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Managing vascular disease one patient at a time

by James H. Thomas, MD, RVT, FACS, Former Chair of Surgery

At The University of Kansas Hospital, we are constantly exploring the advantages and disadvantages of current vascular disease treatments. We know there is no panacea for this complicated disease, but we strive to discover the best options for each patient.

Managing and rehabilitating patients with vascular disease has been a challenging endeavor since abdominal aortic aneurysms were first described back in 2000 BC. While we understand vascular disease far better today and have access to state-of-the-art technological advancements, we still have much to learn about its causes, treatments and complications.

Vascular disease can manifest itself in high-risk conditions such as aortic aneurysms, critical limb ischemia of the lower extremities and stroke. Abdominal aneurysms occur in 12% of men between 75 and 84 years of age, with the mortality rate of rupture in excess of 90%. For those who develop critical limb ischemia, the risk of amputation approaches 30% annually and the mortality rate is in excess of 15% per year. Stroke is widely considered the third leading cause of death in the United States.

When faced with such dire prognoses, vascular patients and physicians may be anxious to try the most innovative, state-of-the-art treatment available to them. At The University of Kansas Hospital, we choose to approach vascular therapies in a progressive, yet cautious, manner. For example, the relatively recent addition of endovascular techniques to the classic operations for vascular diseases has extended the ability of clinicians to provide care for patients. However, we believe endovascular therapy should not replace, but rather serve as an adjunct to traditional vascular disease management.

As with any disease, it is absolutely vital to properly screen vascular patients and match them with appropriate interventions. Sometimes invasive treatments are warranted. Sometimes the very best approach a physician can take is surveillance. By vigilantly monitoring our patients, we can determine the most effective plan of action and improve patient outcomes. We must be careful to consider not only the short-term results for our patients, but also the long-term results of invasive procedures.

During my tenure as chair of the Department of Surgery, it has become abundantly clear that the input and participation of physicians from several specialties is critical to the well-being of our vascular patients. Without a doubt, an interdisciplinary team approach including physicians from vascular surgery, interventional cardiology, radiology and neurology consistently yields excellent results. The co-authors of each article in this publication represent those major specialties at The University of Kansas Hospital, and I’m sure you will recognize their expertise. Interdisciplinary collaboration has made each of us a better physician and has ensured the success of our vascular program.

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