UC Davis Vascular Center Spotlight with Professor David L. Dawson, MD

Tell us about the UC Davis Vascular Center’s interdisciplinary approach to treating peripheral vascular disease.

The UC Davis Vascular Center provides total vascular care. Ours is a multidisciplinary center, integrating the services of all specialists and subspecialists involved in diagnosing and treating any form of blood-vessel disease—from varicose veins to complex vascular disorders. Teams work together during clinic visits and procedures to provide the best care for patients with vascular disease or injury.

What are the different medical disciplines involved in treating patients at your center?

Our multidisciplinary teams can include vascular surgeons, cardiologists, thoracic surgeons, interventional radiologists, neurovascular radiologists, nephrologists, podiatrists, and consulting medical specialists. In addition, we have dedicated inpatient and outpatient nursing teams, specifically trained in vascular services. We also have a state-of-the-art noninvasive vascular laboratory that supports diagnosis, procedure planning, and follow-up care.

How specifically are surgeons and interventionists working together to treat patients with peripheral vascular disease? How have you managed to eliminate the barriers that have traditionally existed between the different specialties involved in treating these patients?

Peripheral artery disease (PAD) is one of the most common health problems that the UC Davis Vascular Center treats and our primary goal is to catch it early, deter its progression, and reduce the occurrence of even more severe vascular or cardiac events. We have found that the most significant barriers to achieving this goal are external, not internal. Despite the pr­­­evalence of PAD, many patients and doctors don’t recognize common symptoms, and they may miss opportunities for risk-factor modification and early intervention. Our team is actively involved in delivering a comprehensive lifestyle modification program that includes smoking cessation, weight loss, and physical activity combined with appropriate medications, such as anti-platelet drugs or cholesterol-lowering therapies. We are also closely involved with senior and active mature adult communities in providing education and outreach about the importance of paying attention to vascular health.

Tell us about the staff and management structure of your vascular program. What are the duties of the various staff members? Are they cross-trained for the different treatment approaches?

Cross-training is a priority in our program. The operating room (OR) staff has learned about catheter-based interventions. Cath lab nurses have learned to function in a hybrid OR, supporting cases with both open and endovascular components. Clinic nurses see vascular patients every day of the week with a surgeon, cardiologist, radiologist or vascular medicine physician.

Each service area has an experienced manager, who provides leadership and focus, including nurse managers for each treatment area, ward or clinic.

Our residents and fellows acquire multidisciplinary experience. Interventional cardiology fellows get experience on the vascular surgery service and the curriculum for vascular surgery fellows and residents includes rotations on cardiology, radiology and other vascular specialty services.

This “cross pollination” directly benefits our patients. When patients see specialists who have access to a full range of therapeutic options, they can have confidence that their treatment recommendations include all relevant options. For example, when a patient with carotid artery disease sees a UC Davis vascular surgeon, that specialist can offer open surgery (carotid endarterectomy), carotid artery stenting or medical management, with specific recommendations for the individual patient based on individual circumstances.

Describe your surgical and endovascular suites. Are the suites shared or separate?  What are some of the unique features you had to incorporate to make this work?

State-of-the-art imaging capabilities exist in our Department of Radiology, Cardiac Catheterization Laboratory (CCL) and hybrid endovascular operating room (OR). While specialists may have a “home base” or specific location where they most commonly work, UC Davis physicians regularly cross traditional lines. This includes collaborations that bring together special expertise to handle complex problems. For example, an interventional cardiologist may partner with a thoracic surgeon for endovascular repair of a traumatic thoracic aortic injury. It is also common to see our various specialists in “non-traditional” locations; for example, vascular surgeons in the CCL take advantage of imaging capabilities and support staff expertise when treating critical limb ischemia due to advanced PAD. Interdepartmental collaboration has made every treatment location at UC Davis Health System accessible to all of our credentialed vascular specialists. ­

What is the current breakdown of the types of procedures performed at your center?

We offer the full range of minimally invasive procedures as well as cutting edge surgical procedures. In some cases, these are primary procedures. UC Davis serves as a regional referral center so much of our case volume includes patients who require complex treatment plans. Common procedures in our center include endovascular therapies and open surgeries for aortic aneurysm repair, revascularization for PAD, carotid surgery and stenting, creation and preservation of dialysis access, treatment of venous disease, cancer therapies, and neurointervention. In addition, our team is committed to long-term post-procedure monitoring and follow up, which allows us to assess the outcomes of the therapies we employ.

How are your rooms equipped? What types of imaging modalities do you have available and for which types of procedures are they used?

Our hybrid surgical suite, like our cath lab and radiology facilities, includes x-ray, 3-D imaging, duplex ultrasound imaging, digital fluoroscopy, high-quality digital subtraction angiography, and intravascular ultrasound. A full range of treatment options is also available, with angioplasty, various types of stents, laser, atherectomy, thrombus management tools, and other devices and supplies readily available to specialists in each treatment location.

What are some of the innovative technologies and techniques available at your center?

UC Davis Health System is a level 1 trauma center and treats patients with aortic injuries that occur due to trauma, such as motor vehicle crashes. Our team of cardiovascular specialists has demonstrated the effectiveness of using stents—as compared to traditional open-chest surgery—to repair aortas that are torn as the result of accidents. This approach reduces OR time, blood transfusions and deaths.

What benefits in terms of quality of patient care and cost-savings do you foresee with a program such as yours?
The primary benefit is in our commitment to early detection and treatment of vascular disease and mitigating life-threatening complications. Cardiovascular disease is the nation’s leading killer for both men and women among all racial and ethnic groups, and greater and earlier attention to blood vessels can significantly change that trend.

For many conditions, such as aortic aneurysm repair, the shift from major open operations to less invasive endovascular treatments has reduced procedural risks and allowed for much quicker recovery and return to normal activity levels.

Being a patient-focused center, our treatment plans are tailored to each patient’s unique situation and needs.

Is your center involved in any clinical research at present?

Our center has a very active and robust clinical research program focused on utilizing new types of stents for carotid artery disease, abdominal aortic aneurysm disease, and lower extremity arterial disease. UC Davis Vascular Center Medical Director John Laird, an internationally renowned interventional cardiologist, has been the national principal investigator on several recent trials of stents for iliac and femoral arteries.

This year, we kicked off a stem cell study that will determine if a patient’s own stem cells can generate new blood vessels and circumvent the need for amputations due to critical limb ischemia. Currently, UC Davis is the only West coast site for this investigation.

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Dr. David L. Dawson is a professor of vascular and endovascular surgery for UC Davis Health System.