Dr. Jacob Schwartzman, a vascular surgeon with Mount Sinai Medical Center in Key West, joined Good Morning Keys on KeysTalk 96.9/102.5FM yesterday morning to talk about vascular surgery.
Vascular surgery is a broad specialty.
Dr. Schwartzman said, “It’s a very unique specialty and without getting into too much of an anatomy lesson, blood vessels come in two sorts. They’re the arteries that bring blood away from the heart, and there are the veins that bring blood back to the heart. Basically, we are surgeons who deal with diseases of both the arteries and the veins anywhere outside of the heart and the brain. So if you have blockage in an artery in the heart, you would need to see a cardiologist, or the same problem inside the brain, you would need to see a neurosurgeon or a neuro interventionalist. But vascular surgeons can take care of your arteries and your veins pretty much everywhere else in the body, and that goes from the the root of the aorta, which supplies blood to the head to the neck area, the upper arms, blood flow to the intestines, blood flow to the kidneys, and then moving down to the legs. We are also the only specialty that is able to provide both open and endovascular care for the areas that we treat. So what that means is, many of you have heard of having stents put into someone’s heart. Well, we do stenting procedures for veins, for people’s legs, for certain situations, in the arms, etc, but we also have the skill set to do open bypass surgery when necessary and because we have the skill set to do both, we are also the only specialty that has equipoise in terms of what we’re going to offer for a patient based on their particular anatomy. So we don’t have one preference or another. We do what we think is right based on the the anatomy of the patient, what they’re coming in with and those kind of things.”
What are some of the common diseases that vascular surgeons treat?
Dr. Schwartzman said they “are related to blocked arteries, and these can be, again, in the neck and the arms, or very commonly, the legs. One of my personal passions is limb salvage in people who have diabetes and lower extremity revascularization. So some people with blocked arteries in the legs, for example, when they walk around, they can experience severe pain due to lack of blood flow in their legs, manifested by cramping of the muscles, leading to intolerance of walking and inability to go very far. More serious manifestations of this can be people who have diabetes, who develop ulcers on their feet that put them at risk for amputations. One of the main focuses of our specialty is to try to increase chances of limb salvage and provide blood flow for podiatrists to be able to heal these patient’s wounds. Another major area of focus that’s kind of separate from the ones that I’ve mentioned so far is the people who are on dialysis, who have kidney failure. So people who require dialysis, they basically need to go to dialysis four times a week to be hooked up to a machine and we provide these surgical conduits that the dialysis nurses use to be able to run blood flow through these machines fast enough to keep folks alive on dialysis with kidney failure. So it’s a very broad specialty. That last one is a particular interest of mine. But overall, vascular is a beautiful specialty. It has many unique features. It is very complex and is also very rewarding and a major privilege to take care of patients who have these problems.”
Vascular issues can be incredibly common.
Dr. Schwartzman said, “Some of the conditions that lead to people having vascular disease are very, very common in the United States overall and in Key West specifically. Some of the major risk factors are smoking, that’s probably number one, and diabetes would be number two. Renal failure itself can be caused by vascular disease, but once you have it can increase your risk of having vascular disease. But yes, vascular problems are very, very common, and it is our privilege to be able to come down here and provide care for people who need it here. I would say that a good starting point is if you think you may have a vascular problem, would be to talk to your primary care doctor and ask them about that specifically, as well as if you have a cardiologist, they have also a lot of experience, generally speaking, with identifying vascular problems and referring to one of us in the event that that may be necessary. I have two partners who also come down here, and we are all three of us, equally capable of handling pretty much the entire breadth of vascular problems. In the rare cases that we encounter a problem that we can not handle, we will refer you to the correct specialty that can.”
For diabetes patients in the past, amputation was quite common.
Dr. Schwartzman said, “People have been working at limb salvage for years and years, but over the last 20 to 30 years, there has been kind of an explosion in the advanced endovascular therapies that can be offered for these situations. The problem is that diabetes and high blood pressure, cholesterol, genetics, all of these things that cause blocked arteries in the legs, these are systemic diseases, and they affect the patient everywhere. So it’s a very unusual situation where somebody comes to us with a single unique problem of having an issue in their leg. They often have coronary artery disease as well, cerebrovascular disease, issues with their kidneys, etc. So we do work with other medical specialists to optimize these other issues in preparation for some of the therapies we offer. But more to the point, in the past, historically, options have been limited to major, very invasive, open surgeries to treat these problems, but now we have a lot of minimally invasive options to treat them instead, and we perform some of the most advanced of these types of treatments, even on very sick patients, through minimally invasive techniques. What I mean by that is a single needle puncture in the groin, sometimes in the foot, sometimes in the arm, to treat all the way from the aorta down to the toes.”
