Vascular & Endovascular Surgery Division

Welcome!

Our mission at the University of Virginia Division of Vascular & Endovascular surgery is to provide world-class, innovative open surgical, hybrid, and endovascular treatments for patients with vascular disease. The needs of the patient are our focus. We offer the spectrum of minimally invasive, advanced endovascular procedures, yet remain engaged and skilled in open surgical reconstruction for those who need it.

Along with this, excellence in vascular education, renowned clinical outcomes research, quality and efficiency, as well as leadership in vascular health policies are critical in allowing us to fortify this focus and enrich care of our patients.

We collaborate closely with multiple specialties including cardiac surgery, cardiology, vascular medicine, and interventional radiology to deliver streamlined comprehensive, multidisciplinary cardiovascular treatment in the UVA Heart and Vascular Center and its care center structure.

Our vascular and endovascular surgery fellowship program is one of the best in the country with an outstanding all-around experience. I encourage you to visit our fellowship website.

In constant pursuit of advancement, we participate in the regional Virginias Vascular Study Group (VVSG) and the national Vascular Quality Initiative (VQI) of the Society for Vascular Surgery Patient Safety Organization (SVS/PSO), as well as the National Surgical Quality Improvement Program (NSQIP). Our own Vascular and Endovascular Surgery Outcomes Collaborative (VESOC), Vascular Quality and Safety Team (VQST), and translational laboratories allow us internal mechanisms to identify opportunities to improve quality and academic study. We are active in national and international clinical trials involving novel devices and treatments for peripheral arterial disease, arterial trauma, aortic aneurysms and aortic dissection.  Visit our department research site to find out more.

At UVA Vascular & Endovascular Surgery we are continually working to improve care for our patients, and serve our university, local, regional, national and international communities. Whether you are a patient, referring provider, student, resident or industry partner, we thank you for your interest.

Please contact me if you have questions about our programs.

Darrin Clouse, MD
Chief, Vascular & Endovascular Surgery Division
Professor of Surgery

Aortic aneurysms and aortic dissection can affect the entire aorta from the valve in the heart to the arteries supplying the legs and everywhere in between. These require a cohesive team to provide state-of-the-art therapies. Vascular and endovascular surgery, as a cornerstone with cardiac surgery, form this group’s foundation. Vascular medical specialists, cardiologists, and interventional radiologists provide multidisciplinary insights and skill in managing all aspects of aortic care. The UVA Aortic Alert Program allows ease of transfer and rapid consultation.

Carotid Artery Stenosis

Treatment of carotid artery stenosis can prevent risk of primary or recurrent stroke. We provide comprehensive carotid care with expert insights into need for revascularization. When recommended, we perform carotid endarterectomy, carotid angioplasty and stenting, as well as the latest modality to perform stent placement, trans-carotid artery revascularization (TCAR) with flow reversal cerebral protection, through a small incision in the neck. More rarely, vertebral artery disease may need to be addressed.

Supra-Aortic Trunk Stenosis

The branches of the aortic arch include the innominate, or brachiocephalic artery, and the common carotid and subclavian arteries. Diseases in these locations can lead to stroke, transient ischemic attack, upper extremity symptoms, or vertebral and coronary steal syndromes. Surgical, endovascular and hybrid treatment of these lesions is a concentration of our team.

Peripheral Artery Diseases

Peripheral artery disease due to atherosclerosis can cause claudication and life-style limiting pain. It can also progress to chronic limb threatening ischemia with tissue loss. Acute limb ischemia from thrombosis or embolization requiring urgent or emergent care can occur. Aneurysms in extremity arteries due to atherosclerosis and degeneration are common. Treatment may include surveillance and medical risk-modification or endovascular intervention, open surgical reconstruction, and hybrid procedures incorporating both to treat any of these entities.

Arterial Disease in Athletes and the Young

Less frequent pathologies causing limb ischemia are anatomic and functional popliteal entrapment, arterial adventitial cystic disease, and endofibrosis in distance cyclists and endurance athletes. UVA vascular and endovascular surgery has specific expertise in treating and caring longitudinally for these unique vascular diseases.

