Mike and Amy visited Kenneth Reese, MD, an internal medicine specialist in Knoxville. Dr. Reese ordered ultrasounds and made Mike an appointment with a vascular surgeon for consultation. The couple went to Fort Sanders Regional Medical Center in downtown Knoxville for the ultrasounds and were told to head straight to the emergency room to wait for the results.

The Danger of Blood Clots

It was more serious than they originally thought – the ultrasounds revealed multiple blood clots in Mike’s right leg. The blockages were preventing blood flow to the leg and foot. At Fort Sanders Regional Premier Surgical Vascular Surgeon Maksim Gusev, MD, immediately performed emergency surgery to prevent the blood clots from moving to his brain or heart and to establish blood flow to the right foot.

Dr. Gusev says, “Mr. Campbell presented with excruciating pain and motor weakness in his right foot, which had mild sensory weakness and no pulse. His left foot and the rest of his vasculature was normal.”

Because Mike is a smoker, he is predisposed to forming blood clots, which in his case occurred behind the knee. Dr. Gusev explains that the clots were blocking blood flow to the lower extremity and his right foot, causing numbness, pain and a gray color.

“The patient had profound neuro motor deficits, meaning the nerves and muscles were affected by the lack of oxygen. I performed an emergent revascularization to reestablish blood flow to his foot.” Dr. Gusev used an endovascular approach, which means he accessed the clots from within the blood vessels. The surgery allowed Dr. Gusev to remove the clots and clear out Mike’s arteries, opening up the narrowed areas to reestablish blood flow.

Minimally Invasive Surgery Helps Patient Avoid Amputation

“The nurse called me every hour with an update,” says Amy. “Finally, after the surgery was done, Dr. Gusev called me himself to give me the report that everything went well, but my husband needed to stay overnight for observation and healing.”

Mike spent one night in the intensive care unit at Fort Sanders Regional for observation. Dr. Gusev confirms immediate surgical intervention saved Mike’s foot from being amputated.

“My husband is a mechanic and works 10 to 12-hour days,” Amy says. “An amputation would have taken him out of work.”

“At Fort Sanders Regional, we have cutting-edge technology that is always changing and allowing us to treat the patient with minimally invasive intervention. This reduces complications and shortens recovery time and reduces pain during recovery,” says Dr. Gusev.

Dr. Gusev made an incision for one needle access point in the groin and then two incisions in the calf muscle to “let it breathe.” The two skin fascia incisions along Mike’s calf allowed for temporary swelling after injury. Dr. Gusev says, “The muscles in his foot were starved of oxygen for several days. When fresh blood and oxygen flood back in, the area swells up. We had to make room for this temporary swelling or else the nerves can suffocate and die afterward.”

The Campbells are from Florida and are fans of the University of Florida and its mascot, the Gator. Mike has a gator tattoo on his leg, right in the place where the incisions were made. Dr. Gusev ended up having to make an incision between the gator’s eyes and teeth, and later told his patient, “I did my best to keep the head intact, but your alligator now has crooked teeth!”

Mike was discharged to go home and instructed to rest for several days before returning to work. He had two follow-up appointments and is feeling great.

An Important First Step for Preventing Blood Clots

Dr. Gusev’s advice for preventing blood clots in adults? Quit smoking. He says, “People who smoke are predisposed to forming these clots, so my first recommendation is smoking cessation. If you cannot quit, then reducing tobacco use is advised. It’s also important to have frequent checkups and to know what to do if symptoms of blood vessel abnormality arise, like not being able to find your pulse in your foot.”

The Campbells are so thankful for the expert care they received at the hospital and would recommend it to any of their friends. “Dr. Gusev was amazing,” Amy says. “He was on top of things He has a great bedside manner and was very knowledgeable about everything that was happening. He saved Mike’s foot.”

Dr. Maksim Gusev is a Vascular Surgeon with Premier Vascular and Vein Center in Knoxville, TN. To request an appointment with Dr. Gusev call (865) 588-8229 or visit https://www.premiervascularveincenter.com/book-online/

The post Quick Vascular Intervention Saves Knox Man’s Foot first appeared on Premier Surgical.

