typically involves several short sessions of about 15 to 45 minutes each in the physician’s office.

This procedure uses a special medication to dissolve clots that form in the veins, which block blood flow. The surgeon guides a thin plastic tube called a catheter to the blocked area. He or she then delivers medication to melt away the clot and to allow blood to flow freely.

Surgical reconstruction
For severe cases of chronic venous disease, surgeons can repair the non-functioning valves to improve circulation and prevent venous ulcers.