(845) 334-4709 www.hahv.org

®

The Center of Vascular Excellence

Staffed with board-certified vascular surgeons and specialty trained registered

nurses and technologists in a new and dedicated suite, the Center of Vascular Excellence provides state-of-the-art diagnostic and therapeutic treatment of vascular diseases. Our team is devoted to providing our community with excellent diagnostic services as well as management and treatment of vascular disease.

New Angiography Suite at Benedictine Hospital Campus Our suite is a state-of-the-art Siemens Artis Zee C-arm, which is a special image intensifying device used in medical imaging. It provides our physicians with highly-detailed images of patients’ blood vessels during diagnostic and treatment procedures. The cutting-edge technology allows our physicians to obtain three-dimensional images in high resolution, with low doses of radiation and contrast and easy access for our patients. The Artis Zee is well-suited for performing minimally-invasive endovascular and angiographic procedures.

Vascular Services

Peripheral Arterial Disease

Cryoplasty

Atherectomy

Lower Extremity Bypass

Deep Venous Thrombosis Management

Varicose Veins and Venous Ulcers

Dialysis Access Care

Venous Access Procedures

HERO Device

Hybrid Grafts

Carotid Artery Disease

Thoracic and Abdominal Aneurysm

Vascular Embolization

Our Doctors

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Peripheral Arterial Disease

Peripheral Arterial Disease (PAD) is characterized by narrowing of extremity arteries (usually leg arteries) caused by fatty deposits or plaque resulting in reduced blood flow through the artery. Some patients have no symptoms, while others feel pain, weakness, or numbness. Wound healing may be slower than normal, and the affected limb might have diminished hair and nail growth or a different hue and temperature.

After being referred by a primary physician, diagnostic tests for PAD include Doppler and Ultrasound Imaging, CT Scanning and Magnetic Resonance Angiography which can guide a treatment plan.

For less severe cases, treatment options can include smoking cessation, diet changes, exercise, and medication. Minimally invasive options such as angiography, stent placement and clot-removal treatments, attempt to physically open up clogged arteries.

Severe cases with long portions of clogged arteries may need a surgical treatment such as peripheral bypass surgery, which uses a native vein or synthetic graft to reroute blood around a blockage. The procedure has a three to four day recovery period.

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Cryoplasty

Cryoplasty or cryo-balloon angioplasty is a procedure very similar to angioplasty in which your vascular surgeon inserts a balloon catheter into a blocked artery to repair an obstruction within the vessel. In conventional angioplasty, depending on the location of the blockage, a stent may be inserted at the location of the repair to prevent the blockage from returning, a condition referred to as restenosis.

In cryoplasty, once the balloon catheter reaches the site of the blockage, it is filled with liquid nitrous oxide, which immediately evaporates into a gas, causing the balloon to inflate and freeze the surrounding tissue. This cooling to 14 deg F (-10 deg C) promotes the dilation or opening of the artery, minimizes the potential for growth of new scar tissue, and reduces the likelihood that the blockage in the treated location will reoccur. Generally a stent is not used in this procedure, as the freezing at the site of the repair is less likely to cause restenosis or the re-narrowing or blockage of the vessel.

To learn more about Cyroplasty go to: www.bostonscientific.com/cryoplasty

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Atherectomy

Atherectomy is a minimally invasive surgical method of removing, atherosclerosis from a blood vessel within the body, and can be used to effectively treat peripheral arterial disease of the lower extremities.

Unlike angioplasty and stents, which push plaque into the vessel wall, atherectomy involves removing the plaque burden within the vessel. Increasing the vessel lumen by removing the plaque burden improves downstream wound healing, reduces claudication and pushes amputation levels more distal.

Atherectomy may be performed instead of or in addition to other procedures and can improve both the immediate and long-term success of balloon angioplasty and stenting.

To learn more about Atherectomy go to: www.ev3.net/peripheral/us/plaque-excision/turbohawk.htm www.csi360.com

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Lower Extremity Bypass

For patients who are not good candidates for angioplasty, or who have been unsuccessful in a prior angioplasty attempt, Lower Extremity Bypass surgery is a well-established and effective procedure. In these procedures, an alternative pathway for blood flow is created to bypass the area of blockage and restore direct flow to the lower leg and foot. This is a major surgical procedure performed under anesthesia via incisions in the leg.

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Deep Venous Thrombosis Management

The Center of Vascular Excellence offers management and treatment of deep venous thrombosis including both percutaneous mechanical thrombectomy and thrombolysis, as well as placement of both temporary and permanent IVC filters. Follow-up care including evaluation and removal is available for select patients.