The screenings will be held on Saturday, November 4th, 2023, from 8am – 12pm at Premier Vascular & Vein Center at 6408 Papermill Drive, Knoxville.

The event includes a painless vascular ultrasound that will check for 3 kinds of dangerous vascular disease: carotid artery disease, abdominal aortic aneurysms, and peripheral arterial disease.

“A lot of people may not realize they have vascular disease and untreated vascular disease can lead to deadly stroke and aneurysms,” explains Premier Vascular Surgeon Dr. Deanna Nelson. “We want to help those heroes who protect everyday us be proactive when it comes to their vascular health. That’s why we wanted to do these free vascular screenings for our veterans, fire, police and first responders.”

The screening is free, but you must reserve and schedule a spot beforehand. .

To register call (865) 588-8229 during business hours or visit: https://www.premiervascularveincenter.com/free-vascular-screening/

The post Free Vascular Screenings for Local Heroes first appeared on Premier Surgical.

Doris Dixon, Carotid Artery Surgery Patient

Diagnosed with carotid artery disease and peripheral artery disease, Pigeon Forge resident Doris Dixon often experienced skyrocketing blood pressure and could feel her heartbeat pounding in her ears. After feeling tightness in her chest, she was referred to Scott Callicutt, MD, a Premier Surgical vascular surgeon at Parkwest Medical Center.

Arterial disease occurs when plaque builds up over time in the arteries, preventing adequate blood flow to various parts of the body. Dr. Callicutt determined that she had severe 90 percent carotid stenosis, leaving her at high risk of stroke.

Dr. Callicutt recently performed a “textbook perfect” carotid artery surgery on Dixon, who says she couldn’t have had better people caring for her at Parkwest. “In the middle of a pandemic, they took care of me, even making me hot tea.”

Dixon was impressed with Dr. Callicutt’s confidence and explanation of everything that would happen. “I’ll put it this way,” she says. “No one else will touch an artery of mine except him.”

Dr. Scott Callicutt, Vascular Surgeon

During Dixon’s stent surgery, Dr. Callicutt used a new method called Transcarotid
Artery Revascularization, or TCAR. During the procedure, the direction of blood flow is reversed so that blood and stroke-causing plaque flows away from the brain
while the physician places the stent. After the stent is placed successfully, the flow of blood is reversed, resuming its normal direction.

Dr. Callicutt says Dixon’s age and anatomy made her an excellent candidate for the TCAR procedure. Dr. Callicutt says Dixon was at risk of a having a stroke and experiencing other complications, such as losing her vision, ability to speak or possible paralysis.

Dr. Callicutt explains, “Thanks to the evolution of this technology, with this procedure we are able to stent the carotid artery more safely than we’ve been able to do before, which protects the patient and reduces the risk of a stroke.”

The TCAR procedure prevents plaque from traveling to the brain during carotid artery surgery.

To her surprise, Dixon did not experience any pain following her procedure. “I had wonderful results, and recovery was easy,” she says. She spent one night at Parkwest after her procedure and was moving around the next day.

Dixon’s labs are normal and she no longer has to take prescription medications for her condition. She is able to tend her flower gardens, which fill her with great pride.

She expresses tremendous gratitude for the entire team of medical professionals
who cared for her, especially Dr. Callicutt. “He is exceptional, and so is everyone he’s connected with.”

Working Out the Kinks
Dr. Callicutt is passionate about helping his patients solve lifelong problems,
not just providing a temporary solution. He compares a blocked artery to a kink in a garden hose, stopping the flow and preventing the hose from delivering water to the grass.

The three highest risk factors for carotid or peripheral artery disease are diabetes, hypertension and smoking. As with any disease or chronic condition, doctors monitor patients with symptoms and recommend lifestyle habits such as not smoking and eating a healthy diet and exercising.

For more details about the TCAR procedure, visit our TCAR page at https://www.premiersurgical.com/tcar/.

The post New Procedure Opens Doors – and Arteries to Prevent Stroke first appeared on Premier Surgical.

