NMMC Expands Vascular Services
TUPELO, Miss.—Since 1981, North Mississippi Medical Center has been known as the leader in heart care in north Mississippi and a pioneer in cardiac services across the state and nation.
Now with three vascular surgeons on staff, NMMC has extended its expertise and launched the NMMC Heart and Vascular Institute. The three vascular surgeons—Drs. Sourabh Mukherjee, Joey Stinson and Justin Parden—practice at Cardiothoracic and Vascular Surgery Clinic, located on the fourth floor of NMMC’s East Tower, and perform a variety of procedures at NMMC.
The body’s amazing vascular system is made up of vessels that carry blood throughout the body. Arteries carry oxygen-rich blood away from the heart, while veins carry oxygen-poor blood back to the heart. Blood leaves the left side of the heart and is pumped out to the rest of the body. The main artery from the heart is called the aorta.
As we age, our arteries tend to thicken, get stiffer and narrow—a processed called arteriosclerosis. When plaque builds up and narrows the blood vessels leading to the heart, it can cause a heart attack.
The same situation in the arteries leading to the brain can cause strokes. Narrowing of the arteries in other places, such as the legs, can cause Peripheral Arterial Disease and lead to sores, pain with walking or amputation. Dilation of these arteries is an aneurysm.
Complete Carotid Care
Carotid arteries occur when plaque builds up in the main blood vessels to the brain. Eighty percent of strokes are “ischemic strokes,” where part of the circulation to the brain is cut off, usually by blockages in the carotid arteries.
Vascular surgeon Joey Stinson, M.D., says they help prevent stroke with two main types of procedures. “In a carotid endarterectomy, we remove the plaque from the artery through a neck incision then repair the artery using a graft from vein elsewhere in the body or a woven patch,” he says. “The other option is carotid stenting, a minimally invasive procedure where we place a small, expandable tube called a stent in the narrowed artery.”
An aortic aneurysm is an enlargement or “bulge” that develops in a weakened area within the largest artery in the body. These can happen in the abdomen (abdominal aortic aneurysm) or in the chest (thoracic aortic aneurysm). “Untreated, an aneurysm can burst and cause death,” Dr. Stinson says.
Vascular surgeons perform two types of aneurysm repair—endovascular (or minimallyinvasive) and open surgery.
“With open surgery, we make an abdominal incision and remove the aneurysm then sew a graft in place to reestablish blood flow,” Dr. Stinson says. “In the minimally-invasive procedure, we don’t remove anything. Instead we use a catheter to place a stent graft to reinforce the wall of the aorta from the inside and help keep the damaged area from rupturing.”
Most lower limb loss in Mississippi is caused by peripheral arterial disease (PAD) or diabetes.
PAD occurs when atherosclerosis, or hardening of the arteries, causes a buildup of plaque in the blood vessels that carry oxygen and nutrients to all the tissues of the body. As these plaques worsen, they reduce essential blood flow to the limbs and can even cause complete blockages of the arteries, resulting in amputation.
“Early diagnosis and treatment is key to being able to spare a person’s limbs,” says vascular surgeon Justin Parden, M.D.
The most conservative treatment is lifestyle changes—exercise, smoking cessation, healthy eating and medical management.
Vascular surgeons offer three minimally-invasive procedures—artherectomy, balloon angioplasty and stents. Artherectomy uses a catheter with a blade on the end to remove plaque from a blood vessel. In balloon angioplasty, a catheter is guided to the narrowed artery then a balloon is inflated to open up the artery. Sometimes a tiny stent will be placed to hold the artery open and reduce the risk of it narrowing again.
For patients who are not good candidates for a minimally-invasive approach, open surgery may be required. “In a traditional open surgical bypass, we create an alternate route to circumvent the area of blockage,” Dr. Parden says. “We take a graft or vein from elsewhere in the body and stitch it in place to restore blood flow to the lower leg and foot.”
If blood thickens in a clump that becomes solid, a clot forms. “If a piece of the clot breaks off, it could travel to the lungs and make breathing difficult, or even cause death,” says vascular surgeon Sourabh Mukherjee, M.D. “DVT is usually treated with medications called blood thinners.”
Vascular surgeons offer catheter directed thrombolytic therapy for clots in the leg, thigh or pelvis which are apt to travel. This procedure uses a catheter to deliver drugs called lytics or “clot busters” directly to the site of the clot.
In certain situations, they perform a minimally-invasive procedure known as venous stenting. “We insert a catheter and open a small balloon in the blocked or narrowed vein to open it wider,” Dr. Mukherjee says. “Then we place a stent to keep the vein open.”
If a person’s kidneys fail, his body is unable to clean and filter his blood. When kidney function falls below a certain threshold, dialysis is needed. Vascular surgeons offer dialysis access in two ways.
“We can create an AV fistula by taking a nearby vein and sewing it to a nearby artery. Over time the vein develops into a usable fistula,” Dr. Mukherjee explains. “If a person’s veins are too small for an AV fistula, we can create an AV graft by sewing a prosthetic graft between an artery and vein in the arm or leg.”
For more information, call 1-800-THE DESK (1-800-843-3375).