Vascular Surgery Overview

Vascular Surgery Overview

Vascular Surgery

The Vascular System is the network of veins that move blood throughout the body. Veins are flexible, hollow tubes with flaps inside called valves. The valves open and close allowing or restricting blood flow. The muscles surrounding the veins contract to open valves and relax to close them. This exercise of pumping blood to your vital organs is necessary for them to receive the needed oxygen and blood to perform properly.

If the valves inside your veins become damaged, the valves may not close completely. This allows blood to flow in both directions. When your muscles relax, the valves inside the damaged vein(s) will not be able to hold the blood. This can cause pooling of blood or swelling in the veins. The veins bulge and appear as ropes under the skin. The blood begins to move more slowly through the veins, it may stick to the sides of the vessel walls and blood clots can form.

Surgical Specialists of Ocala have the highest level of training and expertise to treat vascular disorders in the least invasive way possible.

Aneurysm Repair

Ocala Aneurysm Repair


Ocala Abdominal Aortic Aneurysm Repair

An aortic aneurysm occurs when the walls of the main blood vessel that carries blood away from the heart (the aorta) malfunction. This could be a bulge or blockage which restricts the flow of blood. An abdominal aortic aneurysm (AAA) is located in the abdominal area, near the navel. Aneurysms can also occur in other areas of the aorta, but the abdomen is the most common site. For your Ocala abdominal aortic aneurysm, contact Dr. Ravi Chandra today.

Large aneurysms can burst, or rupture, and cause heavy bleeding into the abdomen. A ruptured aortic aneurysm is a medical emergency requiring immediate treatment.

Endovascular stent graft: Surgical Specialists of Ocala normally choose the least invasive surgical procedure whenever possible. It is called an endovascular stent graft to repair AAA. An incision is made in the groin to access the femoral artery. A wire is placed in the vessel over which a variety of specialized catheters are used to pass a folded graft to the area of the aneurysm. Under selected circumstances, the surgeon may instead be able to access the common femoral artery without making an incision (percutaneously). Either way, once the femoral artery is accessed, dye is injected to guide the placement of a stent-graft device into the area of the aneurysm. Once the device is correctly positioned, the stent graft is unfolded and expanded with a balloon that pushes it up against the normal aortic wall. This type of graft is not sewn into place. Blood flows through the graft instead of the abnormally dilated aorta, which decreases the pulsations on the aortic wall.

Open Surgery: Some cases will require an open procedure that is more invasive. Surgical Specialists of Ocala take the patient’s full condition into consideration to choose the safest and most effective outcome. Open surgical correction of AAA involves removing the section of the abdominal aorta that is dilated and replacing it with a prosthesis made of synthetic material (also known as a graft) that is sutured into place. This will allow blood to flow normally and the artery wall is used to cover the graft. Planned or elective surgery reduces the risk of rupture of large asymptomatic AAA, and graft failure is uncommon.

Surgery is done in an operating room while the patient is under general anesthesia, and generally takes four to six hours. After surgery, a patient is taken to the intensive care unit for monitoring. Several catheters are used, including a urinary catheter (to drain the bladder), an arterial catheter (to monitor blood pressure), a central venous catheter (to monitor pressures in the heart), an epidural catheter (to give pain medicine), and a nasogastric tube (a tube from the stomach to the nose that is initially used to keep the stomach empty). Patients are generally able to go home after four to seven days, and are able to resume normal activities in about four weeks.

Iliac Aneurysm

An iliac aneurysm is bulging and weakness in the wall of the iliac artery, a group of arteries located in the pelvis. An iliac aneurysm can burst, which can cause life-threatening uncontrolled bleeding.


  • Atherosclerosis (hardening of the arteries)
  • Infections
  • Trauma from hip or lower-back surgery


  • Being older than 60
  • Being a man
  • High cholesterol
  • High blood pressure
  • Smoking

Symptoms include:

  • Back pain
  • Lower abdominal pain
  • Groin pain

Surgical Specialists of Ocala prefer to use the least invasive endoscopic procedure (only requiring a small incision in the groin) to repair Ocala iliac aneurysms. The surgeon uses a graft (a cylinder-like tube) to repair the aneurysm. In some cases, open surgery (requiring a larger incision in the chest) may be necessary to repair the aneurysm.

