Clinical Research
Division of Vascular and Endovascular Surgery

Endovascular Surgery
A revolution has taken place in the care of patients with vascular disease over the past 10 years, and NYU Medical Center has been at the forefront. An entirely new approach involving the convergence of advanced imaging and endovascular surgical techniques has resulted in a minimally invasive approach to problems that formerly required extensive open surgery and prolonged convalescence. As an example, a patient with a life-threatening, enlarging abdominal aortic aneurysm can now expect to be discharged from NYU on the morning following a one-hour procedure. NYU has pioneered the multidisciplinary approach that makes this revolution in treatment possible.

A close collaborative effort between surgeons, interventional radiologists, and cutting-edge biomedical engineers is a unique feature of the NYU program, which currently performs more endovascular reconstructions than any institution in the United States. This type of collaborative innovation is truly in its infancy, and the opportunities are unlimited.

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Improving Outcomes of Endovascular Surgery
NYU Medical Center is one of the leading institutions performing endovascular surgery for the treatment of abdominal aortic aneurysms. The vascular surgery group at NYU now has one of the largest experiences in North America for this procedure, with excellent outcomes. Due to the large volume of these procedures performed, vascular surgeons are able to analyze the outcomes of this endovascular surgery to enhance the techniques and intricacies of this minimally invasive approach even further.

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Congenital Vascular Malformations Program
These congenital anomalies can be manifest at any point from birth to adulthood, producing symptoms ranging from a disfiguring birthmark to hemorrhage or even heart failure. While these lesions have been described since antiquity, they are still commonly misdiagnosed and incorrectly treated in the medical community. NYU Medical Center is internationally known as one of only three institutions in the world with recognized expertise in this field.

Our Vascular Anomaly Clinic is staffed by a multidisciplinary group that convenes once a month to evaluate children and adults referred from across the United States, as well as many other countries. All patients are evaluated and treated, regardless of their ability to pay. This group of plastic surgeons, pediatricians, interventional radiologists, vascular surgeons and dermatologists not only design and provide a course of treatment for each patient; they are also responsible for publishing much of the world’s scientific literature in this field. Research activities include new plastic surgical and endovascular approaches as well as basic science in the areas of genetics and angiogenesis.

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Carotid Stenting
New technologies are continuously emerging for the treatment of carotid artery stenosis. These blockages are a leading cause of stroke. Traditionally, open surgery or carotid endarterectomy is used to treat this particular condition. Recently, new techniques including carotid artery stenting are now being performed in clinical trials. The problem with carotid artery stenting is the potential release of small particles when the artery is manipulated, which then travel into the cerebral circulation and can cause stroke as a result of the treatment procedure. The Divisions of Vascular Surgery and Interventional Radiology at NYU have been selected to participate in a clinical trial (ARCHER) that seeks to prevent this complication. A new protection device consists of a small filter placed above the area of manipulation in the artery to trap small particles, thereby reducing the risk of stroke as a complication of this procedure.

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Limb Salvage Through Angiogenesis - Growing New Vessels to Prevent Amputation
Narrowing or blockage in the arteries of the legs can lead to the inability to walk, the inability to heal wounds of the calf or foot, and even gangrene. This condition, known as arterial insufficiency, is most commonly due to diabetes, high cholesterol, hardening of the arteries, and smoking. Some patients with this disorder will require invasive procedures such as balloon angioplasty or arterial bypass surgery to save their legs. Other patients will require amputations because the extent of the arterial blockage in their legs is so severe that surgery or ballooning won’t work.

In the Division of Peripheral Vascular Surgery, our research is focused on how to prompt the body to heal, on demand, the condition of arterial insufficiency. The human body maintains the capacity to grow new blood vessels to replace blocked and narrowed ones. New blood vessel growth, also known as angiogenesis, already occurs normally in many instances in the body. Unfortunately, for reasons that are not yet clear, the body fails to grow adequate amounts of new blood vessels to replenish blood starved legs.

Through research into (1) the interactions of growth factors, (2) hidden messages within the molecules of blood-starved leg muscle, and (3) known conditions where angiogenesis occurs in the body, we anticipate being able to determine how to promote new blood vessel growth on demand. We could promote increased blood flow in blood-starved legs without resorting to invasive procedures. Ultimately, we expect to save legs that currently would be lost to amputation by being able to induce angiogenesis in the legs of patients with limb-threatening arterial insufficiency.