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Varicose Veins and Venous Ulcers

Varicose veins and venous ulcers are both caused by improper functioning of venous valves, usually of the legs. The valves help ensure that blood pumps back towards the heart, despite the effects of gravity. When the venous valves break down, due to factors such as age, heredity, obesity, pregnancy or prolonged standing, blood flows backwards and causes bulging varicose veins or chronic venous ulcer wounds.

One diagnostic test is venous ultrasound, which is a non-invasive test that uses high-frequency sound waves to diagnose blood clots, and weak valves and veins. The venogram is another option that uses dye to detect vein abnormalities.

Lifestyle changes to manage these conditions include avoiding prolonged standing, leg elevation when possible, support stockings and weight control and loss, as extra pounds increase the pressure on the venous system.

Laser ablation is a newer treatment option that doesn’t require anesthesia or even stitches; it delivers heat energy under the skin to seal vessel walls closed. Sclerotherapy is another outpatient procedure that uses injected chemicals to stick veins together, and may be used in cases where laser ablation is not an option.

For more severe cases, vein excision or phlebectomy, and vein stripping are both ways to surgically remove problematic veins.

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Dialysis Access Care

For patients undergoing hemodialysis treatments, our team must first prepare a vascular access, where blood will be removed and returned during dialysis. With proper planning, the dialysis process can be efficient and carries a reduced chance of complications. Two common methods that we perform are arteriovenous (AV) fistulas and grafts.

AV fistulas connect an artery directly to a vein, typically in the forearm. Connecting the artery to the vein allows more blood flow to the vein, and the vein grows larger and stronger, which makes the repeated needle insertions for hemodialysis treatments easier. Once properly formed (up to 24 months later), the fistula is less likely than other kinds of vascular access to become infected or form clots, and can last for years. The procedure uses local anesthetic and can be performed on an outpatient basis.

For patients who cannot get an AV fistula, or need to immediately begin hemodialysis, a graft is a treatment option. A graft is an artificial vein connected under the skin that connects to an artery, and can be ready for use within a month. Although there is an increased risk of clotting and infection, a graft can last for several years if well-cared for.

Our experienced surgeons and medical staff at the Center of Vascular Excellence can also perform catheter repair and repositioning, and diagnose and treat other dialysis-related conditions like high venous pressures, prolonged bleeding, graft thrombectomy and non-maturing fistula.

In case of declotting failure or unusable access, our expert physician dialysis specialists will insert a temporary or tunneled catheter to ensure access. Our goal is to provide efficient and considerate treatment of your dialysis patients’ access needs on an as needed basis. This allows for more efficient dialysis treatment and less access down time.

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Venous Access Procedures

A Central Venous Access Catheter (CVAC) is a tube that is inserted beneath your skin so there is a simple, pain-free way for doctors or nurses to draw your blood or give you medication or nutrients. When you have a CVAC, you are spared the irritation and discomfort of repeated needle sticks.

The Vascular Center offers placement of all CVAC’s including tunneled ports, Permcaths, and Hickman catheters for any of your patients’ access needs.

All procedures are done using real-time fluoroscopic and ultrasound guidance ensuring both patient comfort and safety. Any invasive procedure is performed under conscious sedation by our dedicated and experienced nursing staff. We now offer the Power Port for patients undergoing power injections for imaging exams such as CT or MRI.

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Hero Device

Hybrid Graft

New hemodialysis access designed for patients who are catheter dependent, have exhausted all other access options (such as grafts and fistulas) due to blockages or damages to the major veins leading to the heart.

To learn more about the Hero Device go to: www.hemosphere.com

The GORE® Hybrid Vascular Graft is indicated for use as a vascular prosthesis for dialysis access or bypass for other peripheral vascular diseases. The device is designed to address the most common causes of graft failure; intimal hyperplasia, thrombosis, and seroma. The device simplifies access to vessels with a new over the wire deployment method through a smaller than usual incision in the skin that reduces vessel injury and dissection. The GORE Hybrid Vascular Graft has been used to create new access sites in anatomical locations that would have been abandoned otherwise, preserving the amount of access sites available throughout the patient’s long-term therapy.

To learn more about the Hybrid Graft go to: www.goremedical.com/hybrid

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Carotid Artery Disease

Located on either side of your neck, under the jaw, the carotid arteries are the main blood supply for the brain. Carotid Artery Disease (CAD), or stenosis, is a condition that results from the buildup of plaque and narrowing of the arteries. Pieces of plaque can break loose or a blood clot can form at the area of the plaque, either which can block or slow blood flow through the arteries that supply blood to the brain. Results of this blockage can lead to an ischemic attack (mini-strokes) or major stroke.

To diagnose CAD, tests are used such as Ultrasound, Magnetic Resonance Angiography, CT Scanning, or an Angiogram. For prevention, lifestyle changes and medication can be recommended to manage the disease. For some patients a surgical procedure called “carotid endarterectomy” can remove plaque from the carotid artery. This procedure requires an overnight stay in the hospital.