Thoracic Outlet Syndrome

Arterial, venous and neurogenic compression in the thoracic outlet between the shoulder and chest can cause aneurysm formation, thromboembolization, venous thrombosis, or acute and chronic pain. When this happens this is called thoracic outlet syndrome (TOS). Once diagnosed, decompression with rib and muscle resection are warranted. Thrombolysis with venous reconstruction, or arterial reconstruction may accompany these depending on the affected structures. Our UVA team is recognized for its specialty care in this clinical arena.

Abdominal aortic branch disease, or renovisceral artery disease, may have many important signs and symptoms. We have considerable understanding of the diagnostic modalities and treatment strategies for these disorders. Endovascular, catheter-based, procedures and/or open surgical reconstruction may be needed. We are ready and skilled in management.

Renal Artery Stenosis

Renal artery narrowing, or stenosis, is usually due to atherosclerosis and may lead to difficulty in hypertension control, or decreased renal function. Aneurysms of the renal artery may occur and can also cause hypertension and have a risk of rupture.

Mesenteric Artery Stenosis

Stenosis of the celiac axis, superior mesenteric artery (SMA), or the inferior mesenteric artery (IMA) can cause pain with eating, called intestinal angina, nausea, or diarrhea. This is chronic mesenteric ischemia (CMI) and when these symptoms occur revascularization is required. UVA has specialized expertise to treat CMI.  Acute thrombotic events in patients with pre-existing stenosis of these vessels, or emboli from a cardiac or aortic origin can lead to acute mesenteric ischemia (AMI), which is time-sensitive and life threatening. Our team, along with other surgical and interventional groups, is developing an AMI alert and response team to provide rapid treatment and improve outcomes.

Median Arcuate Ligament Syndrome

Rarer entities affecting the visceral vessels may include inflammation of the blood vessels or compression. One such process is called median arcuate ligament syndrome (MALS). This may cause abdominal discomforts, but requires specialized diagnosis and understanding of all treatment methods. UVA vascular and endovascular surgery is a recognized center in MALS care.

The UVA Vein Center focuses on diseases involve the venous system. Varicose veins, spider veins, venous thrombosis, chronic venous insufficiency, and venous syndromes of compression, including the iliac, renal and ovarian veins, are common and our multidisciplinary team of vein specialists is ready to care for vein health needs. The latest ablation and catheter-based techniques, sclerotherapy, and open surgery when needed, are all part of trusted UVA comprehensive vein care.

Our group’s commitment to patient-centered research begins with continual review of institutional, regional and national quality and results. Examples of our UVA medical center investigation include national presentations regarding how socioeconomic features affect vascular surgery results, treatment of popliteal entrapment, MALS, TOS and hybrid repair of complex aortic aneurysms. We participate in the leadership of the VVSG and the SVS VQI and recent projects include investigation of how tick-borne illness, prevalent in Virginia, might affect biologic tissue used for arterial reconstructions leading to early failure. This has led to multiple clinical grant proposals and work. On the national level, we participate in SVS VQI VISION assessing matched data from the VQI with patient’s medicare claim information allowing longer-term analysis of patient-related outcomes. A current example of this is a project led by UVA Vascular and Endovascular surgery looking at national data on results of various surgical strategies treating patients with both carotid stenosis and coronary artery disease.

UVA vascular and endovascular surgery participates in many major clinical trials. These include trials of major aortic endograft devices to treat aortic aneurysm or dissection and encompass newer branched and fenestrated devices. Trials of technologies to enhance autogenous vein bypass grafts and use of new tissue-engineered human acellular scaffolds as bypass grafts are beginning. We are proud of our active participation and leadership in many trials bringing novel features of treatment to our patients.

We are in the initiation phase starting to develop a focus on non-radiation associated procedural image guidance for catheter-based interventions. Our translational research facilities provide us an arena to perform preliminary experiments and develop large-animal protocols for image guidance and endovascular procedure management.