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Vascular Surgery – What It Is and How It Can Help
Learn from Dr. Stephen Hoenig about what vascular surgery is, and how it helps people live healthier lives.
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Learn more about Stephen Hoenig, MD
Stephen Hoenig, MD
Stephen J. Hoenig is board-certified in vascular surgery and has special certification in vascular imaging, endovascular interventions, and advanced wound care. Born and raised in Massachusetts, he finished his undergraduate studies at Massachusetts Institute of Technology and then received his medical degree from the Columbia College of Physicians and Surgeons.Learn more about Stephen Hoenig, MD
Transcription:
Vascular Surgery – What It Is and How It Can Help
Scott Webb: Vascular disease includes any condition that affects your circulatory system or system of blood vessels. And we're going to learn more today about vascular disease and the minimally invasive surgical options from Dr. Steven Honig.
Scott Webb (Host): He's the chair of the Department of surgery at Emerson Hospital and surgeon in the Vascular care group.
Scott Webb: This is the Health Works here podcast for Emerson Health. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about vascular disorders and things related to that. If we have time, maybe we'll do a little sort of a 101 at the end here. Maybe talk about the difference between artery and a vein, which I'm sure some of us think we know, but great to have your expertise. But before we get there, what are vascular disorders and who gets them?
Dr. Stephen Hoenig: Vascular disorders, many people think of diseases of the vascular system, they think of the heart. But the heart is largely managed by cardiologists and cardiac surgeons. When people have problems in the arteries and veins in their head, that often is deferred to neurosurgeons and neurologists. And all of the other arteries in the body, in the neck, in the arms, in the abdomen, in the legs, all are the responsibilities of the vascular surgeon. There are a large number of vascular surgeons compared to another field called vascular medicine where they handle purely the medical part of vascular disease.
Scott Webb: So what are some of the disorders then? Let's talk about that. The typical disorders that folks get. Who gets them? Why do they get them? Are we talking maybe behavior, lifestyle, family history, the whole kitten caboodle, yeah?
Dr. Stephen Hoenig: You know, when you break up vascular disease, in my practice at least, a lot of people have varicose veins and vein problems, and that is a population of people that tend to be younger. A lot of women after they have children, but also a lot of men develop big, prominent veins that can be very uncomfortable along with spider veins. And we handle a lot of those kinds of things.
But by and large, the largest part of my practice is dealing with people who have artery problems. And that tends to be a different population than the varicose vein problems because those patients are generally either older or they suffer from diabetes mellitus, or they suffer from a habit, which many people still do, which is cigarette abuse or cigarette use. And so, we spend a lot of time trying to optimize people's lifestyles. We spend a lot of time trying to encourage people to live better, to stop smoking, to control their diabetes and in so doing maybe exercise more, try to walk through discomforts.
And so the kind of problems that develop are two types of problems in the arteries. One is a blockage of the artery and the other is the opposite, which is aneurysmal dilatation or when the artery gets bigger. And those problems, when you have a narrowing, you have poor blood flow to different organs. But when you have an artery getting bigger, it can lead to it getting bigger and bigger, and then potentially even popping, causing what's called a rupture, and that can often be life-threatening.
And then, we also deal with some other things, such as when people have end-stage renal disease, end-stage kidney disease, and they need to be on dialysis, and the vascular surgeons will help establish access so that people can have dialysis on a regular basis. And then, vascular surgeries, the type of treatments that I learned when I was in training was big open surgeries. We would do a lot of open, big surgeries, and that's one of the things that drew me to vascular surgery because it's a highly technical field in repairing arteries. But it's also, it turns out, an evolving field where now, there's less open surgery and more minimally invasive surgery.
So like in every specialty, Scott, there's this move towards trying to have procedures that are less invasive and less uncomfortable to do. When we talk about orthopedic surgery, you know, we talk about doing things arthroscopically or when we talk about bariatric surgery or any kind of general surgery, we talk about laparoscopic surgery. Well, in vascular surgery, we do a lot of endovascular surgery where we put needles into vessels with small incisions. And then, we manipulate and go throughout the body with wires and catheters and balloons and clean out arteries and put in stent grafts and all sorts of things so that patients can barely feel what we're doing. And so, the field has evolved enormously in the last 24 years since I started my practice.
