Dialysis Fistula/Graft Declotting
Definition
Dialysis fistula/graft declotting is a medical procedure performed to remove blood clots that have formed in an arteriovenous (AV) fistula or graft, which are vascular access points used for hemodialysis treatments in patients with kidney failure. The removal of clots helps to restore blood flow and maintain the functionality of the fistula or graft for effective dialysis.
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Neurovascular Surgery
With the latest microsurgical and endovascular technologies, we offer unparalleled treatment to patients with all types of neurovascular disease affecting blood vessels in the brain and spinal cord. This includes aneurysms, vascular malformations, and artery and venous stenosis, or blockages. Our cutting-edge research also allows for more refined, personalized medicine. Our expert clinicians specialize in managing all types of brain, neck, and spinal cord vascular disorders. Our therapeutic treatment strategies include: Open microsurgery Less invasive endovascular (interventional) treatment Stereotactic radiation (Gamma Knife radiosurgery) RehabilitationStroke Center
Timely treatment is essential to maximizing quality of life after a stroke. At the Yale Stroke Center, our highly skilled physicians take pride in delivering safe, patient-centered, and efficient care. We provide emergency treatments for conditions such as acute stroke and brain bleeds, where immediate interventions are required, but also elective treatments for aneurysms and other vascular lesions that are discovered incidentally. A dedicated neurovascular surgeon is on call and ready to mobilize a team at a moment’s notice—24 hours a day, 7 days a week. We streamline access to emergency neurovascular care for referring physicians, guaranteeing that patients will receive the timeliest and best care anywhere. Our collaborative team includes neurologists, neurosurgeons, and neuroradiologists, as well as physical medicine and rehabilitation specialists, working together to deliver cutting-edge interventional treatment and imaging. In the emergency department, radiologists are always available to provide readings of imaging scans so that patients can proceed as quickly as possible to treatment. We have an array of 3-D imaging workstations to ensure doctors can pinpoint where they need to concentrate care. We work closely with Yale New Haven Hospital’s emergency medical service and emergency department teams to rapidly diagnose and treat acute stroke and other cerebrovascular disorders 24 hours a day. Our Y Access Line allows for the quick and easy transfer of patients to Yale New Haven Hospital. We also offer SkyHealth, an emergency patient transport helicopter, staffed by highly skilled medical professionals, including a critical care flight nurse and a trained paramedic. Life-saving interventions are delivered en route, for the best possible clinical outcomes. Our state-of-the-art, VISIUS Surgical Theater is equipped with a powerful MRI and an integrated, bi-plane X-ray angiography system that allows our experts to better visualize arteries and vessels. The ability to receive preoperative diagnostic imaging; open micro-surgery; percutaneous, catheter-based endovascular treatments; and postoperative checks all in the same room is unique in the tri-state area. Our services include: A dedicated neurointensive care unit A stroke consult service with a patient- and family-centered approach to the treatment and rehabilitation of patients with cerebrovascular disease Specialized stroke clinics for community physician referrals, stroke consults, and primary and secondary stroke prevention Telemedicine Program Through our Stroke Telemedicine Program, our neurologists use a video- and image-sharing telecommunications system to provide acute stroke care consultative services to outlying hospitals in the state. Yale New Haven Hospital is the only hospital in Connecticut to offer stroke telemedicine services. Within minutes of making an initial call to the Stroke Telemedicine Program, an on-call neurologist can examine a patient at the remote hospital to helThoracic Outlet Syndrome Program
The Yale Thoracic Outlet Syndrome Program provides dedicated evaluation and treatment of patients with Thoracic Outlet Syndrome (TOS), a condition in which the subclavian vein, artery, or brachial plexus is compressed as it travels from the chest to the arm between the collarbone and the first rib. TOS may cause swelling, discoloration, numbness, or tingling of the patient's arm, limiting activities of daily living and quality of life. Patients with TOS may be young, athletic, or use excessive overhead shoulder movements for their profession or recreation. The Yale Thoracic Outlet Syndrome Program offers a multidisciplinary approach to patients with this debilitating condition. Our team includes vascular and thoracic surgeons, diagnostic and interventional radiologists, physical therapists, advanced practice providers, and nurses who work together to provide early diagnosis and comprehensive management at an individual level. TOS is divided into three types, based on the predominant structures affected. Neurogenic TOS is the most common type, affecting the brachial plexus nerves. Patients may experience neck, shoulder, or arm discomfort or headaches. Patients often report that symptoms began after experiencing a traumatic injury. Experts believe this occurs most commonly due to the shortening and thickening of the anterior scalene muscle, which connects the spine to the first rib. Venous TOS is the next most common type, with complete or high-grade blockage of the subclavian-axillary vein (located between the first rib and the collarbone). Patients often report previous repetitive overhead shoulder movements, such as pitching or swimming. Patients may present with swelling of the whole arm, discoloration, and pain. Arterial TOS is the least common type, although it is the most dangerous. Chronic compression of the subclavian artery may lead to a blockage or the creation of an aneurysm—a weakening and ballooning of the artery. Patients may present with a cold, painful arm and difficulty moving or feeling their fingers. We recognize that TOS is a complex condition and that treatment is highly specific to each patient. On a patient’s first visit, we perform a detailed history and physical exam. If TOS is suspected, a variety of specialized diagnostic tests may be performed to support the diagnosis. For patients presenting with neurogenic TOS, physical therapy may be the first-line therapy. This may treat the scalene muscles, muscles surrounding the spine, and the muscles that support the thoracic outlet and shoulder. Botox® therapy of the anterior scalene muscle is another treatment option for patients with persistent symptoms. While conservative treatment is often successful in alleviating symptoms of neurogenic TOS, surgical decompression may be recommended if patients do not find long-term relief. For patients presenting with venous or arterial TOS, our vascular surgeons will first perform revascularization to relieve symptoms