TransCarotid Artery Revascularization or TCAR is a procedure that combines two previously known procedures – carotid endarterectomy or CEA, and carotid artery stenting or CAS.

Dr. Afshin Skibba, Vascular Surgeon

Premier Vascular Surgeon Dr. Afshin Skibba was the first to perform the TCAR technique at Fort Sanders Regional Medical Center in Knoxville. The hospital was recently recognized as a Center of Excellence for TCAR. There are only three facilities in the Tennessee and Mississippi region that have been awarded this prestigious recognition.

This recognition designates that Fort Sanders Regional stands out both in handling a significant volume of TCAR procedures, as well as having excellent TCAR outcomes.

To learn more about this procedure, we spoke with Dr. Skibba.

What is TCAR?
Before TransCarotid Artery Revascularization (TCAR), carotid endarterectomy (CEA) had been the gold standard for carotid revascularization. This procedure involves opening the neck, fixing the artery, then repairing it with a patch, and has good outcomes. Then, carotid artery stenting (CAS) became available, allowing the carotid lesion to be fixed via a needle stick in the groin or in the arm. CAS has been used only sparingly as the risk of stroke is substantially higher with CAS compared with CEA.

The TCAR procedure prevents plaque from traveling to the brain during carotid artery surgery.

Then TCAR became available. This procedure takes the best features of CEA and CAS and combines then into one procedure. With TCAR, the carotid lesion is fixed with a stent and balloon, but under the conditions of reversed blood flow in the carotid artery, such that any debris that is liberated during that process exit the body and is caught in a filter, rather than traveling to the brain and causing a stroke. The risk of stroke of TCAR is lower than both CEA and CAS and is the lowest reported to date.

How does TCAR help patients who may be at risk for strokes?
With TCAR, a small incision is made above the collarbone to expose the common carotid artery. A surgeon places a soft, flexible sheath into the carotid artery, connecting it to a system that reverses the blood flow away from the brain. This protects the brain from possible debris such as fragments of plaque that may come loose during the procedure.

The blood is then filtered and returned to a second sheath placed in the patient’s femoral vein in the groin. This allows stenting to be performed (to clear blockages) while the blood flow is reversed. Once the stent is placed, the flow reversal is turned off and normal blood flow to the brain resumes.

Aside from having a lower risk of stroke, TCAR also has a lower risk of cranial nerve trouble, of blood transfusion issues, heart attacks, and abnormal heart rhythms, and other complications associated with carotid artery procedures, when compared to CEA.

Who are the best candidates for TCAR?
The majority of patients who need a carotid intervention qualify for a TCAR. Specifically, to qualify, the patient must meet either one of a number of medical high-risk criteria, or one of a number of anatomic high-risk criteria, which is determined by the vascular surgeon.

To learn more about the TCAR procedure and the Premier Surgical Vascular Surgeons who perform it, visit our TCAR webpage at https://www.premiersurgical.com/tcar/.

Other references:
https://www.stonybrookmedicine.edu/patientcare/surgery/patient-care/clinical/vascular-surgery/tcar-transcarotid-artery-revascularization
https://www.honorhealth.com/healthy-living/tcar-a-minimally-invasive-alternative-prevent-stroke

The post Premier Surgical’s Dr. Skibba explains TCAR first appeared on Premier Surgical.

Open surgical repair was the standard method of aneurysm repair for five decades.

Dr. Juan Parodi, Dr. Julio  Palmaz and Dr. Nicholas  Volodos are recognized as pioneers of endovascular aneurysm repair.  Dr. Parodi and Dr. Palmaz performed their first case in September of 1990. Dr. Frank Veith and Dr. Michael Marin and Dr. Parodi performed the first endovascular case in the United States in New York on November 22, 1992.

After years of technological development, endovascular repair of abdominal aortic aneurysms were eventually approved in the United States in September of 1999.  My endovascular team, which was already performing complex vascular cases since the early ’90s, was brought together and was excited about being pioneers. With appropriate treatment planning and strategy, the team was ready.