Scott Webb: Yeah, I'm sure it has. And before things get too far away from us, I'd sort of teased there, get an understanding of the difference between arteries and veins and you've mentioned both there. And you know, it's one of those things where I think I know the difference, but I know you know for sure. So what's the difference between artery and a vein, doctor?
Dr. Stephen Hoenig: so An artery is a blood vessel, a tube, that brings blood from the heart out to the toes or to the brain cells or to the fingertips. And the veins are blood vessels that carry blood back. And the major difference there is that when the heart pumps, it carries kinetic energy. The blood is hopping, it's going really fast and it's highly pressurized. The pressure of blood as it leaves the heart is what your blood pressure is, usually like 120/80, like everybody knows blood pressure measurements, and that's the pressure in an artery. But when the blood gets to the toes or the ear lobes or wherever it's going, by the time it gets there, it's lost all of the kinetic energy and it's just sitting there. And so you may say, "Well, gosh, how does blood get back from those places back?"
Scott Webb: Exactly right. How's it do that?
Dr. Stephen Hoenig: Well, the only way it does that is there's this complicated system of valves in the veins and the muscles. The veins are often within the muscles of the body. And when the muscle squeezes, blood goes every which direction, but the valves direct the blood back to the heart. For instance, if you're sitting on an airplane for a long period of time, your legs may get a little swollen, but that's because your muscles aren't pumping. And gravity is dropping blood down into your toes and the blood doesn't get adequately back to the heart. And there are all sorts of disorders and the veins when those valves don't work and where blood can't get back up to the heart effectively. So that's the major difference.
The other big difference is that veins are thin-walled, very soft structures, like, if you look on your hands, you see veins there. Those are veins. And arteries tend to be thicker-walled, smaller vessels that carry highly pressurized blood from the heart back out to the fingertips.
Scott Webb: Well, are there other things that we can do to avoid vascular problems? I know we cannot outrun our family history and quitting smoking would be at the top of the list, but are there some other things?
Dr. Stephen Hoenig: There are. I mentioned that the three big actors in the world of artery problems is smoking, a long history of smoking. And, you know, just to put in a little bit of a plug for this, if you've smoked 50 years in your life, there are a lot of people who say to me, "Well, gosh, doc, I've been smoking 50 years. It's not going to do anything now if I quit." And that's not true. There's actually very good data to suggest that even if you quit right now, there's a great benefit. It may not lead to a healthy, completely clean body, but at least it may not lead to progression of the disease. Like you're living with what you have now and that's good, but it might not get worse.
So the other thing is diabetes, which is a huge problem in this country and all over the world and, in large part, much of the diabetes is related to being overweight. You know, that's kind of the bottom line, is certainly being very overweight leads to diabetes. It can be poorly controlled and, when that happens, vascular diseases follows pretty closely.
And you can't do anything obviously about age, that's just one of those things. But as the population is getting older, we take care of a lot of people who have advanced age. I have a healthy spritely, wonderful 9- year-old woman who comes into my office with a problem. You know, that 95-year-old might in fact be a whole lot healthier than some of the 55-year-old people. You don't get to 95 years old if you don't have a good DNA. So I don't rule out people for intervention just on the basis of their age. But however, you know, it's not uncommon if I'm going to do an operation, the same people who get the diseases, the artery diseases, that I work with may also have heart disease, you know, or lung disease. And so, sometimes I will work very closely with the heart doctors, the cardiologists, to make sure that they're going to get through an operation, that they won't have a heart attack, for instance, in the middle of one of my operations
Scott Webb: Yeah, I'm sure it is very collaborative, multidisciplinary, interdisciplinary. One of the things I wanted to ask while I've still got some time here, is you mentioned stents earlier and some of the things you do, the interventions you can do to help folks. What is a stent exactly?
Dr. Stephen Hoenig: Well, a stent is a certain type of metal that you insert into the body, but it's really small, like the size of a piece of spaghetti. And when it's so small, it can enter into the artery through a tiny little hole. And then, the stent is designed such that when it gets to the place you want to put it, you can make it bigger. So you can make it bigger, either by a balloon that's inside of the stent expanding and pushing it open to a size that you want to make it like a stainless steel stent, or there are stents made of a nickel-containing element called Nitinol, which has a memory to it. And you actually deliver it in a covering. And then, when you deliver the covering, the stent opens up to its predetermined size.
