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Vascular Surgeons Adapt to Changes in Field

By Bruce Gewertz, MD
Chair, Department of Surgery

The vascular surgical services at Cedars-Sinai have evolved considerably over the past decade. In specific, the nature of the clinical work has been significantly affected by the sea change in vascular interventions, moving from predominantly open surgery to minimally invasive endovascular approaches.

In addition to lowering the morbidity from vascular procedures, this shift has markedly reduced the length of stay of vascular patients. While vascular surgeons from our department continue to collaborate closely with Interventional Radiology and Cardiology, it is noteworthy that the education of vascular surgeons has been retooled and the modern vascular surgeon is highly capable of utilizing both open and endovascular techniques.

The most obvious shift has been seen in the treatment of abdominal aortic aneurysms. At the current time, nearly 90 percent of aneurysms are successfully treated by endovascular means, while 10 percent with unfavorable anatomy continue to require open procedures. Even eight years ago, the mix was much closer to 50-50. The advent of new devices, delivery systems and exciting techniques such as fenestrated prosthetic grafts may virtually eliminate open aortic surgery in the coming years.

With the recruitment of Ali Khoynezhad, MD, PhD, and the enthusiastic participation of Raj Rao, MD, Suhail Dohad, MD, and Aamir Shah, MD, Cedars-Sinai now has one of the largest thoracic aortic programs in the country. The number of thoracic endografts has increased dramatically in the past few years with annual volumes of 44 cases per year. Coupled with our historical strengths in abdominal and arch aneurysms, we are now the market leader in expert care of the full range of aortic pathologies from the aortic valve to the bifurcation.

In cerebrovascular disease, Cedars-Sinai continues to perform more carotid procedures than any University HealthSystem Consortium (UHC) hospital in California. We offer the options of both open endarterectomy and carotid stenting. The latter is used for particularly high-risk patients or those with recurrent disease. Across the country, the balance between these approaches has stabilized at 70-30; our local experience parallels this. Our cerebrovascular services are strongly supported by our colleagues in stroke neurology (Patrick Lyden, MD, and crew) and by Michael Alexander, MD, and Marcel Maya, MD, in neuroendovascular services. The neurologic morbidity from these procedures at our hospital is among the lowest in the country.

In sum, vascular surgery at Cedars-Sinai is remarkably healthy. As the treatment of vascular disease has changed, our attending and faculty surgeons have adapted and now offer the full range of endovascular treatments. Cedars-Sinai vascular surgeons continue to publish and present at virtually every major regional and national meeting in the field. A number of our residents have gone on to prestigious vascular fellowships and academic careers. Given these trends, the next few years should be even more exciting.