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Minimally Invasive Venous Program
Varicose veins typically derive from incompetent valves within the superficial and deep venous systems in the lower extremities. While these varicosities are typically not dangerous, they typically cause lower extremity discomfort and are of cosmetic concern. In the past, these veins have been treated with a variety of invasive surgeries to remove the varicosities. However, more recently, physicians at NYU have pioneered a new program allowing treatment of these varicosities with minimally invasive techniques.

One technique centers on endovascular closure using radiowaves. A catheter is introduced into the venous system under local anesthesia using ultrasound guidance. With the catheter in place, heat is generated to close the veins down without removing them. This eliminates the need for surgical incisions. A second technique involves use of a scope-based technology. Scopes are introduced under the skin, allowing veins to be removed again without surgical incisions. The vascular surgical group at NYU Medical Center has gained national notoriety in pioneering these two new techniques. Research efforts continue in this area as we seek to bring these relatively new techniques to an even higher level.

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Evaluating Stent Grafts for Repair of Abdominal Aortic Aneurysm
Vascular surgeons at NYU Medical Center have been instrumental in the evaluation and ultimate FDA approval of aortic endografts. As new aortic endografts are developed, once again we have been at the forefront as an FDA-designated site for stent graft trials. GORE, an internationally recognized biomedical research company, has developed a new aortic stent graft called Excluder. As one of only several “designated” implantation sites, NYU Medical Center is a participant in the clinical trial that will be presented to the FDA prior to the clinical approval of this new and improved stent used in the repair of abdominal aortic aneurysms.

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Improving Outcomes of Carotid Endarterectomy
The Division of Vascular Surgery at NYU Medical Center is participating in a research study involving all New York State hospitals, which is funded by the National Institute of Health. This project will analyze the outcomes of carotid endarterectomy with the intent of identifying factors responsible for the rare complications involved with this procedure, in an effort to improve outcomes further.

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Stroke Prevention Screenings
The Division of Vascular Surgery has developed a free stroke prevention program which is available to the public. Approximately six screenings are held each year. The purpose of the program is to determine which population is at a moderate risk for experiencing a stroke and to ascertain which tests are best suited to identify this population. All participants are at least 60 years of age and have at least one of the following risk factors:

- Current smoker
- History of high blood pressure
- History of cardiac disease
- History of stroke in the immediate family

The tests performed at the screenings include:

- Measurement of blood pressure
- Rhythm EKG
- Modified ultrasound of the carotid arteries

All participants receive the results of their examinations at the screening. Appointments are made in advance so there is very little waiting. The program is made available by a grant received by the Ira DeCamp Foundation. For more information, call 212-263-7709.

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Analysis of Magnetic Resonance Angiography to Direct Treatment for Lower Extremity Arterial Occlusive Disease
Conventional imaging of patients’ arteries has revolved around invasive angiography. During this procedure, a needle is introduced to the artery and contrast is injected. This examination can be painful and may have significant complications. Over the last five years, the Division of Vascular Surgery at NYU Medical Center has been innovative in using magnetic resonance angiography (MRA) as a noninvasive way of imaging blood vessels within the human body. Recently MRA has become an accepted method of vascular imaging. This is largely due to the innovative work done at NYU. More recently, newer techniques have been developed at NYU, and research continues in the area of minimally invasive or noninvasive imaging of blood vessels to plan surgical intervention.

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Multidisciplinary Treatment of Visceral Artery Pseudoaneurysms
A pseudoaneurysm is a break in a vessel which allows blood to leak out of circulation into an area surrounding the blood vessel. Typically this represents a small hole in an artery which may be caused by trauma or infection. Visceral arteries are the arteries that supply circulation to the intestines and organs within the abdomen. Surgical repair of visceral artery pseudoaneurysms has been difficult. Recently, NYU has developed a technique whereby a covered stent is used to treat visceral artery pseudoaneurysms without surgical incision. A stent is passed through an introducer system via a needle stick to the level of the pseudoaneurysm, and a covered stent is deployed. The Division of Vascular Surgery at NYU Medical Center continues to develop this technique and others for minimally invasive repair of this dangerous condition.

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Carotid Endarterectomy in a City Hospital Population
Carotid artery stenosis is known to be representative of atherosclerosis throughout the human body. Typically patients who are found to have carotid stenosis in a private hospital setting have had extensive cardiac evaluation, and follow-up by internists. This project will allow vascular surgeons to evaluate an underprivileged population who has not had the advantage of continuous medical follow-up by a private physician. It will allow vascular surgeons to evaluate the necessity for extensive cardiac evaluations prior to carotid surgery, as many of the patients in the city hospital population ultimately come to carotid surgery without prior medical or cardiac evaluation. This will be groundbreaking work in the area of healthcare for the indigent population with respect to vascular surgery.

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