The really beauty of stents is that, for instance, we used to do big open aneurysm repairs where we would open up people's abdomens and repair and replace the aorta. And it was a good operation, but the patient would often stay in the hospital for a week after the procedure. It might take a couple months to recover. And now, we have a procedure where we insert through the groin, the femoral artery and the groin. And then, we advance it and put it into the abdominal aorta from the inside and open it up and it sort of realigns the abdominal aorta with this new pipe. And it's a procedure that can be done awake, and patients go home. They probably could go home the same day with minimal discomfort, no big open incisions. And they go right back to their standard activity level. So this is a technology that's been around a little while. Emerson and I started doing this procedure 18 years ago in 2004, and we've been doing it ever since.
And there's another type of stent that is a new technology where instead of doing an open operation in the neck to clean out the carotid arteries, we now can put stents in the carotid artery safely by reversing the flow in the carotid arteries so that little pieces of clot don't go up into the brain.
These are all very technical things, but technology's changing really fast. And these endovascular advancements in technology have really helped us greatly and helped the patients, of course, first.
Scott Webb: You know, doctor, we're talking today about vascular disorders and arteries and veins and so much good stuff. But let's talk a little bit about wounds and wound care.
Dr. Stephen Hoenig: Well, I'm glad you asked that question. Emerson Hospital has helped me set up a wound care center, which I'm the medical director of. And often, patients come to me with vascular disease in the arteries or the veins, and subsequently develop very significant wounds in their feet and their lower legs. So we have all sorts of technology, including special types of skin grafts. We have hyperbaric therapy, which is highly concentrated oxygen therapy to help people heal their wounds. So with the help of this, these specialized nurses and technicians, we're able to bring wounds to complete healing. Sometimes it involves coming to the clinic on a regular basis. But at the end of the day, if we can save a leg, save a foot, save a toe, then we feel like we've really done something special for that patient.
Scott Webb: Yeah. And it's amazing to me we get the experts on from Emerson Health and you make it sound so easy. And yet, I know there's years and decades of science, technology and training on your part. It's really amazing. So much great information today, doctor. Thanks so much. You stay well.
Dr. Stephen Hoenig: Thank you very much for inviting me on your show.
Scott Webb: And visit emersonhealth.org for more information or to make an appointment. And thanks for listening to Emerson's Health Works Here podcast. I'm Scott Webb. And make sure to catch the next episode by subscribing to the Health Works Here Podcast on Apple, Google, Spotify, or wherever podcasts can be heard.
Vascular Surgery – What It Is and How It Can Help
Scott Webb: Vascular disease includes any condition that affects your circulatory system or system of blood vessels. And we're going to learn more today about vascular disease and the minimally invasive surgical options from Dr. Steven Honig.
Scott Webb (Host): He's the chair of the Department of surgery at Emerson Hospital and surgeon in the Vascular care group.
Scott Webb: This is the Health Works here podcast for Emerson Health. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about vascular disorders and things related to that. If we have time, maybe we'll do a little sort of a 101 at the end here. Maybe talk about the difference between artery and a vein, which I'm sure some of us think we know, but great to have your expertise. But before we get there, what are vascular disorders and who gets them?
Dr. Stephen Hoenig: Vascular disorders, many people think of diseases of the vascular system, they think of the heart. But the heart is largely managed by cardiologists and cardiac surgeons. When people have problems in the arteries and veins in their head, that often is deferred to neurosurgeons and neurologists. And all of the other arteries in the body, in the neck, in the arms, in the abdomen, in the legs, all are the responsibilities of the vascular surgeon. There are a large number of vascular surgeons compared to another field called vascular medicine where they handle purely the medical part of vascular disease.
Scott Webb: So what are some of the disorders then? Let's talk about that. The typical disorders that folks get. Who gets them? Why do they get them? Are we talking maybe behavior, lifestyle, family history, the whole kitten caboodle, yeah?
Dr. Stephen Hoenig: You know, when you break up vascular disease, in my practice at least, a lot of people have varicose veins and vein problems, and that is a population of people that tend to be younger. A lot of women after they have children, but also a lot of men develop big, prominent veins that can be very uncomfortable along with spider veins. And we handle a lot of those kinds of things.
