Departments

At Yale Medicine, our team of highly trained vascular surgeons are here to help with a variety of circulation issues. This includes anything from blocked blood vessels and stubborn wounds to conditions that could lead to losing a limb. Our goal is to give complete care that's as easy on you as possible, which is why we focus on techniques that don't require major surgery, like treatments done inside the blood vessels themselves. Our doctors give personalized and complete care to adults with vascular problems. We rely on the newest and most advanced equipment and methods to diagnose and treat these conditions. Specialized care is offered in the following areas: Abdominal and thoracic aortic aneurysm: Bulges in the main artery that can occur in the belly or chest area. Aortoiliac occlusive disease: Blocked arteries that supply blood to the abdomen, pelvis, and legs. Carotid artery stenosis: Narrowed arteries in the neck that can reduce blood flow to the brain. Claudication: Treatments to help relieve cramping in the legs while walking or exercising Diabetic ulcers: Sores that are slow to heal in people with diabetes. Dialysis access: For patients who need dialysis (a treatment for kidney failure), we create an entry point into the bloodstream that the dialysis machine can use. Foot ulcers: Sores on the feet that can develop due to poor circulation or other health issue. Lower extremity artery conditions Lower extremity vein conditions Renal vascular disease: Conditions that affect blood flow to the kidneys. Thoracic aortic aneurysm and aortic dissection: Bulges and tears in the part of the main artery that runs through the chest. Thoracic outlet syndrome: Discomfort or circulation problems caused when blood vessels or nerves just below the neck are compressed. Varicose veins: Treatments to remove or reduce enlarged veins that appear most often on the legs. Visceral artery disease: Blood vessels that supply the internal organs, ensuring they're not narrowed or blocked.

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

Our program offers innovative care for patients with advanced and complex structural heart disease. From diagnosis to treatment, our team is dedicated to treating all forms of structural heart disease, some of which are congenital, or present at birth, and others that develop with age. We take the utmost care in treating these defects, which can affect the interior walls of the heart, the valves inside the heart, and the arteries and veins that carry blood to the rest of the body. As the first program in the state of Connecticut dedicated to the care of adult patients with complex congenital heart disease, we offer the full spectrum of care, providing regular inpatient and outpatient services to adult congenital heart patients. We offer an array of imaging, exercise testing, and surgical options, as well as less invasive catheterization therapies. Our multidisciplinary team includes interventional experts in congenital cardiac catheterization and electrophysiology who have decades of combined experience in the field. Our cardiothoracic surgical team has expertise in congenital heart disease and adult cardiac surgery with experience that spans three decades. Other members of the team include experts from the Yale General & Advanced Heart Failure Program, as well as a wide array of subspecialists in related areas, including liver and kidney disease. Adolescents and adult patients can expect to receive detailed education about their underlying congenital heart defect, its management, and the implications for future functioning. We ensure that our patients with pediatric congenital heart disease will be managed in the context of adult medicine with a multidisciplinary team that includes pediatric and adult cardiologists, adult pulmonologists, genetic counselors, and social workers. Our center provides state-of-the-art diagnostic imaging, including echocardiography and MRI. We work closely with Yale Medicine High-Risk Obstetric and Maternal-Fetal Medicine Programs to provide obstetrics and perinatology services to women with congenital heart disease, and we provide referrals for fetal echocardiography in cases where it is appropriate.

We have a robust history in advancing the practice of cardiovascular catheterization and intervention, and we offer a full spectrum of cardiac care in our state-of-the-art facilities. We care for patients throughout the region at locations throughout Connecticut, and are a national and international referral center for specialty percutaneous interventional procedures, commonly known as angioplasty. Our physicians specialize in complex coronary disease, structural heart disease, and peripheral vascular diseases, and we operate one of the largest carotid artery disease programs in New England. We also have a Comprehensive Coronary Physiology Program that provides care for patients with chest pain that is chronic, unexplained or difficult to manage. Our interventions include: Transradial coronary intervention Coronary chronic total occlusion recanalization and coronary reentry transcatheter aortic valve implantation Intravascular ultrasound and physiologic translesional pressure assessment Rotational atherectomy Thrombectomy Proximal and distal embolic protection Drug eluting stents Advanced hemodynamic support Atrial septal defect, patent foramen ovale, and ventricular septal defect closure Alcohol septal ablation for hypertrophic cardiomyopathy Aortic and mitral valvuloplasty Left main and multivessel percutaneous coronary intervention (PCI) Various peripheral vascular interventions