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Thoracic and Abdominal Aneurysm

An aneurysm is the weakening or ballooning of an artery wall in the thoracic (chest) or abdominal (belly) aorta, usually caused by plaque buildup from disease or heredity. Typically, they exist without symptoms, but if they increase in size over time, there is a significant chance of rupture, which can lead to hemorrhaging and even death.

Tests to detect an aneurysm include abdominal ultrasound, CT scanning and CT angiogram, as well as a traditional angiogram with an intra-arterial catheter.

It is believed that atherosclerosis, which also contributes to Peripheral Arterial Disease, also can worsen aneurysms. Lifestyle changes can manage the condition’s development.

Endovascular repair is a minimally invasive treatment option, which places a stent graft in the diseased vessel to restore normal blood flow, with a 1-2 day recovery time. There is a surgical option called “Open Repair,” which places a graft in place of where the aneurysm was. It has a recovery time of 3-5 days, so it is only used in severe cases.

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Vascular Embolization

Catheter Embolization is the technique of deliberately preventing blood flow to obtain a therapeutic effect, usually to shrink a tumor or block blood supply.Small tubes called catheters can be navigated to just about any blood vessel in the body and are combined with synthetic materials called “embolic agents” to block the blood flow to achieve the desired result.

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About Our Physicians

Jeffrey Hnath, M.D.Dr. Hnath returns to The Vascular Group after being in private practice in New Haven, CT. He completed his general surgery residency and vascular surgery fellowship at Albany Medical Center. Dr. Hnath is a native of the northeast having been born and raised in Connecticut.

Dr. Hnath graduated with from Fairfield University with a Bachelors degree in science and then went on to medical school in Omaha, Nebraska at Creighton University before coming to upstate New York for training. He is board certified in general surgery as well as in vascular surgery.

Stephanie Saltzberg, M.D., FACSDr. Saltzberg graduated magna cum laude with a B.A. from The University of Pennsylvania. She received her medical degree from Boston University School of Medicine graduating cum laude. She completed her surgical residency at the Beth Israel Deaconess Medical Center/Harvard Medical School. Dr. Saltzberg then completed her vascular surgery fellowship at New York University Medical Center in 2004.

Dr. Saltzberg is board certified in both General and Vascular Surgery. She also holds certification as a registered vascular technologist in ultrasound. She is a Fellow of the American College of Surgeons.

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Melissa D. Shah, M.D.Dr. Shah attended Brown University in Providence, Rhode Island where she graduated in 1999 with a Bachelors degree in Biology. She went on to get a Master’s Degree in Science followed by her medical degree from Albany Medical College in 2005. Dr. Shah completed her surgical residency at Boston University Medical Center in Massachusetts and her vascular surgery fellowship at Albany Medical College.

Dr. Melissa Shah resides in Poughkeepsie, NY and primarily sees patients in Poughkeepsie, NY.

Andreas Spirig, M.D., FACSDr. Spirig attended The University of Chicago and George Washington University graduating with a BS degree in Zoology in 1983. He received his Medical Degree from Howard University School of Medicine in 1987. He completed his residency at Thomas Jefferson University Hospital in Philadelphia, PA in 1992 where he also went on to complete a research fellowship in Trauma Surgery in 1993. Dr. Spirig completed his vascular surgery fellowship at KansasUniversity Medical Center in Kansas City, Kansas in 1994.

Dr. Spirig is board certified in both General and Vascular Surgery. He is a Fellow of the American College of Surgeons.

About Our Physicians

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Richard Burzine, PA-CRichard Burzine is a graduate of the Harlem Hospital PA program and City University of New York. He is board certified in both Surgery and Medicine and has been a Guest Lecturer at the Sophie Davis School of Medicine.

Mr. Burzine first practiced in Neurosurgery at North Shore Hospital Medical Center. He then went on to complete a PA fellowship in internal medicine in Brooklyn, New York eventually joining NYC Health & Hospital Corporation as Chief PA of the Department of Neurosurgery for Lincoln, Harlem and Metropolitan Hospitals.

Mr. Burzine joined the Division of Vascular Surgery at Lincoln and Harlem Hospital with emphasis on dialysis access and diabetic limb salvage in 2004. He subsequently joined The Vascular Group in July 2007 servicing the Lower Hudson Valley with emphasis on vascular health, diabetic limb care and dialysis access.

He is a member of the Vascular Access Society of America, NYSSPA and AAPA.

About Our Physician Assistant

The Center of Vascular ExcellenceMary’s Avenue Campus

105 Mary’s Avenue, Kingston, N.Y. 12401

www.hahv.org (845) 334-4709