On December 3^rd, 1999, I brought the endovascular team together including myself, Abercrombie interventional radiologist Dr. Lloyd Smith and my lead surgical technologist Kimberly Hardy and successfully carried out the first endovascular aneurysm repair in East Tennessee.  My involvement in early endovascular aortic techniques and deployments including hybrid techniques allowed me to help teach other colleagues, vascular surgical personnel and participate in multiple new trials and registries. This was the beginning of a new and exciting era.

Endograft used in 1999

The early endovascular aortic stent grafts were larger and not as flexible and could not accommodate some of the anatomic challenges.  The evolution of new technology though has allowed lower profile stent grafts to track easily and treat a wide array of aortic pathology. We can now treat more patients with endovascular techniques than ever before.

Two decades have gone by and we continue to develop and embrace new technology that ultimately saves lives and limbs.

ENDOVASCULAR ANEURYSM REPAIR

The aorta is the largest blood vessel in the body. An aortic aneurysm is a bulging or ballooning of the wall of the abdominal aorta.  As the aneurysm enlarges it stretches the aorta. Abdominal aortic aneurysms can often grow slowly without symptoms, making them difficult to detect. Once detected you should be in an aortic surveillance program watching for potential growth.  Small aneurysms can stay stable and small and never grow. Some small aneurysms never rupture. Some aneurysms grow slowly over time and others expand quickly.

If you have a symptomatic or enlarging abdominal aortic aneurysm, you might notice:

• Deep, constant pain in your abdomen or on the side of your abdomen or back pain

If your aneurysm reaches a critical point the aorta can rupture and can cause life-threatening bleeding. Your vascular surgeon can help you with surveillance and decision making regarding the best treatment option.

Risk factors:  There are multiple risk factors but the most common are listed below

• Tobacco use. Smoking can weaken the aortic walls, increasing the risk not only of developing an aortic aneurysm but of rupture.
• These aneurysms occur most often in people age 65 and older but can also occur in younger patients.
• Men develop abdominal aortic aneurysms much more often than women
• Family history. If anyone in your family had an abdominal aortic aneurysm it increases your risk of having the condition. Please get an ultrasound of your abdominal aorta.
• Other aneurysms. Having an aneurysm in another large blood vessel, such as the artery behind the knee or the aorta in the chest, increases your risk of an abdominal aortic aneurysm.

The current procedure usually takes 2-3 hours through two small groin incisions. It can also be performed under local anesthesia percutaneously without skin incisions if appropriate.  This is certainly much different than two decades ago and patients are usually discharged within one to two days.

Image: https://www.researchgate.net/figure/Ancure-Endograft-bifurcated-graft-with-the-markers-enhanced-Markers-are-sewn-at-regular_fig1_3221520

Image: https://surgery.ucsf.edu/media/1672048/aneurysm_endovascular%20repair.jpg

The post Marking the 20th Anniversary of First Endo AAA Repair first appeared on Premier Surgical.

Don (pictured with wife Coralee) can walk much easier after Vascular Surgery.

Walking down the street, up the stairs or at home, we tend to take our steps for granted until something stops us in our tracks.

Don Proaps, 71, relaxes for a moment in his home in West Knox County, recalling how his steps came to a halt. It started with unexplained pain in in his feet that spread to his ankles and then up through his legs.

“It was pretty bad,” Proaps says. “I couldn’t walk around the yard, and I couldn’t walk up the steps good.”

The only thing that seemed to slow the pain down was rest. That sounds simple enough, but Proaps says it was a big hassle in situations that called for a lot of walking.

“Like at the mall,” Proaps says. “Every so often I’d just have to stop and sit down” For a long time, Proaps says he “chalked it up to old age and arthritis.” The pain intensified over time.

Proaps’ family doctor made a referral to Premier Surgical Vascular Surgeon at Parkwest Medical Center, C. Scott  Callicutt, MD, who has seen this kind of thing many times before. Dr. Callicutt says Proaps had the symptoms of peripheral artery disease (PAD).

“Unless you stop walking, the pain’s just going to get worse,” Dr. Callicutt says. “Generally, that’s what happens. People walk to a point, their legs hurt, their legs are fatigued, they stop, the pain goes away, and then they’re able to walk again. That’s what was going on with Mr. Proaps.”