Ocala Pseudoaneurysm Repair

A pseudoaneurysm, also known as a false aneurysm, is a hematoma that forms as the result of a leaking hole in an artery into the surrounding tissue. Unlike a true aneurysm, which is a localized dilatation of an artery including all layers of the wall, a pseudo aneurysm forms outside the arterial wall. Distinctively, in a pseudoaneurysm, the hole in the arterial wall is generally the consequence of a vascular injury. By opposition, true aneurysms are usually the consequence of an arterial wall congenital or acquired deficiency, for example by means of atherosclerosis.


  • Heart Attack
  • Complication of cardiac catheterization
  • Injury of a heart chamber or artery

Symptoms include:

  • Swelling or pulsatile mass on the chest

Some pseudoaneurysms resolve themselves, though others require treatment to prevent hemorrhage, an uncontrolled leak or other complications. In most cases the Surgical Specialists of Ocala place a covered stent endovascularly across the hole to where the artery is leaking. This technique has a high success rate and is less invasive than open surgery.

Carotid Surgery

Ocala Carotid Artery Disease Repair

The interior lining of the carotid artery is smooth, allowing for effective blood flow. Through stress, high blood pressure and anxiety blood flows more rapidly through the carotid artery sometimes causing erosion or bumps along the smooth lining. Over time and in some cases a poor diet, cholesterol, calcium and fibrous tissues lodge into the erosions forming a plaque-like build up. As more plaque builds up, your arteries narrow and stiffen. This process is called atherosclerosis, or hardening of the arteries. Eventually, enough plaque builds up to reduce blood flow through your carotid arteries, or to cause irregularities in the normally smooth inner walls of the arteries.

Your carotid arteries are located on each side of your neck and extend from your aorta in your chest to enter the base of your skull. These important arteries supply blood to your brain.

Carotid artery disease is a serious issue because clots can form on the plaque. Plaque or clots can also break loose and travel to the brain. If a clot or plaque blocks the blood flow to your brain sufficiently, it can cause an ischemic stroke, which can cause permanent brain damage, or death, if a large enough area of the brain is affected. If a clot or plaque blocks only a tiny artery in the brain, it may cause a transient ischemic attack (TIA), also known as a mini-stroke. A TIA is often a warning sign that a stroke may occur in the near future, and it should be a signal to seek treatment soon, before a stroke occurs.

Carotid Artery Endarterectomy

To remove plaque in your carotid arteries and help prevent a stroke, your physician may recommend a carotid Endarterectomy. Carotid Endarterectomy is one of the most commonly performed vascular operations, and is a safe and long-lasting treatment.

You may either be put to sleep or, alternatively, your anesthesiologist or surgeon can numb your neck area and keep you awake so you can communicate with the surgeon during the operation. By staying awake, you may help your physician monitor your brain’s reaction to the decreased blood supply. Once you are either asleep or the area around your neck is completely numb, your surgeon will shave the skin on your neck where he or she is going to make an incision, to help prevent infections. Your surgeon then makes the incision on one side of your neck to expose your blocked carotid artery. Next, your surgeon temporarily clamps your carotid artery to stop blood from flowing through it. During the procedure, your brain receives blood from the carotid artery on the other side of your neck. Alternatively, your surgeon can insert a shunt to detour the blood around the artery that is being repaired.

After your surgeon clamps your carotid artery, he or she makes an incision directly into the blocked section. Next, your surgeon peels out the plaque deposit by removing the inner lining of the diseased section of your artery containing the plaque. After removing the plaque, your surgeon stitches your artery, removes the clamps or the bypass, and stops any bleeding. He or she then closes your neck incision and the procedure is complete. Often, a patch is used to widen the artery as part of the procedure. The patch material used can be your own vein, usually from the leg, or a variety of synthetic materials depending upon your particular circumstance. The procedure takes about 2 hours to perform but may seem slightly longer depending upon the anesthetic and preparation time.

Carotid Stenting

Surgical Specialists of Ocala help patients prevent the more complicated conditions that can occur when a carotid artery becomes completely clogged. Carotid stenting is a procedure where surgeons become the plumbers for the clogged arteries to open the clogged passages to prevent or treat stroke. Stenting is a procedure that involves temporarily inserting and inflating a tiny balloon where your carotid artery is clogged to widen the artery.

Carotid stenting is often combined with the placement of a small metal coil called a stent in the clogged artery. The stent helps prop the artery open and decreases the chance of it narrowing again.


