Page 29 - Layout 1

MEDICINE IN
SAN ANTONIO

cedure lasting several hours with pro- of patients and the community at large was of smoking and an exercise program, we
longed hospitalization of several days, minimal. Open surgical procedures were are able to medically manage and hopefully
with slow recovery. the standard of care. prevent vascular disease.
NOW, most of the treatments for revas- NOW, the patient can be seen at the of-
cularization of the lower extremities can be fice in the morning, followed by noninva- THEN, the specialty that offered all
done at an outpatient cath lab including an- sive studies, angiograms, and angioplasty or available modalities for diagnosis and treat-
gioplasty, atherectomy and stent if indicated. stent placement, and return home all in the ment, including follow up of a patient with
same day. vascular disease, was the vascular surgeon.
THEN, the treatment of an abdominal NOW, after all the improvements of
aortic aneurysm was only open repair, THEN, wound care consisted mainly of minimally invasive procedures like angio-
whether as elective or as an emergency, in pa- debridement and wet-to-dry dressings as plasty, atherectomy and stents, other spe-
tients presenting with a ruptured abdominal well as betadine sponge dressings. The pa- cialties offer some of the modalities to treat
aortic aneurysm. This was associated with tient would take a long time to recover and vascular disease. However, vascular sur-
very high morbidity and mortality. required prolonged hospitalizations. geons continue to offer prevention, and all
NOW, most of the elective patients are NOW, we have wound care centers that modalities of treatment for vascular disease
treated with a stent graft. All the workup is provide delicate and continuous care of and long term follow up, remembering that
done as an outpatient. Following that, the these patients. The wide variety of wound vascular disease lasts a lifetime.
patient presents to the hospital the morning care products have resulted in excellent
of surgery and most of the time, they are healing of these wounds. besides special- We have made a lot of progress in the
discharged the following day. The treatment ists in wound care, we have realized patients treatment of vascular disease over the last
of ruptured abdominal aortic aneurysm now who have podiatry care have less chance of 40 years; however, we continue to have
can also be done with endovascular proce- leg amputation. Education has improved cerebrovascular accidents and amputations
dures, like a stent graft, if indicated. and continues to elevate the level of health despite having many more modalities for
in the community. therapy and intervention to include smaller
THEN, the treatment for acute and NOW, we have a vascular disease aware- balloons, stents, and delivery systems. The
chronic renal insufficiency was dialysis; ness month, cardiovascular disease aware- problem is that we continue to treat the
however, catheters were not available and ness month, and stroke awareness month; complications of vascular disease and not
“a Scribner shunt” was necessary to be im- all trying to educate the community at-large the origin of vascular disease. An impor-
planted for the treatment of acute he- of symptoms related to vascular disease in tant factor in the prevention of vascular dis-
modialysis. Artificial grafts, like bovine a way to prevent complications. ease and its complications is the education
grafts and PTFE grafts, were primarily used of the community; this is the best way to
at that time for chronic hemodialysis. very THEN, smoking was very popular. improve the health of our community. I
few primary fistulas were created. doctors and patients were able to smoke believe that in the future, the answer for this
NOW, we have numerous catheters that anywhere, including in the hospital. problem is in the prevention of vascular
can be placed for acute temporary he- NOW, we have designated areas and the disease. Meanwhile, we hope to conquer
modialysis as well as permanent hemodial- incidence of smoking continues to decrease. re-stenosis and hyperplastic tissue forma-
ysis while waiting for maturation of a fistula tion that develop in all areas of invasive
or graft. For many years now we have at- THEN, the medical therapy for vascular treatment, minimally invasive or not. We
tempted to create a primary fistula when disease consisted of a wide variety of med- hope to develop medication that will en-
possible, for all patients, because we have ications to include Persantine, aspirin and courage the regression of plaque and pre-
realized the longevity of primary fistulas Trental; additionally we prescribed exercise vent the complications that we have now.
compared to grafts and they have a low programs, lifestyle modification and cessa-
grade of infection. tion of smoking. Gerardo Ortega, MD is a vascular surgeon at
NOW, with the advent of new medica- Peripheral Vascular Associates in San Antonio
THEN, amputation prevention was, for tions and new anticoagulation therapy to- and is a Board Member and Past President of the
the most part, revascularization. Education gether with lifestyle modification, cessation Bexar County Medical Society.

visit us at www.bcms.org 29