PAD is a problem with the circulation in the arteries that carry blood from the heart to the limbs. It affects about 10 million people in the U.S., and left untreated can progress to problems like foot wounds that won’t heal, development of gangrene, limb loss and even death.

Dr. Callicutt explains that plaque can build up in arteries, causing them to get narrow, and that results in a lack of blood flow to certain areas of the body.

“The muscles are demanding oxygen and blood flow as you walk. It gets to a point where the supply can’t meet the demand because of the blockage,” Dr. Callicutt explains. “The muscles start to hurt because they’re not getting enough blood flow or oxygen.”

There are minimally invasive ways to treat PAD, but Proaps’ case was too advanced for them. Fortunately, Dr. Callicutt, Premier Surgical, and Parkwest Medical Center are experienced in vascular surgery procedures that offer the highest level of care to patients like Proaps.

“We went in with the dye test and the arteriogram to see if there was anything we could do minimally invasively,” Dr. Callicutt says. “He was beyond the stage of ballooning and stenting or removing the blockage, so we moved to bypass as the best long-term option.”

Peripheral artery bypass is a type of surgery that reroutes the blood supply around a blocked artery. Dr. Callicutt used a graft to replace the blocked part of the two arteries that were causing problems for Proaps.

Proaps is pleased with the results. “I can get around pretty good now,” he says, “and I believe I’ll keep getting better.”

It’s a much better scenario than what might have awaited Proaps if he hadn’t undergone the surgery. Dr. Callicutt says the complications can be devastating.

“His lifestyle would continue to be impacted, he wouldn’t be able to walk or do his activities of daily living,” Dr. Callicutt says. “There is a risk of limb loss if this disease progresses.”

Proaps is glad he finally has answers and a solution to his pain with surgery at Parkwest Medical Center, and he’s also glad he found Dr. Callicutt. “He’s really good and very smart,” Proaps says. “He knows what he’s doing!”

Not sure if you have PAD? Check out Premier Surgical’s PAD checklist today!

[inbound_button font_size=”20″ color=”#c8232b” text_color=”#ffffff” icon=”” url=”” width=”” target=”_self”]PAD Checklist[/inbound_button]

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September is National PAD Awareness Month. Peripheral artery disease (PAD) is a medical condition caused by the buildup of plaque in the arteries. Arteries are the blood vessels that carry blood to different parts of the body including the head, organs, and limbs.

Atherosclerosis is a term used to describe the buildup of plaque in the arteries. This plaque buildup, which is made up of cholesterol, fat, fibrous tissue, calcium, and other substances in the blood, can narrow the opening of the arteries. It reduces the blood flow and the supply of oxygen to the cells. Although PAD can affect any artery, it usually affects the arteries of the legs.

What are the signs and symptoms?

Many people with PAD have no or mild signs and symptoms of the disease. Although some do suffer from claudication. It’s a form of muscle pain or cramping in the affected extremity, usually triggered by physical activity. The pain or cramping usually subsides after a few minutes of rest. The location of the pain depends on the location of the clogged artery. In the case of PAD, the calf is the most common location.

Other symptoms associated with PAD include leg numbness or weakness, change in the color of the legs, a distinct temperature difference between the legs or feet (one leg or foot is colder), sores in the lower extremities that won’t heal, and weak pulse in the legs or feet.

Who is at risk?

People who are obese and those with diabetes, high blood pressure, high cholesterol, and a family history of PAD or heart disease are at high risk of developing the condition. Smoking also increases one’s risk of developing PAD.

When to see a doctor?

PAD is a serious condition. When left unmanaged, it can lead to limb tissue death (which often lead to amputation), stroke, and heart attack.

If you’re over the age of 50 and suffering from leg pain or numbness, it may be time to seek medical attention. Don’t dismiss these symptoms as normal part of aging. Early detection and treatment of peripheral arterial disease can help improve patients’ quality of life and reduce the risk of amputation.

