When Traditional, Open Vascular Surgery is the Best Treatment

Endovascular procedures have been a tremendous innovation, allowing surgeons to repair many conditions without large incisions. Instead, the surgeons use the body’s blood vessels as a superhighway to reach problem areas with a catheter. However, that approach is not appropriate for everyone, and in some cases open surgery still offers the most effective treatment.

 

Patients should evaluate the implications of all their surgical options by asking questions about alternatives related to their diagnosis. And, when open surgery is the best answer, it’s important to select a hospital with a comprehensive, multidisciplinary program that takes a “team” approach to patient care. It should also have highly experienced surgeons who are well-versed in dealing with every scenario.

“When seeking care to undergo open repair of a condition such as an aortic aneurysm, for example, it is critically important to select a surgeon and a hospital who handle a high volume of these cases,” says W. Anthony Lee, M.D., chief of vascular surgery at Boca Raton Regional Hospital, part of Baptist Health. “With the increase in minimally invasive procedures, these types of open surgeries are now rarely performed in many hospitals, and many surgeons lack the experience and skill set to perform such complex repairs.”

(Watch video: Hear from W. Anthony Lee, M.D., chief of vascular surgery at Boca Raton Regional Hospital, and anesthesiologist Leslie Renfro, M.D.. Video by Dylan Kyle.)

That’s not the case at Boca Regional. “We offer both, and we do both very well,” Dr. Lee says. “When a patient comes to us, we can truly tailor the therapy to the interests of the patient, not because we’re limited by what we can do.”

The team approach has been carefully cultivated at Boca Raton Regional Hospital to ensure success with aortic surgery, says anesthesiologist Leslie Renfro, M.D.

“While our team does include the surgeon, Dr. Lee, and myself, the anesthesiologist, it also involves many other people. We have the same nurses in the operating room, we have the same surgical techs in the operating room, we use the same nurses in the ICU,” Dr. Renfro explains. “Consistency is of utmost importance. Things can change quickly, and we know how to help one another.”

The team uses an established  “clinical pathway” called Enhanced Recovery After Surgery, or ERAS, which includes extensive preoperative preparation and guidance for the patient, less use of opioids for pain management, avoidance of blood transfusions when possible, and a postoperative program to get patients back on their feet as soon as possible. Dr. Renfro says it has considerably reduced the postoperative length of stay in the hospital.

In addition to general anesthesia, Dr. Renfro places a very small catheter in the patient’s back prior to surgery in order to continuously pump local anesthetic medication directly to the surgery site before, during and after the surgery. This innovative pain management makes the surgery less traumatic on the body by significantly blunting the pain associated with such incisions. After surgery, patients require far less pain medication and often go home without the need for opioids, she says.

“Without exposure to opioids, the patients are more alert, they breathe better, and they don’t have as much ICU delirium. They’re able to get up and move around much faster, which overall improves the recovery,” Dr. Renfro says.

It’s all part of a thoughtful, well-designed program with clear strategic objectives, Dr. Renfro says.

“By using the ERAS protocol for the open aortic surgeries, the patients gain a lot by coming to Boca Regional. They have a team dedicated to their care. They’re leaving the hospital three to seven days sooner than they would have before, they have overall better pain management, less opioid usage, decreased blood transfusion and overall, a very good experience.”