SALISBURY – In an effort to expand available services, the Salisbury VA Medical Center has recently begun offering vascular services at the facility. Inpatient and outpatient consultations began in December and the first vascular surgeries were completed in January.
The field of vascular surgery is one that involves all of the blood vessels outside of the heart and the brain.
Dr. Randolph Geary, a vascular surgeon at the Salisbury VA and professor of surgery at Wake Forest University, said there are five major vascular diseases surgeons tend to see at any medical center, starting with carotid artery disease.
“Carotid disease affects the arteries in your neck that provide blood flow to the brain,” said Geary. “That’s a common place for people to see hardening of the arteries as we age, and it can put you at risk for a stroke.”
Peripheral Artery Disease (PAD), another major area of vascular disease, refers to blocked arteries in the extremities and is generally seen in the legs, according to Geary.
“With PAD, a patient tries to walk and can’t walk as far as they want because of the pain. This is because their muscles have run out of blood flow and oxygen causing them to hurt,” he explained. “Also, if they have wounds, ulcers or recent surgeries, say on their feet, and don’t have normal blood flow, that creates a situation where we need to improve the circulation to avoid a future amputation. This is seen commonly with diabetes, kidney failure, and just hardening of the arteries in general.”
Aneurysms are the third major item vascular doctors tend to deal with, said Geary
“We see a lot of patients who have dilated arteries – that’s what an aneurysm is. The majority of them occur in the abdomen in the biggest artery in the body, called the aorta,” he said. “It’s a common problem for people as they age, particularly in smokers. A lot of veterans are screened for aneurysms with ultrasound, and they typically don’t know they have one until it shows up on a screening.”
“We try to find the aneurysms before they get too large and have them repaired. We aren’t currently performing aortic aneurysm repairs here yet, but we have equipment on order that will give us that capability,” added Geary. “We are able to repair aneurysms in other locations at Salisbury, including aneurysms of the artery that is behind the knee.”
The fourth common vascular problem, according to Geary, is venous disease.
“It’s very common for people to have veins in their legs that don’t work – they may have had varicose veins or they’ve had blood clots in their legs before and can develop ulcers at the ankle that won’t heal. Some of these patients can be helped with a procedure to laser shut a leaky vein and we will be doing these procedures at some point. It’s a program where we need to get in more equipment as well,” he said.
Providing dialysis patients with access points are the fifth common vascular procedure, said Geary.
“We are seeing dialysis patients that need access for treatment. It’s a surgical procedure to typically create a fistula for a patient on dialysis by connecting to an artery in their arm,” he said.
“We’re doing access surgeries for dialysis now; we’ve also done surgeries to bypass blocked arteries in a leg to help the patient heal a wound on the foot that wasn’t healing. We have also treated aneurysms in the leg, and soon we will be performing balloon angioplasty procedures and placing stents that go along with by-pass surgeries as well,” he added.
Geary is currently working at the Salisbury VAMC two days a week. He said he’s been enjoying the opportunity to take care of veterans again.
“I did a lot of my training in medical school, and then as a general surgery resident and vascular surgery fellow working at the Puget Sound VA, which has a big catchment area and a very sophisticated vascular program,” he said. “I’ve had many great experiences working with Veterans. Unfortunately, as we age, vascular problems become more and more common, but treating them is what we’re trained to do and what we’re here for. They’re grateful that we’re here trying to help them out.”
Kaye Green, director of the Salisbury VAMC, said she is proud to be able to provide new programs to the Veterans Salisbury VAMC serves.
“We have been working diligently over the past two years to increase our clinical capabilities and offer more complex care, which is what our significant Veteran population deserves,” she said. “I am very pleased with Dr. Geary’s leadership in getting our vascular surgery program up and running. I’m equally pleased with our plans to start providing orthopedic joint replacements in the very near future with Dr. Christopher Nagy, who joined VA from the community.”
“By establishing these programs at the Salisbury VA, we avoid having to refer veterans to other VA facilities such as Durham or Asheville for care that we would like to provide closer to their homes,” she added. “We are committed to the continued expansion of our clinical capability into the future to provide the best care possible to Salisbury-area veterans.”