A pioneer in minimally invasive therapies for congenital heart disease, the Pediatric Interventional Cardiac Catheterization Program at Yale performs diagnostic and interventional catheterization procedures on patients with congenital heart disease from childhood into adulthood. We perform a variety of procedures including closures of atrial septal defect, patent foramen ovale, and patent ductus arteriosus. Ours is the only congenital cardiac catheterization laboratory in Connecticut that offers transcatheter pulmonary valve replacements, including the Melody and Edwards valves. Yale New Haven Children's Hospital's digital pediatric catheterization suite features state-of-the-art equipment that allows for a multidisciplinary approach to patient care. Our team has expertise in nonsurgical transcatheter treatment of aortic and pulmonary valve stenosis, coarctation of the aorta, intravascular stent placement for narrowed arteries and vessels, and blood vessel coil occlusion. Our interventional team also works collaboratively with our pediatric cardiothoracic surgeons to deliver the most innovative hybrid procedures that are intended to minimize surgical time and difficulty, while making patients safer. Through active participation in clinical trials, we continue to push the boundaries of noninvasive treatments to replace pulmonary valves and close atrial septal defects.

Our advanced vascular medicine specialists are part of a long tradition of innovation in the diagnosis and treatment of peripheral artery disease, a common circulatory problem in which narrowed arteries reduce blood flow to the limbs. At our Vascular Clinic, we employ all state-of-the-art percutaneous intervention (angioplasty) techniques and work in collaboration with a multidisciplinary team. Our goal is to help patients manage their symptoms. We also want to stop the progression of atherosclerosis, or the buildup of plaque, in patients’ arteries. That, in turn, reduces risk of heart attack and stroke. Lifestyle changes, including quitting smoking, are the single most important step. In the event that lifestyle changes are not enough, medicine to prevent blood clots, lower blood pressure and cholesterol, and control pain might help manage the condition.

The Yale Medicine Interventional Radiology (IR) program is one of the leading programs in the nation. Our interventional radiologists, recognized as pioneers in the field of minimally invasive medicine, work with nursing and technologist staff to offer image-guided, non-surgical treatments for vascular and non-vascular disease with excellent outcomes for pediatric and adult patients. Our interventional radiology procedures are performed for a broad range of conditions spanning gastrointestinal/hepatobiliary, gynecology, infectious disease, oncology , pediatrics, pain management, urology, and venous and arterial disease. Interventional radiologists use advanced imaging modalities including ultrasound, fluoroscopy, computed tomography, and magnetic resonance imaging to perform procedures through tiny pinholes, thereby avoiding surgery and long recovery times. IR advances enable minimally invasive treatment of many conditions on an outpatient basis, allowing patients to recover in the comfort of their own home. We also offer comprehensive care dedicated to the treatment of pediatric patients, including vascular malformations, biopsy service with sedation, feeding tube maintenance, and expert care in hepatobiliary, urological, gastrointestinal, and musculoskeletal disorders. Our team at Yale New Haven Hospital was the first in Connecticut and among the first in the nation to perform transcatheter pulmonary embolectomy, a procedure for the removal of a blood clot from the pulmonary arteries. Such patients are initially evaluated by a multidisciplinary Pulmonary Embolism Response Team (PERT) , and a comprehensive treatment plan is then developed. We also have one of the world’s leading hereditary hemorrhagic telangiectasia (HHT) and vascular malformation programs. Founded in 1994, both serve as role models for other programs around the world. We offer a wide range of minimally invasive Interventional Radiology treatments, all available at Yale New Haven Hospital. Heart and vascular Angiography, angioplasty, and stenting for arterial disease Embolization for acute, traumatic gastrointestinal and genitourinary bleeding Endovascular treatment of aneurysms and pseudoaneurysms Inferior vena cava filter placement and removal Non-surgical dialysis fistula creation and repair Pulmonary embolectomy to remove pulmonary embolism (blood clot in the lungs) Treatment of arteriovenous malformations Venography, venous stenting, and related procedures for venous occlusion and clot Venous ablation for varicose veins Gastrointestinal/Hepatobiliary Gastrojejunostomy placement and gastrostomy for nutrition Transjugular intrahepatic portosystemic shunt (TIPS) placement for upper GI bleeding and refractory ascites Treatment of benign and malignant bile duct obstructions Treatment of fluid collections in the abdomen, chest, and pelvis Gynecology Fallopian tube recanalization for infertility Uterine fibroid embolization for fibroids and uterine artery embolization fo

