Robert Wood Johnson Medical School has become one of the premier centers in New Jersey for the treatment of patients with aneurysms. We treat thoracic aneurysms, thoracoabdominal aneurysms, abdominal aortic aneurysms, iliac artery aneurysms, and popliteal aneurysms, which are located in the arteries behind the knees. Our team of highly trained physicians specializes in the treatment of complex thoracic, thoracoabdominalm, and intra-abdominal aneurysms in both acute and chronic presentations. We offer open surgical repair, but most recently have become a leader in innovative endovascular repairs for patients with complex aneurysms. More Info

The Cerebrovascular Disease Program provides diagnostic services, management guidelines and treatment options for patients with symptomatic and asymptomatic disease of the Great Vessels in the chest and the extracranial carotid arteries in the neck.

Our program works in conjunction with the acute stroke program at Robert Wood Johnson University Hospital to provide timely and accurate diagnosis and management of carotid disease. Our surgical team offers both traditional carotid endarterectomy and carotid stenting, and participates in clinical trials for stenting procedures. The expertise of the surgical team has resulted in an extremely low perioperative stroke rate of less than 2 percent, which rivals the nation's best.

We treat many complex cerebrovascular problems, such as carotid aneurysms, carotid body tumors and vertebrobasilar disease. In addition, we are part of a multidisciplinary team of experts involved with the treatment of acute stroke and atherosclerotic cerebrovascular disease. Our team includes vascular surgeons, interventional radiologists, anesthesiologists and neurologists, all working together to provide the best treatment possible at RWJUH.

Carotid Artery Interventions

The most common cause of a stroke is a sudden blockage of blood flow to an artery in the brain. The blockage is usually from plaque or a clot located in the carotid artery in the neck that has travelled to the brain. A narrowing, or blockage, of the carotid artery, if severe, is usually treated by surgery to prevent a stroke from occurring. Patients who have already had strokes from this or other etiologies can also benefit from surgical intervention. Options for surgical intervention include both carotid artery surgery (called an "endarterectomy") and carotid artery stenting, a minimally invasive, endovascular alternative.

Carotid Surgery

More than 150 carotid surgeries are performed annually at Robert Wood Johnson University Hospital with outstanding results. While the national average for risk of stoke as a complication of the procedure is 2.5 percent to 3 percent, and the New Jersey average is 1.5 percent to 2 percent, the stroke risk at Robert Wood Johnson is only 1 percent, rivaling the best results of any institution nationwide. Surgery on the carotid artery is usually performed under general anesthesia with continuous brain wave monitoring, but can also be performed with a regional cervical block.

Carotid Stenting

Endovascular treatment of carotid disease is an emerging technology. Our highly trained faculty can provide carotid artery stenting as an alternative to traditional surgical procedures. We have offered carotid artery stenting for several years at this institution, and are among the leaders in this field in the state of New Jersey. With our extensive training and experience, the number of patients we can offer this treatment option is rising rapidly every year.

For more information regarding stroke and carotid artery interventions, please visit the following websites:

1. www.emedicinehealth.com
2. www.vascularweb.org
3. www.abbottvascular.com

Our surgical team is on the cutting edge when it comes to the management and treatment of both arterial and venous disease using endovascular modalities. Endovascular treatment for vascular disease is a rapidly growing area, and the physicians at Robert Wood Johnson are leading the way. Using state-of-the-art advances, our surgeons are now able to offer minimally invasive treatment for patients with complex disease. This option allows patients to have faster recovery with less pain and a minimal inpatient stay. Some procedures can be performed as an outpatient. When successful, these procedures minimize the need for standard major vascular surgical procedures.

Special Treatments or Services

• Endovascular Aneurysm Repair — Endovascular Stent Grafts
• Angiography
• Balloon Angioplasty
• Stenting
• Atherectomy
• Thrombolysis
• Dialysis Access Revisions
• Endovenous Ablation — The Venefit Procedure

Endovascular Surgery

Endovascular surgery at Robert Wood Johnson University Hospital has grown tremendously over the past five years. We have developed a state-of-the-art endovascular surgical program that includes procedures for arterial diseases, aneurysms, venous disease and deep venous thrombosis, and dialysis access. Our Vascular Center of Excellence can provide endovascular treatment options for the most basic and most complicated vascular issues.

About 1,000 endovascular procedures are performed annually at our institution. Endovascular procedures are now routinely performed for thoracic and abdominal aneurysms, peripheral aneurysms such as popliteal aneurysms, peripheral arterial disease, arterial-venous malformations, venous disease and varicose veins, dialysis access procedures and a variety of other less common vascular disorders.

Endovascular procedures for the treatment of vascular disease have revolutionized the practice of vascular surgery, and Robert Wood Johnson continues to be a leader in the community by providing these new technologies to our patients. We have been able to provide safer treatment options and better outcomes as a result of our shift to more minimally invasive procedures. Many patients who were in the past turned down for vascular procedures can now be satisfactorily treated with minimal risk, short hospital stays and fast recoveries. Our services include angiography, balloon angioplasty, cryoplasty, stenting, laser atherectomy, mechanical atherectomy, arterial and venous thrombolysis, and both chemical and mechanical thrombolysis.