Premier Surgical in Knoxville’s experienced vascular surgeons can assess and diagnose your condition to determine whether or not you have PAD. If you’re diabetic, a smoker, and experiencing leg pain, swelling, and foot wounds that won’t heal, consider making an appointment with one of Premier Surgical’s vascular surgeons. Early detection and treatment of PAD can save your leg and your life.

The post PAD Awareness Month first appeared on Premier Surgical.

What is Vascular Disease?

Problems in the vascular system may lead to serious consequences. Vascular diseases can happen as a result of inflammation and weakening of the veins and the arteries. They may also develop as a result of fatty deposits in the blood vessels. This buildup of fatty deposits can result from having too much cholesterol or triglycerides in the blood.

Vascular Disease as a Risk Factor to Heart Disease

Collectively referred to as plaques, these fatty deposits contain cholesterol, but also calcium deposits, fats, and other substances from the blood. Over time, these plaque deposits can narrow the arteries, limiting the blood flow in the body. This condition is called atherosclerosis.

In many cases, atherosclerosis develops gradually. During the early stages it doesn’t produce any symptoms but when the plaque deposits progress and further limits the blood flow, it can lead to angina.

Angina is a medical condition that results from insufficient supply of oxygen-rich blood to the heart muscles. Chest pain is the most distinct symptom of angina, although discomfort may also be felt in other areas including the jaw, shoulders, arms, or back. When left unmanaged, angina can lead to more serious heart problems including severe arrhythmias, heart attack, and even sudden cardiac death.

Aside from angina, problems in the vascular system can also cause stroke, a potentially life-threatening condition. This happens when the plaque breaks away from the artery wall and cause blockage in the brain artery.

Preventing Vascular and Heart Diseases

Lifestyle plays an important role in the prevention of vascular and heart diseases. Maintaining a healthy body weight through a well-balanced diet and regular physical activity can make a difference in the prevention of these diseases. People with a family history of vascular and heart disease should be more mindful of their lifestyle, as their risk may be higher.

At Premier Surgical in Knoxville, our Board Certified Vascular surgeons are well-trained in the diagnosis and treatment of vascular disease. To schedule a consultation, contact us online or call 865-306-5775 today.

The post Vascular and Heart Disease first appeared on Premier Surgical.

About one in every 20 Americans over the age of 50 suffers from peripheral artery disease (PAD). It is a medical condition that results from narrowing of the arteries. It most commonly affects the legs, but may also occur in the stomach, arms, and even head. These peripheral arteries are usually clogged with fatty deposits or plaque, making one more susceptible to heart attack or stroke.

A new set of guidelines was published in November 2016 for managing patients with PAD. These updated recommendations, published by ACC and the American Heart Association, replace the 2011 guidelines. The new guidelines are meant to provide comprehensive recommendations for those living with PAD.

Management

The guidelines recommend that patients with PAD participate in a structured exercise program. Researchers found that a structured exercise program can help improve leg circulation and reduce pain that sometimes comes with activity. Optimum results have been achieved by those who have undergone supervised structured exercise programs.

Vascular procedures, such as angioplasty or stent placement, may be recommended to those with critical limb ischemia. These procedures may also be suggested to patients who still experience problems with walking even after undergoing both medical and exercise therapy.

It is also suggested that PAD patients  undergo annual flu shots to avoid cardiovascular complications as a result of catching the flu. Smoking cessation and avoidance of secondhand smoke are also recommended.

Signs and Symptoms

Aside from medical management, the new set of guidelines also emphasized the signs and symptoms of PAD which do not only include claudication but also ischemic rest pain, non-healing wound, walking impairment, and lower extremity pulses.

For those showing the signs and symptoms of PAD, healthcare professionals recommend measuring the ankle brachial index (ABI) of these patients. Although measuring ABI is not the best way to determine PAD, especially among those with chronic kidney disease and diabetes, it still helps in detecting the disease.

At Premier Surgical in Knoxville, we have a team of well-experienced vascular surgeons   extensively trained in the area of managing and treating vascular diseases . If you feel like you have the symptoms of peripheral artery disease, visit the Vascular Surgeon page on our website.

Not sure if you’re at risk for PAD?

See our checklist!

The post Updated PAD Guidelines first appeared on Premier Surgical.