The Hematology Program at Smilow Cancer Hospital offers comprehensive diagnosis and treatment of blood cancers: lymphoma, leukemia, and myeloma. While the causes of these cancers remain unknown, great strides in treatment, some of which originated from Yale Cancer Center research, are improving survival rates. The overall aim of treatment is to bring about a complete remission. Treatment approaches for blood cancers may include chemotherapy, radiation oncology, stem cell or marrow transplantation, or immunotherapy. Each patient receives an individual treatment plan, which includes standard care and/or clinical trials, which offer novel treatment options. Yale hematopathologists employ the complete range of diagnostic tools available, including bone marrow examination, bone imaging, M protein analysis, cytogenetics, immunophenotyping, and FISH and PCR analysis, as well as genetic testing and the identification of markers that guide prognosis. Additionally, patients have access to caregivers who help them cope with the physical, emotional, and psychological issues related to these cancers. Advanced practice nurses and social workers assist with education, general information, and practical issues of travel and accommodation assistance. The blood cancers we are fighting: Lymphoma is the most common blood cancer, affecting 81,000 Americans each year. While its rates continue to rise, there have also been rapid advances in treatment, and the current 5-year survival rate for all people diagnosed with Hodgkin lymphoma is 87%. Leukemia is a malignant cancer of the bone marrow and blood, diagnosed in 60,000 Americans each year. It is the most common cancer in children and teens. The leukemia death rate for children ranging from birth to age 14 in the United States has declined 60% over the past three decades, due to treatment advances. Myeloma is a disease of the plasma cell, and affects approximately 34,000 new patients annually. Overall survival in patients with myeloma has shown improvement in recent years, with treatments recently approved by the Food and Drug Administration (FDA). Monoclonal gammopathy of undetermined significance (MGUS) is a precursor condition that could potentially lead to cancer and should be closely evaluated and monitored. Our myeloma specialists are dedicated to the care of these patients and see them as part of a MGUS Clinic. Stem Cell Transplant The Stem Cell Transplant Program at Smilow Cancer Hospital is a FACT accredited program that was started in 1994 and currently performs around 200 transplants yearly. We perform stem cell and bone marrow transplants for a variety of malignant and benign diseases in both pediatric and adult populations. There are two types of stem cell transplantation that we perform: Autologous transplant: involves using a patient’s own stem cells, whichare collected from their blood and frozen. Allogeneic transplant: involves receiving stem cells from another person, called a donor. A search

Charcot Marie Tooth disease (CMT) is the name used to describe a group of inherited peripheral nerve disorders caused by a range of changes in the genes responsible for nerve function. Currently, there are more than 80 genes identified as potential causes of CMT. CMT can affect both children and adults and is one of the most common hereditary neurologic hereditary disorders, affecting 1 in 2,500 people. Patients with CMT experience nerve damage leading to sensory loss and changes in sensation, balance, and muscle strength, especially in the legs and hands. Depending on the genetic variant and other factors, the severity of symptoms may range from mild to severe. The Charcot Marie Tooth disease program at Yale was recognized by the CMT Association (CMTA) as one of forty CMTA Centers of Excellence worldwide. Multidisciplinary care of CMT patients is customized to patients’ needs and involves neurologists, orthopaedic surgeons, and physical and occupational therapists. Diagnosing neuromuscular disorders, including CMT, is a complex process involving neurologic examination and diagnostic testing, which often includes laboratory testing and electrodiagnostic evaluation with nerve conduction studies and needle electromyography. Genetic testing is used to identify the gene causing CMT. In recent years, the rapid development of technology allowed a wide expansion of genetic testing for diagnosing hereditary disorders (including CMT), which now helps us to find the cause of CMT in more than 70% of patients. An accurate diagnosis helps us to avoid unnecessary testing and potentially harmful treatments. Advances in research and understanding of hereditary neurologic disorders have also led to new therapies for genetic diseases that may help develop effective treatments for CMT. The CMTA Center of Excellence at Yale is led by neurologist and neuromuscular specialist Sasha Zivkovic, MD, PhD, and orthopaedic surgeon Irvin Oh, MD, who collaborate with physical and occupational therapists. A monthly CMT clinic will be held at the North Haven Yale campus, and care will be coordinated with Yale neuromuscular specialists who evaluate patients in New Haven, Greenwich, Guilford, and New London. The goal is to enhance the care of adult patients with Charcot Marie Tooth disease, improve their quality of life, and promote clinical research in the field. The program helps treat many patients with nonsurgical techniques, including bracing and physical and occupational therapies, and, if indicated, reconstructive foot surgery, which helps many people to stand, walk, and run without pain. During reconstructive surgery, the foot bones and muscles are repaired, so the feet do not turn inward. Correction of high arches and misshapen toes may restore flexibility and balance for natural foot movements without pain. The program will also promote clinical and translational research of hereditary neuropathies to advance the care and quality of life of CMT patients and their f

