What is vascular disease?

“Most people are familiar with heart disease and with the consequences of blockages in the vessels that carry blood to and from the heart,” says Lin. “One of the most recognized vascular diseases is abdominal aortic aneurysm, which is an enlargement of a bulge that develops in a weakened area within the aorta in the abdomen. These pressures then generate with each heartbeat that pushes against the aneurysm and it tends to enlarge. If the aneurysm weakens it can rupture. Typically, we want to monitor it and repair it with surgery if it becomes large enough before it bursts.

“We also take care of carotid artery disease, which can cause stroke. Carotid disease occurs when the main blood vessels to the brain develop plaque or hardening of the artery. These build up then can become very severe and lead to stroke, which damages part of the brain. In fact, 80 percent of strokes are ischemic strokes where parts of the circulation to the brain are cut off, usually due to blockage in the carotid artery. It is the third leading cause of death in the U.S.

“Another very common vascular disease is peripheral arterial disease. This happens when there's hardening of the artery in the legs. Essentially, there's blood flow that's reduced to the limbs and it can cause complete blockage in the legs. Early on, people may have difficulty walking. They get cramping pain, and eventually if it gets really bad they may get foot ulcers, infections, and even gangrene that can lead to amputation. People with PADs are more likely to get heart attacks and strokes.

“Another vascular disease is varicose veins, which a lot of patients have. You can notice the bulging veins in the leg, which then returns the blood back to the heart and it causes heavy aching, throbbing, and itching. Some of the more serious vascular diseases are blood clots or deep vein thrombosis. Deep thrombosis can cause leg swelling and pain. DVT in the blood clot in the leg can travel into the lungs causing pulmonary embolus, and that can kill somebody. Most people present with shortness of breath. Those are the main issues that vascular surgeons treat.”

What are some of the symptoms, and what causes vascular disease?

“Usually, it's age. As we age, we tend to develop hardening of the arteries. Smokers can get it as well. Smoking damages the inside lining of the blood vessels. Diabetes is also a common cause. Hypercholesterolemia, high cholesterol, and high blood pressure can cause damage to the blood vessels. Usually, we want to make sure we control risk factors and make sure that you take aspirin, quit smoking, and exercise.”

Give us an overview of the vascular surgery services you offer in your practice.

“Vascular surgeons are specialists who are highly trained to treat diseases of the vascular system, which include arteries, veins, and blood vessels comprised of arterial blood that carries oxygen-rich blood from the heart to the rest of the body. The veins then return the blood back to the heart. I think of myself as a plumber for the body. We can do ballooning. We can do angioplasty and stenting. We can also do surgery to bypass the blockage. We can fix aneurysms. If they bulge out, we can replace them either through a stent graft or by sewing blood vessels. Then we also take care of patients with medication; medical therapy is also very big.”

Share with me your practice philosophy.

“I believe in patient autonomy. I think it's important in an initial visit to identify a patient's specific concern and what bothers them to really customize a comprehensive treatment plan for their vascular condition. I strive to provide the patient with accurate information about their diagnosis and then provide them with evidence-based vascular care. There are many options. Some patients don't want any surgery or more aggressive intervention. So, then we start with medical therapy. 

“When their condition gets severe enough, they may need minimally invasive procedures. That's usually the next side of therapy, like arteriogram or venogram or stenting to open blood vessels. Eventually, if they get severe enough they may need something bigger like an operation, and that's something we also offer.”

What are some of the challenges you encounter in treating vascular disease?

“A lot of it is the initial recognition. We have to be able to recognize the problem. If you get leg pain and leg cramps, you really want to see a vascular surgeon. Maybe see your primary care doctor first and discuss your situation with your doctor you trust to see if you do have vascular disease. Then they can refer to the vascular surgeon.

“Sometimes it's family history. Patients with abdominal aortic aneurysm tend to be smokers and have a family history of aneurysms; it's a silent killer. A lot of patients may not know to be screened for aneurysms so that's something that we also want patients to be aware of. If you have family history of that, we want to make a note of it and get it checked out. I usually tell patients that we can't cure atherosclerosis, but we can manage it. We can manage it so you can live a longer, healthier life.”

Are there either some facts you'd like to reinforce or some myths you'd like to dispel about vascular disease?

“Yes. People think that when they hear surgery you're going for intervention. That's not necessarily true. When you see a vascular specialist or a vascular surgeon, you're really discussing options. Not every vascular disease needs surgery and making the right diagnosis is a good start. We must make sure that leg symptoms aren’t from a pinched nerve or from sciatica or musculoskeletal issues rather than an arterial or vein problem. We have to make sure we make the correct diagnosis and come up with a good treatment plan.”

Is there some current or exciting research or are there some advancements in treatments of vascular disease that have you hopeful about the future of treating these diseases?

“Absolutely. There is an explosion of technology in diagnosing and treating vascular disease, especially in the last 20 years. We switched our focus to being minimally invasive, so we no longer really must open someone's belly or abdomen or make big incisions. A lot of it is catheter-based procedures. Instead of doing a heart catheter, we're doing leg catheterizations and some procedures that correct the blockage or improve the flow without having to make big incisions, and that may correct a lot of the problem.

“The other thing is we've had a lot of medical advancements and therapies. Sometimes you can’t dissolve the clot, and you must go in and remove the clots. But a lot of times we can perform therapies that can improve the longevity of our stents and our bypasses.

“We have digitized a lot of what we do in terms of imaging. Vascular imaging has gotten so much better that we can see things that we weren't able to see before. In the past, we may not have even known a patient had a vascular disease. From an x-ray somebody was getting or through CAT scan imaging an aneurysm may have been discovered. Then it's more of a discussion of whether or not to monitor that aneurysm or to treat it. It really depends on a patient's symptoms and the size of it. There are certainly a lot of things that we can do.”

What attracted you to MSU Health Care?

“MSU has a great name and a great program. I was recruited here to build the vascular surgery program in the Lansing area, and I took up that challenge. I'm very excited about that opportunity. I think there are a lot of under-recognized and under-treated vascular diseases, and I'm hoping to help patients with vascular disease live healthy, long lives.”

What motivated you to get an MBA in 2017?

“I've always wanted to be a doctor and I love what I do taking care of patients, doing operations, and managing vascular disease. That's what I'm trained to do. In the last 15 years, medicine has changed a lot. I wasn’t as familiar with the business side of medicine, and I felt like getting a master’s in business administration would help in terms of looking at the flow of medical care and how to improve it because a lot of what we do in medicine is teamwork.

“It takes a whole team to get things done, and medicine has really become a group of people working together. We were taught in medical school to do everything ourselves. In business it's very different. We worked a lot in teams. You can’t graduate with your MBA if you don’t know how to work with a team. The other thing I learned was leadership. One of the things I really wanted to learn is about how to become a better leader and to grow more personally and professionally so hopefully I can manage patients and my team better.”