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MEDICINE IN
SAN ANTONIO

Vascular Surgery

Then & Now

By Gerardo Ortega, MD

I came to San Antonio in ease continue to be the same, the incidence until all problems were resolved.
August 1981 to start my practice of diabetes and obesity throughout the NOW, the patient is worked up at an
world and the United States have increased outpatient clinic to include an angiography
in vascular surgery with
considerably, thereby causing the incidence and intervention or angioplasty and stent
Peripheral Vascular Associates. of vascular disease to also increase. placement in most of the cases. Carotid ar-
The specialty of vascular surgery tery occlusive disease continues to be a par-
was interesting and rewarding THEN, the workup for vascular disease ticipant in a large number of strokes in our
because of the ability to consisted of asking the history and physical population.
immediately see the results of examination followed by a doppler study;
revascularization of a lower alternatively, a vascular study and then the THEN, a patient would be treated with
gold standard arteriography. After one of the gold standard carotid thromboen-
extremity, the removal of a
these processes was completed, then open darterectomy, and if the patient was symp-
blood clot from an artery or surgical procedures such as femoral- tomatic, could be admitted to the hospital
vein, the removal of a plaque popliteal bypass graft or carotid throm- and placed on Iv heparin for several days
that is producing a stroke, and boendarterectomy was the principle mode in preparation for surgery. We had NO
the removal or repair of a of therapy. dRG, HMO, PPO, or CAPITATION. Pa-
ruptured abdominal aortic NOW, the workup of a patient is similar tients would stay in the hospital as many
aneurysm. However, the to the way we did it then. However, more days as needed.
advanced noninvasive studies prevent or NOW, the gold standard continues to be
treatments NOW have changed
help avoid invasive diagnostic procedures. carotid thromboendarterectomy for the
a lot from what they were The development of minimally invasive treatment of symptomatic or high-grade
back THEN. procedures from around the year 2000 until carotid artery occlusive disease at the bifur-
now have increased the ability to perform cation of the carotid artery. For high risk
THEN, the causes of vascular disease these types of procedures and with more patients, either because of difficult anatomy
were a combination of risk factors to in- efficacy and less trauma to the patient, with or high cardiac risk, angioplasty and stent
clude smoking, hypertension, hyperlipi- smaller devices, including stents. placement of the carotid artery bifurcation
demia, hypercholesterolemia, obesity, can be utilized.
diabetes, lack of exercise and hereditary as THEN, the patient could be admitted to
well as poor diet. the hospital for diagnosis and management THEN, revascularization of the lower
NOW, while the causes of vascular dis- of vascular disease and stay in the hospital extremity was always an open surgical pro-

28 San Antonio Medicine • January 2020