Are there any warning signs that someone may be susceptible to blood clots?
Dr. Schwartzman said, “Blood clots can occur both in the veins and the arteries. People are more likely to be familiar with venous blood clots than they are arterial. Venous blood clots will manifest as sudden onset of swelling, usually associated with some kind of inciting incident, such as taking a long drive or a long plane ride or prolonged mobility from a surgery or a trauma situation, something like that. Generally speaking, we also look for genetic causes of these blood clots. But the major risk with blood clots in the veins is that pieces of them can break apart and detach themselves and then go into the heart and the lungs, and we call that a pulmonary embolism, and that is potentially life threatening a lot of the time for venous blood clots. All that is necessary is just for patients to be on anticoagulation or blood thinners. But in certain situations, if the blood clot is extensive enough and goes up into the pelvic area, there are procedures designed to be able to remove them, and then in rare cases where people have blood clots in the veins, that for whatever reason, they cannot tolerate blood thinners or anticoagulation, there are other procedures we perform to try to minimize the risk of death from having a blood clot, such as putting in an interior vena cava filter. With regards to blood clots in the arteries, these tend to be more serious. For example, one manifestation of a blood clot in the arteries would be a stroke. That would be a blood clot that goes up into the brain arteries. Generally speaking, when that does occur, and it occurs on the microscopic level, up in the brain, then the specialist that would be needed would be a neuro interventionalist. But overall, other common manifestations of blood clots in the arteries, would be the sudden severe onset of pain, not being able to feel a pulse in the foot, blue discoloration, or sometimes white discoloration, inability to move your foot or your legs or sometimes your arms, etc. Again, there are other places that blood clots can occur, such as the arteries in the intestine, which that would manifest as severe, sudden onset abdominal pain, nausea and sometimes bloody bowel movements. If any of these situations do arise, it is very important for the patient to promptly seek medical attention, call 911, and go to the emergency room. With regards to venous blood clots, again, as long as these don’t migrate into the heart, these are typically a little bit more innocuous, but the typical symptoms there would be swelling of the leg, that sudden onset pain in the calf, that kind of occurs suddenly, pain with walking. But really it’s the swelling that we look for to diagnose the venous blood clots. All of these can be diagnosed with ultrasound and sometimes CAT scan, depending on exactly where we need to look.”
Diet and exercise can also mitigate some of these issues.
Dr. Schwartzman said, “Diets high in fats have been typically implicated in a lot of the arterial disease we see and in things like elevated cholesterol, etc. But there is some newer literature suggesting that it may be actually secondary to blood sugar elevations, especially spiked in insulin and acute elevations in blood sugars after very high sugary meals and things like that. Exercise is very important, and no matter what person comes in with to my office, I encourage exercise in pretty much all situations for arterial disease, walking is actually the most important. Riding a bike is helpful, but walking actually exercises the lower leg muscles more than biking, which uses kind of the proximal upper thigh areas. But generally speaking, when a patient asks me what they should do for exercise, I basically just say, yes, do it, whatever you’re doing, do more of it. Inactivity, I would say, is probably the biggest killer of people in the United States, compared to really anything else.”
What brought Dr. Schwartzman to the vascular surgery field?
He said, “I had a thing for science and math, and when I was kind of deciding on career options early and around high school, I figured that being a doctor and helping people and getting people better would be a very rewarding thing to me personally, and I actually applied straight out of high school to go to medical school through a seven year medical program that’s combined undergrad and medical school through Boston University, and I got in and that’s what I did, and I never looked back. Regarding my choice of surgery as a career choice, I actually decided on vascular relatively late in my residency, but the choice of surgery was pretty much a no brainer as soon as I got to medical school and started doing cadaver dissections, anatomy lab and everything like that, I knew that that’s what I wanted to do, and then it was just a matter of picking a specialty. I hope that I’ve given some sense of how passionate I am about this. Generally speaking, all of us vascular specialists are equally passionate, and we consider it a privilege to be able to do what we do, especially with regards to the more complex things that even 10, 20 years ago weren’t able to be done by anybody. So thank you very much for having me, and thank you very much for allowing me to kind of spread the information about what we have to offer, and we’re always happy to help.”
For more information, click here: https://www.msmc.com/doctor/jacob-schwartzman/