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12.03.2013

Vascular and Endovascular Surgery Division Transforms Treatments, Research and Training

Under the leadership of Omaida C. Velazquez, M.D., the Division of Vascular and Endovascular Surgery is coming of age at the University of Miami Miller School of Medicine. From a diverse faculty trained in the latest minimally invasive technologies, to leading edge vascular treatments, the division’s six-year transformation is now fulfilling its tripartite mission of advancing vascular health and treatments for our community, boosting research efforts in innovative therapies and educating the next generation of physicians.

The division’s diverse clinical faculty of nine dually board-certified general and vascular and endovascular surgeons and two research faculty members is the largest in South Florida and the only team to have an ACGME-certified Vascular & Endovascular training program.

“When you look at the faces of our doctors, they match the faces of our community, and I’m very proud of that,” said Velazquez, professor of surgery and division chief, and holder of the David Kimmelman Endowed Chair in Vascular and Endovascular Surgery.

The intricacies of vascular surgery, open reconstruction of the arteries and veins, and endovascular surgery, a minimally invasive catheter-based reconstruction, take more than just a steady hand. Surgeons must also possess the advanced knowledge and skill to provide comprehensive care for some of the most complex cases, including thoracoabdominal aortic aneurysms, aortic dissections, peripheral and visceral artery aneurysms and cerebrovascular disease, which is the third leading cause of death in the nation.

“Since our arteries and veins are connected from head to toe, repair can be extensive and multi-level,” said Velazquez. “By combining expertise in vascular and endovascular surgery, patients who otherwise would face grim outcomes, such as amputation, end up receiving some very extraordinary treatment and get a full and durable repair.”

Vascular-related diseases may be less well known than those of the heart, brain or eyes, but proper function of the spindly, blood-carrying tubes is just as essential. In fact, vascular disease, often a “silent killer,” is quite common, affecting millions of people annually.

Imagine enjoying a picnic with friends and family when suddenly, the left side of your face goes numb, your vision is obscured and you can’t tell anyone what is happening. Such is the case with carotid artery disease, in which fatty, waxy deposits called plaques slowly clog your carotid arteries in the neck area, shedding dangerous debris that block blood flow to the brain and ultimately cause a stroke.

One way to repair a clogged carotid artery is to make an incision in the neck and perform an open carotid endarterectomy or surgical removal of the plaque, a procedure in which vascular surgeons are skilled. However, the endovascular approach is an equally routine tool for the vascular surgeon and can accomplish the same goal. Performed from the inside using special catheters, stents and grafts, it protects the brain while widening and reinforcing the artery. Such a catheter-based method is indicated in some patients, thus minimizing operative complications. Endovascular’s minimally invasive methods to repair enlarged arteries such as aortic aneurysms can be offered to many patients, depending on the anatomy involved, helping prevent future rupture, minimizing pain, decreasing major complications, and speeding recovery time.

“The surgical approach used depends not only on the specific anatomy of the patient, but on the level of physician training and the availability of technology at any given facility,” said Velazquez, who is also Executive Dean for Research, Research Education and Innovative Medicine. “We pride ourselves on offering minimally invasive options whenever possible. Patients are able to recover faster and have fewer complications, so more than 75 percent of the surgeries we do are endovascular.”

Velazquez and her talented and caring team of board certified vascular surgeons – Arash Bornak, M.D., assistant professor of surgery; Lee Goldstein, M.D., assistant professor of surgery; Keith Jones, M.D., assistant professor of surgery; John Karwowski, M.D., associate professor of surgery; Alberto Lopez, M.D., assistant professor of surgery; Jorge Rey, M.D., assistant professor of surgery; Handel Robinson, M.D., assistant professor of surgery; and Marwan Tabbara, M.D., assistant professor of surgery – offer patients traditional open surgical approaches, catheter-based endovascular treatments and also are furthering treatment through regenerative medicine technology.

Innovative treatments are offered to patients under clinical protocols and new non-surgical cures for vascular diseases are explored in collaboration with accomplished scientists on Velazquez’s team—research associate professors of surgery Roberto Vazquez-Padron, Ph.D., and Zhao-Jun Liu, M.D., Ph.D.

Through a clinical trial that is NIH- and industry-funded and FDA-approved, in partnership with the Miller School’s Interdisciplinary Stem Cell Institute, the team is using adult marrow stem cells to improve blood circulation in patients with peripheral artery disease (PAD) and critical limb ischemia (CLI), a disease that starts with symptoms of leg pain while walking and progressively clogs off blood vessels, ultimately leading to the loss of leg function and amputation. PAD and CLI are common manifestations of atherosclerosis, which is buildup of plaque, cholesterol, calcium and lipids inside the arterial tree.

Extracted from patients’ own bone marrow, the stem cells are injected into the affected area, where it is believed they will release growth factors and proteins to regenerate blood vessels and other pro-repair functions.

“It’s very amazing physiology and biology,” said Velazquez. “In some patients – through very aggressive lifestyle modifications – blood vessels can regenerate naturally, but only about one-third are able to do that; two-thirds cannot.”

For those unlucky two-thirds, Velazquez says help is in sight thanks to the Miller School’s adult marrow-stem cell-based therapies, clinical trials and comprehensive care.

“We really have the A-Z of latest advances for vascular treatment,” she said, noting the range of available medicines, surgeries, stent-grafts, and now cell therapies. “We collaborate very closely with our cardiologists to provide treatments that decrease the progression of heart disease and we collaborate with our primary care physicians and endocrinologists to initiate medicines and lifestyle modifications that control co-morbidities, such as diabetes.” Pointing out the robust and talented team assembled, combined with the arsenal of therapies and research, Velazquez said, “Our first priority is keeping patients’ vascular systems healthy so that they can enjoy a longer, happier, higher quality of life.

“We’re ready to let the community know that UHealth is providing the most comprehensive, patient-centered vascular care in South Florida and beyond.”

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