Procedures Aneurysm Repair, Angiogram, Endarterectomy, Surgical Bypass, Vascular Access for Hemodialysis, Vascular Access for Infusion, Amputation, Thrombolytic Therapy


Endovascular repair is a preferred treatment for many people with an abdominal aortic aneurysm (AAA), and an alternative for some who do not qualify for open surgery.

How an AAA is repaired varies depending on location, which then classifies the procedure as either STANDARD or COMPLEX.



If your kidneys fail, unless and until you have a successful kidney transplant, you will need dialysis therapy to clean and filter your blood. The first step is establishing dialysis access one of four ways:

  1. A tunneled catheter in your neck—temporary, because the possibility of infection is high.
  2. An AV fistula—taking a piece of a vein from your arm or leg and sewing it into a nearby artery, and allowing the sewn-in vein to enlarge and become thicker, like an artery. Considered the best option because it has the lowest risk of infection.
  3. An AV graft—the sewing of a prosthetic graft between an artery and vein in your arm or leg. The preferred option if your veins are too small for an AV fistula. AV grafts tend to close more quickly and are more prone to infection because they are not formed from natural tissue.
  4. Peritoneal dialysis—placement of a small tube, called a cannula, in your abdomen to allow the use of the lining of the abdomen (peritoneum) to filter your blood. It requires several “exchanges” every day: you introduce and remove fluid through the tube. A convenient option because you perform the dialysis therapy at home, but infections sometimes occur and the tube can become clogged.



A carotid endarterectomy is a surgical procedure to open or clean the carotid artery with the goal of stroke prevention. It is a durable procedure but not a cure; though rare, blockage can accumulate again.



A catheter is placed in the vein that can be used for dialysis, infusion of medication, nutrition or blood draws. Some of these lines can be left in place for several months.

A tunneled dialysis catheter (TDC) is a dialysis access option for people who need dialysis therapy and may not be able to have a fistula or graft placed. The TDC can be used as soon as correct placement is confirmed. Sometimes people use a TDC temporarily while they wait for a fistula or graft to mature.



In The Leg
Also called lower extremity bypass, leg bypass, fem-pop bypass, fem-tib bypass, fem-distal bypass.

In The Abdomen
Also called aortic bypass, aorto-iliac bypass, aorto-femoral bypass, fem-fem bypass, aorto-mesenteric, and ax-fem bypass, depending on which blood vessel is being bypassed.

With the help of a natural or synthetic graft, a surgical bypass routes blood flow around an area of blockage caused by peripheral arterial disease (PAD). The surgery does not cure the disease or remove the blockage. Think of a surgical bypass as a road detour.

How long it lasts varies
The lifespan of a surgical bypass depends on the health of your arteries, the type of graft used (natural vein grafts last longer than synthetic ones) and other health factors, such as whether you smoke, or have diabetes or kidney failure.



An angiogram is an X-ray procedure that can be both diagnostic and therapeutic. It is considered the gold standard for evaluating blockages in the arterial system. An angiogram detects blockages using X-rays taken during the injection of a contrast agent (iodine dye). The procedure provides information that helps your vascular surgeon determine your best treatment options.

Angiograms are typically performed while you are sedated. The procedure may last 15-20 minutes or up to several hours, depending on how difficult the test is and how much treatment is given.



Thrombolytic therapy is the administration of drugs called lytics or “clot busters” to dissolve blood clots that have acutely (suddenly) blocked your major arteries or veins and pose potentially serious or life-threatening implications. To be effective, the therapy needs to be initiated as soon as possible, before permanent damage has occurred.

The length of a treatment session varies depending on the underlying cause. A session can take from 60 minutes (typical for a heart attack) to 48 hours (often the case for deep vein thrombosis, or DVT).



Amputation is the removal of a limb (arm or leg) or part of an extremity (foot, toe, hand or finger/s) when an alternate treatment is not available or has failed, to remove bone and tissue due to:

  • Extensive infection
  • Lack of blood supply
  • Significant trauma
  • Frostbite
  • Severe burns
  • Wounds


Vascular and Endovascular Surgery


1050 Gemini Avenue #203
Houston, TX 77058


6807 Emmett F. Lowry Expressway
Suite 302
Texas City, TX 77591

Copyright 2023 BILL K. CHANG M.D., FACS. All rights reserved.