Complex knee ligament injuries occur when athletes or patients sustain severe trauma, injuring two or more ligaments in or around the knee. In these cases, surgery is typically needed to repair or reconstruct these important structures. Without this surgery, the knee has potential for being unstable with simple daily activities or athletic pursuits. There is also risk of premature arthritis secondary to the abnormal motion of the knee joint. These injuries can occur during athletics and collision sports, or traumatic events such as falls from heights, or motorcycle or automobile injuries. The most severe of these injuries, a knee dislocation, is typically the result of a high-energy injury resulting in disruption of the normal alignment of the thigh (femur) and the shin (tibia) bones. Unfortunately, these are injuries that can cause both neurologic or blood vessel injuries and can be limb-threatening emergencies. Knee dislocations are fortunately rare, accounting for 0.02-0.2% of all musculoskeletal injuries. To find out more about this program, please fill out a brief survey . A thorough and accurate diagnosis is critical in treating these complicated knee injuries. Proper diagnosis, including identification of the torn ligaments as well as assessment of the location of the tear and associated injuries, is one of the primary challenges with treatment of these injuries. While high-resolution MRI is a critical diagnostic tool, the ability to quickly and accurately diagnose these injuries requires the surgeon to have excellent knowledge of the complex function of the knee ligaments and skilled physical examination techniques. Combined with the MRI images, this allows for an individualized treatment plan for these unique injuries. Through our involvement with Yale New Haven Hospital’s Level 1 Trauma Center program, our orthopaedic and trauma surgeons have developed extensive experience with these injuries over the past 20 years. Our orthopaedists work closely with our general surgery trauma, vascular surgery, plastic surgery and expert musculoskeletal radiology colleagues in order to care for these potentially limb-threatening knee injuries. Prompt diagnosis is of highest importance and we accept referrals and transfers from all outside facilities, which can be arranged through our Yale New Haven Hospital Y Access program (888-YNHH-BED). Patients are occasionally “life flighted” via SkyHealth from outside facilities by helicopter to be treated at our tertiary care center. SkyHealth travels within a 200-mile radius of New Haven. Our team also works closely with affiliated physical therapists who are trained in the management of patients in their recovery phase of healing. As these injuries and procedures are uncommon, a carefully structured rehabilitation program guided by experiences physical therapists is also crucial to patient recovery. Depending upon the clinical situation, care is either performed in an inpatient setting at Yale New Haven Hos

The Cutaneous Granulomatous Disorders Program brings together dermatologists, dermatopathologists, and researchers with expertise in the evaluation and treatment of granulomatous disorders of the skin. Granulomatous disorders of the skin include the following diagnoses: Sarcoidosis Granuloma annulare Necrobiosis lipoidica Reactive granulomatous dermatitis Interstitial granulomatous dermatitis Interstitial granulomatous drug (medication) reaction Palisaded neutrophilic and granulomatous dermatitis Necrobiotic xanthogranuloma Rubella granulomas Granulomatous dermatitis, not otherwise specified These conditions lead to skin rashes, which can be very problematic and are frequently life-altering. Individuals affected by these disorders may experience frustration due to the lack of Food and Drug Administration (FDA)-approved treatment modalities. Yale’s Cutaneous Granulomatous Disorders Program recognizes this and works individually with each patient to find the treatment approach that is most suited to their particular situation and individual goals. The program also strives to identify and evaluate new therapies for these disorders. The primary goal of the Cutaneous Granulomatous Disorders Program is to provide optimal care for each patient seen in our specialty clinic, where we take an individualized approach to each patient’s diagnosis and their goals, pairing these with the best treatment options. The program also has several active clinical trials; patients who are interested may have the ability to participate, potentially providing access to some of the latest molecular therapies undergoing evaluation for the treatment of these disorders. Patients may also have an opportunity to participate in other research projects designed to better understand the molecular pathogenesis of these diseases and their effect on patient well-being. Our team was assembled with the goal of bringing together leading experts in cutaneous granulomatous disorders. The physicians in the program include internationally recognized leaders in medical education on cutaneous granulomatous disorders, scientists that have deciphered the underlying immunology of these disorders, individuals that have developed consensus diagnostic criteria for necrobiotic xanthogranuloma, and physicians that have led the evaluation of new treatment approaches for patients with sarcoidosis, granuloma annulare, and necrobiosis lipoidica. Our team also includes dedicated pharmacists with specialized training in the practical and safe use of cutting-edge dermatologic medications, including those used to treat cutaneous granulomatous disorders. The pharmacists have vast expertise in effectively coordinating insurance coverage and are another important point of contact for our patients as they navigate coverage of specialty medications. For patients with sarcoidosis involving the skin, our dermatologists will work closely with their other specialists to identify the optimal treatment approach. Ya