But by and large, the largest part of my practice is dealing with people who have artery problems. And that tends to be a different population than the varicose vein problems because those patients are generally either older or they suffer from diabetes mellitus, or they suffer from a habit, which many people still do, which is cigarette abuse or cigarette use. And so, we spend a lot of time trying to optimize people's lifestyles. We spend a lot of time trying to encourage people to live better, to stop smoking, to control their diabetes and in so doing maybe exercise more, try to walk through discomforts.
And so the kind of problems that develop are two types of problems in the arteries. One is a blockage of the artery and the other is the opposite, which is aneurysmal dilatation or when the artery gets bigger. And those problems, when you have a narrowing, you have poor blood flow to different organs. But when you have an artery getting bigger, it can lead to it getting bigger and bigger, and then potentially even popping, causing what's called a rupture, and that can often be life-threatening.
And then, we also deal with some other things, such as when people have end-stage renal disease, end-stage kidney disease, and they need to be on dialysis, and the vascular surgeons will help establish access so that people can have dialysis on a regular basis. And then, vascular surgeries, the type of treatments that I learned when I was in training was big open surgeries. We would do a lot of open, big surgeries, and that's one of the things that drew me to vascular surgery because it's a highly technical field in repairing arteries. But it's also, it turns out, an evolving field where now, there's less open surgery and more minimally invasive surgery.
So like in every specialty, Scott, there's this move towards trying to have procedures that are less invasive and less uncomfortable to do. When we talk about orthopedic surgery, you know, we talk about doing things arthroscopically or when we talk about bariatric surgery or any kind of general surgery, we talk about laparoscopic surgery. Well, in vascular surgery, we do a lot of endovascular surgery where we put needles into vessels with small incisions. And then, we manipulate and go throughout the body with wires and catheters and balloons and clean out arteries and put in stent grafts and all sorts of things so that patients can barely feel what we're doing. And so, the field has evolved enormously in the last 24 years since I started my practice.
Scott Webb: Yeah, I'm sure it has. And before things get too far away from us, I'd sort of teased there, get an understanding of the difference between arteries and veins and you've mentioned both there. And you know, it's one of those things where I think I know the difference, but I know you know for sure. So what's the difference between artery and a vein, doctor?
Dr. Stephen Hoenig: so An artery is a blood vessel, a tube, that brings blood from the heart out to the toes or to the brain cells or to the fingertips. And the veins are blood vessels that carry blood back. And the major difference there is that when the heart pumps, it carries kinetic energy. The blood is hopping, it's going really fast and it's highly pressurized. The pressure of blood as it leaves the heart is what your blood pressure is, usually like 120/80, like everybody knows blood pressure measurements, and that's the pressure in an artery. But when the blood gets to the toes or the ear lobes or wherever it's going, by the time it gets there, it's lost all of the kinetic energy and it's just sitting there. And so you may say, "Well, gosh, how does blood get back from those places back?"
Scott Webb: Exactly right. How's it do that?
Dr. Stephen Hoenig: Well, the only way it does that is there's this complicated system of valves in the veins and the muscles. The veins are often within the muscles of the body. And when the muscle squeezes, blood goes every which direction, but the valves direct the blood back to the heart. For instance, if you're sitting on an airplane for a long period of time, your legs may get a little swollen, but that's because your muscles aren't pumping. And gravity is dropping blood down into your toes and the blood doesn't get adequately back to the heart. And there are all sorts of disorders and the veins when those valves don't work and where blood can't get back up to the heart effectively. So that's the major difference.
The other big difference is that veins are thin-walled, very soft structures, like, if you look on your hands, you see veins there. Those are veins. And arteries tend to be thicker-walled, smaller vessels that carry highly pressurized blood from the heart back out to the fingertips.
Scott Webb: Well, are there other things that we can do to avoid vascular problems? I know we cannot outrun our family history and quitting smoking would be at the top of the list, but are there some other things?
Dr. Stephen Hoenig: There are. I mentioned that the three big actors in the world of artery problems is smoking, a long history of smoking. And, you know, just to put in a little bit of a plug for this, if you've smoked 50 years in your life, there are a lot of people who say to me, "Well, gosh, doc, I've been smoking 50 years. It's not going to do anything now if I quit." And that's not true. There's actually very good data to suggest that even if you quit right now, there's a great benefit. It may not lead to a healthy, completely clean body, but at least it may not lead to progression of the disease. Like you're living with what you have now and that's good, but it might not get worse.
