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Treating clogged blood vessels from within

Michal Nawalany, M.D.

Medical advances at Marshfield Clinic: Treating clogged blood vessels from within.

Historically, if you needed surgery on certain blood vessels, your options were limited. Vascular surgeons at Marshfield Clinic performed most surgeries through a large open incision which required several weeks to heal. But that has clearly changed.

"Our treatment has definitely shifted from traditional open surgery to an endovascular- first approach for most of the cases we see, as long as it is the best thing for the patient," said Michal Nawalany, M.D., one of three Marshfield Clinic vascular surgeons. They perform surgery almost anywhere in the body except for the heart and brain.

Endovascular surgery refers to treating a narrowed or completely blocked vessel from within the vessel rather than from outside. Through just one or two small puncture wounds, surgeons deliver a narrow wire through the area of disease. Over this wire, they can route various devices to open narrowed vessels.

These techniques are increasingly being applied to patients with vein problems.  Unlike arteries, which carry oxygen-rich blood away from the heart, veins carry the blood back to the heart. Veins have traditionally been more challenging because they are thinner, harder to keep open and fragile, compared to arteries.

"Veins don't always respond to surgery in such a predictable pattern as arteries do," Dr. Nawalany explained. "Most surgeons didn't want to do reconstructive vein surgery because it could be tedious and frustrating, but the advent of new technology has renewed interest in it. We have a pretty contemporary practice here at Marshfield Clinic."

Endovascular surgery broadens the options so surgeons can tailor treatment to the patient. For some conditions, the traditional open surgery technique is still the treatment of choice. But endovascular surgery has transformed how surgeons usually treat an aortic aneurysm, a dangerous bulge in the main artery that runs from the heart through the chest and abdomen.

"We used to treat these with open surgery through a large abdominal cut," he said. "Patients were hospitalized for a week and faced four to five weeks of slow recovery at home. Now they typically go home the day after surgery and recover much more quickly."

Dr. Nawalany gets great satisfaction from making a positive impact on patients. "There are much fewer patients who we just can't help," he noted. "We've come a long, long way and advances keep developing. It's what keeps me in the game."