TransCarotid Artery Revascularization

Vascular Surgery Overview

TCAR is a patient-friendly, endovascular procedure that incorporates the neuroprotection principles of CEA. It utilizes the ENROUTE® Transcarotid Neuroprotection System to temporarily reverse blood flow away from the brain, collecting any potential debris in the device filter, before returning the blood to a vessel in the leg. With reverse flow neuroprotection established, the ENROUTE® Transcarotid Stent is then implanted in the lesion for long-term plaque stabilization and stroke prevention. TCAR is well-suited for patients who are at higher risk of surgical complications, due to age, medical co-morbidities, or anatomical issues. The TCAR Surveillance Project, a quality initiative led by the Society of Vascular Surgeons, has established Medicare coverage and reimbursement for symptomatic and asymptomatic patients.

Vascular Surgery Overview

Treating Carotid Disease

Carotid artery disease is estimated to be the source of stroke in up to a third of cases and there are 400,000 new diagnoses of carotid artery disease made every year in the United States alone.

Vascular Surgery Overview

Most cases of carotid artery disease, similar to other vascular diseases caused by atherosclerosis, are medically managed. Carotid intervention is indicated when:

  • Symptomatic patients with stenosis ≥ 50%
  • Asymptomatic patients with stenosis ≥ 70%

Vascular Surgery Overview

Carotid endarterectomy (CEA) has long been considered the gold standard treatment because of its low procedural stroke rate. However, CEA carries a higher risk of myocardial infarction, and cranial nerve damage due to the larger incision. TransCarotid Artery Revascularization (TCAR) is a new, less-invasive procedure with the lowest reported carotid stenting stroke rate of 1.4%1.

Clinical Outcomes

Vascular Surgery Overview

Less Invasive

Vascular Surgery Overview

Shorter Hospital Stays

Vascular Surgery Overview

Peripheral Vascular Disease

Peripheral Vascular Disease

At Surgical Specialists of Ocala, we think simplified way to understand peripheral artery disease is to visualize the peripheral arteries as the plumbing pipes for your blood. Just like we are refreshed when we get a drink of water, our organs and tissues receive much-needed oxygen for energy and nourishment as blood carrying oxygen to them through the peripheral arteries.

What happens when these arteries become clogged with plaque or the valves that keep the blood pumping through do not function properly? The limited blood flow prevents the extremities – usually the legs – from receiving proper levels of oxygen. It causes pain or discomfort in the legs. Some patients describe their legs as feeling heavy or sluggish. Other symptoms include:

  • Painful cramping in your hip, thigh or calf muscles after activity, such as walking or climbing stairs (intermittent claudication)
  • Leg numbness or weakness
  • Coldness in your lower leg or foot, especially when compared with the other side
  • Sores on your toes, feet or legs that won’t heal
  • A change in the color of your legs
  • Hair loss or slower hair growth on your feet and legs
  • Slower growth of your toenails
  • Shiny skin on your legs
  • No pulse or a weak pulse in your legs or feet
  • Erectile dysfunction in men

Peripheral Angiography

To determine the most effective treatment, Surgical Specialists of Ocala will most likely recommend a Peripheral Angiogram. This high-tech diagnostic procedure is somewhat like a GPS view of the route the blood is taking through your arteries. Just like we are accustomed to hearing our automotive navigation system recalculate a missed route, the angiography is a way the surgeon can plot a new route to get your blood flow on its correct course.

Surgical Specialists of Ocala will consult with your referring doctor and choose the best procedure to get you back to functioning at full capacity. One of these treatments will be considered:

Peripheral Artery

To determine the most effective treatment, Surgical Specialists of Ocala will most likely recommend a Peripheral Angiogram. This high-tech diagnostic procedure is somewhat like a GPS view of the route the blood is taking through your arteries. Just like we are accustomed to hearing our automotive navigation system recalculate a missed route, the angiography is a way the surgeon can plot a new route to get your blood flow on its correct course.

Peripheral Angioplasty

In this procedure, a small hollow tube (catheter) is threaded through a blood vessel to the affected artery. There, a small balloon on the tip of the catheter is inflated to reopen the artery and flatten the blockage into the artery wall, while at the same time stretching the artery open to increase blood flow. Your doctor may also insert a mesh framework called a stent in the artery to help keep it open. This is the same procedure used to open heart arteries.

Peripheral Bypass

Surgical Specialists of Ocala may advise creating a way around the problem vein. A graft bypass is made by using a vessel from another part of your body or a blood vessel made of synthetic fabric. This technique allows blood to flow around — or bypass — the blocked or narrowed artery.