So the other thing is diabetes, which is a huge problem in this country and all over the world and, in large part, much of the diabetes is related to being overweight. You know, that's kind of the bottom line, is certainly being very overweight leads to diabetes. It can be poorly controlled and, when that happens, vascular diseases follows pretty closely.
And you can't do anything obviously about age, that's just one of those things. But as the population is getting older, we take care of a lot of people who have advanced age. I have a healthy spritely, wonderful 9- year-old woman who comes into my office with a problem. You know, that 95-year-old might in fact be a whole lot healthier than some of the 55-year-old people. You don't get to 95 years old if you don't have a good DNA. So I don't rule out people for intervention just on the basis of their age. But however, you know, it's not uncommon if I'm going to do an operation, the same people who get the diseases, the artery diseases, that I work with may also have heart disease, you know, or lung disease. And so, sometimes I will work very closely with the heart doctors, the cardiologists, to make sure that they're going to get through an operation, that they won't have a heart attack, for instance, in the middle of one of my operations
Scott Webb: Yeah, I'm sure it is very collaborative, multidisciplinary, interdisciplinary. One of the things I wanted to ask while I've still got some time here, is you mentioned stents earlier and some of the things you do, the interventions you can do to help folks. What is a stent exactly?
Dr. Stephen Hoenig: Well, a stent is a certain type of metal that you insert into the body, but it's really small, like the size of a piece of spaghetti. And when it's so small, it can enter into the artery through a tiny little hole. And then, the stent is designed such that when it gets to the place you want to put it, you can make it bigger. So you can make it bigger, either by a balloon that's inside of the stent expanding and pushing it open to a size that you want to make it like a stainless steel stent, or there are stents made of a nickel-containing element called Nitinol, which has a memory to it. And you actually deliver it in a covering. And then, when you deliver the covering, the stent opens up to its predetermined size.
The really beauty of stents is that, for instance, we used to do big open aneurysm repairs where we would open up people's abdomens and repair and replace the aorta. And it was a good operation, but the patient would often stay in the hospital for a week after the procedure. It might take a couple months to recover. And now, we have a procedure where we insert through the groin, the femoral artery and the groin. And then, we advance it and put it into the abdominal aorta from the inside and open it up and it sort of realigns the abdominal aorta with this new pipe. And it's a procedure that can be done awake, and patients go home. They probably could go home the same day with minimal discomfort, no big open incisions. And they go right back to their standard activity level. So this is a technology that's been around a little while. Emerson and I started doing this procedure 18 years ago in 2004, and we've been doing it ever since.
And there's another type of stent that is a new technology where instead of doing an open operation in the neck to clean out the carotid arteries, we now can put stents in the carotid artery safely by reversing the flow in the carotid arteries so that little pieces of clot don't go up into the brain.
These are all very technical things, but technology's changing really fast. And these endovascular advancements in technology have really helped us greatly and helped the patients, of course, first.
Scott Webb: You know, doctor, we're talking today about vascular disorders and arteries and veins and so much good stuff. But let's talk a little bit about wounds and wound care.
Dr. Stephen Hoenig: Well, I'm glad you asked that question. Emerson Hospital has helped me set up a wound care center, which I'm the medical director of. And often, patients come to me with vascular disease in the arteries or the veins, and subsequently develop very significant wounds in their feet and their lower legs. So we have all sorts of technology, including special types of skin grafts. We have hyperbaric therapy, which is highly concentrated oxygen therapy to help people heal their wounds. So with the help of this, these specialized nurses and technicians, we're able to bring wounds to complete healing. Sometimes it involves coming to the clinic on a regular basis. But at the end of the day, if we can save a leg, save a foot, save a toe, then we feel like we've really done something special for that patient.
Scott Webb: Yeah. And it's amazing to me we get the experts on from Emerson Health and you make it sound so easy. And yet, I know there's years and decades of science, technology and training on your part. It's really amazing. So much great information today, doctor. Thanks so much. You stay well.
Dr. Stephen Hoenig: Thank you very much for inviting me on your show.
Scott Webb: And visit emersonhealth.org for more information or to make an appointment. And thanks for listening to Emerson's Health Works Here podcast. I'm Scott Webb. And make sure to catch the next episode by subscribing to the Health Works Here Podcast on Apple, Google, Spotify, or wherever podcasts can be heard.