The division of vascular surgery, in conjunction with The Vascular Center of New Jersey, evaluates and treats patients with severe peripheral arterial disease, also known as PAD. Our focus is on comprehensive management of vascular disease, and our physicians are well versed in vascular medicine, as well as specialists in surgical management of vascular disease. Comprehensive care combined with state-of-the-art surgical revascularization techniques, including endovascular therapy, has resulted in limb salvage rates equal to the best clinical centers.

Special Treatments or Services

• Non-invasive vascular laboratory for testing
• Medical and Cardiac Consultation Services
• State-of-the-art imaging centers in and around New Brunswick
• Endovascular expertise

Peripheral Arterial Disease

Peripheral Arterial Disease (PAD) is caused mainly by atherosclerosis, or hardening of the arteries. The major risk factor is smoking, along with hypercholesterolemia, diabetes and hypertension. Patients suffering from PAD experience leg pain when walking, called claudication, and in the latter stages of the disease can develop pain at rest, ulcerations of the skin and even gangrene.

Medical management of this disease is extremely important, but sometimes the best management fails to control the disease successfully. For many patients, the symptoms may be so severe that they require revascularization to achieve effective relief.

Both open surgical revascularizations and minimally invasive endovascular treatments are performed at Robert Wood Johnson University Hospital. Endovascular treatments such as angioplasty, stenting and atherectomy for the treatment of PAD have been increasingly utilized at our institution as these new devices are introduced into the marketplace.

We have broad experience in both open and endovascular treatment for PAD. Numerous interventions are performed yearly for patients with PAD, in both the elective and emergency settings. The Vascular Center performs more than 300 procedures yearly for the treatment of patients suffering from PAD. Our faculty performs both open and endovascular procedures in the operating room. Because of the explosion of new minimally invasive technology for the treatment of PAD, we have been able to offer treatment to patients with advanced disease with little complications, short hospital stays and short recovery time. We serve as the tertiary care facility for all of Central New Jersey, and are frequently asked to perform limb salvage procedures on patients who have been turned away by many area hospitals and surgeons.

At our Vascular Center of Excellence, limb salvage rates are high and our complication rates are extremely low. But most importantly, our patient satisfaction rate is very high.

For more information about PAD and treatment options, please visit the following websites:

1. www.webmd.com
2. www.vascularweb.org
3. www.heart.org
4. www.emedicinehealth.com

The University Vein Center provides comprehensive evaluation and management for patients with lower-extremity venous disease and leg swelling. Our physicians are specialists in the field of venous surgery and are truly on the forefront of technology when it comes to the treatment of varicose veins, leg fatigue, leg swelling and leg ulcers. Our vein center is focused on patient satisfaction in a pleasant atmosphere. We have led the way in New Jersey in the performance of minimally invasive vein surgery, and we take pride in our results and our high patient satisfaction rate. All procedures are performed minimally invasively. Our treatment of patients with venous ulceration is second to none, as we have published management guidelines for optimal treatment of these patients.

Special Treatments or Services

• Off-site office location in Monroe Township
• Vascular Lab services on site
• Minimally invasive venous procedures
• Endovenous radiofrequency saphenous vein ablation — the Venefit procedure
• Minimally invasive varicose vein removal
• Injection sclerotherapy for spider veins
• Expert treatment for venous ulcers

Venous Disease and Varicose Veins

Vein disease is estimated to be seven to 10 times more common than arterial disease. More than 25 million Americans suffer from symptoms related to diseases of the venous system. Risk factors leading to the development of vein problems include family history of vein disorders, the female sex, previous blood clots, advancing age, obesity and prolonged standing. Females with multiple previous pregnancies are also at a higher risk. Common symptoms of venous disease include leg heaviness, leg fatigue, swelling, varicose veins, spider veins and ulcerations. The most common cause of these symptoms is a dysfunction of the valves in the veins in the legs, especially the main superficial vein called the Saphenous vein.

Venous disease can result from either venous thrombosis or clotting, or valvular reflux. Both processes lead to damaged and/or dysfunctional valves causing pooling of blood in the venous system, which in turn, causes varicose veins, swelling and discomfort.

Treatment for venous disease has changed dramatically over the last five to 10 years. In the past, surgical procedures required general anesthesia, large incisions and long recoveries. All venous procedures are now performed with minimally invasive techniques. Venous surgery is now incision-less and painless. The majority of procedures are performed with only minimal sedation and local anesthesia, all are outpatient procedures, and there is rapid recovery and early return to work. A significant number of procedures are office-based procedures, occurring in a pleasant atmosphere in an office suite.

Sclerotherapy is the treatment of choice for smaller varicose veins and spider veins. It is much more effective than skin laser treatments. It is also painless. The sclerosant solution irritates the vein, causing an occlusion and re-absorption of the vein. The process occurs over a few weeks, and most patients have excellent results. The surgeons perform these procedures in their office, as they do not require anesthesia. There is no specific recovery period. Patients can return to work the same or following day.

For more information about varicose veins, venous disease and the minimally invasive Venefit Procedure (previously known as the VNUS Closure Procedure), please visit the following websites:

1. www.emedicinehealth.com
2. www.vascularweb.org
3. covidien.com

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