UBMD vascular surgeon discusses what she does, how the field continues to evolve with minimally invasive approaches and why she chose this particular specialty of medicine
By Chris Motola
Q: As a vascular surgeon, what kinds of pathologies do you treat?
A: The vascular system is the arteries and veins, so we operate on arteries and veins anywhere in the body outside of the brain and outside of the heart. Things that we treat or operate on that we medically manage are peripheral arterial disease, the arteries in the legs or even in the belly. Where there are blockages people have pain when they’re walking around, wounds on their feet. So we’ll use angiogram ballooning, stenting to open up the blood vessels to give you more blood flow or to reroute blood flow around a blockage. We do abdominal aortic aneurysms, which involves the dilation and ballooning of the blood vessels, usually in the abdomen, although there can be aneurysms all over the body. If they rupture, you’re bleeding out, which is a life-threatening emergency. So we treat those, both endovascularly or open the abdomen and make repairs. We do carotid arteries in the neck, which can be a stroke risk if there are blockages there. We do a lot of work with people with kidney disease. We do venous disease, varicose veins, people with wounds on their legs as well as people who have blood clots in their legs. It can lead to leg swelling and other issues. We also treat blood vessels that lead to the gut and the kidneys.
Q: Are most of these surgeries minimally invasive?
A: A lot of these surgeries are minimally invasive. So if we use balloons and stents we’re able to do a lot of things. Over the last 20 years things have evolved from everything being open to where we start with a minimally invasive approach for most things. We’ll try that first and then decide if an open repair would be better if we can’t do something minimally invasively. The carotid artery we do minimally invasively with a small incision in the base of the neck, or we do it openly. It really depends on the patient’s anatomy and features.
Q: What are the outcomes generally like for these procedures?
A: It very much depends on the patient’s condition at presentation. The outcomes with elective procedures are usually pretty good. If you have a ruptured aneurysm, it’s trickier. The generalized teaching is that if you have a ruptured aneurysm, the chance that you die before you reach the hospital is about 50%. And then it’s about 50% during the hospital stay. So we do a lot of screening and education with primaries to try to prevent them from rupturing in the first place. If we find it before it’s ruptured with imaging, the success rate is about 98%. So it’s super important to catch them. In terms of other outcomes, like treating symptoms or peripheral artery disease, and have, for example, wounds on their feet, you need an intervention to get them to heal. Other symptoms might be pain from walking around, even just around the grocery store. After our procedures they’ll be able to do those things. So outcomes there are very good in terms of both quality and quantity of life.
Q: With regard to the lower extremities, are things like wounds on the feet caused by lack of blood flow?
A: Lack of blood flow is one of the causes. If you’re diabetic, you also are at increased risk of developing wounds on your feet from both the high levels of glucose in the blood and the fact that they can’t feel their feet as well. So they might have something small that they don’t notice that develops into a wound. But without blood flow, it’s not going to heal. So other things that put you at risk of peripheral arterial disease are things like high cholesterol, poor diet, which is huge in Buffalo. We love our chicken wings.
Q: Is Buffalo’s risk profile above the national average?
A: At the overall risk level, our rates of smoking aren’t that high compared to the South. It all kind of averages out. Smoking is another huge, very modifiable risk factor. Quitting smoking will decrease your risk of pretty much all of the diseases that
we treat.
Q: What causes varicose veins?
A: Varicose veins a lot of the time are genetic. So if you have family members with varicose veins, you’re more likely to get them. Another risk factor is being on your feet a lot, so people who have a job that requires a lot of standing are at increased risk. Being overweight and not exercising can also increase venous pressure and increase your risk. It’s more common in women, but men get them too. Part of that might just be that women are more likely to present with them because they don’t like how they look. But they can be painful, they can itch. If you’re symptomatic, there are things that we can do for that too.
Q: Are they a sign of more serious pathology, or more of a nuisance?
A: They’re usually not a sign of something more serious. It’s usually a cosmetic issue, which insurance usually won’t pay for. There can be some discomfort, some itching. There is a chance that they can bleed, but that’s pretty uncommon. Even when it does, it’s not usually life-threatening, but it can be scary if it does. Along that same spectrum is chronic venous insufficiency is edema, or swelling of the legs, so having varicose veins does put you at risk for having swollen legs. From there you can have skin thickening and ulcerations. So it’s usually cosmetic, but some patients can become at risk of infection due to those wounds.
Q: What got you interested in vascular surgery?
A: I grew up in Buffalo, went to medical school here. I always thought I wanted to work with my hands, I liked anatomy, I liked fixing people and not just saying “try this medication.” I did rotations in vascular and I liked that we treat the whole patient. If they have a vascular problem they come back and see me every three, six months to a year. A lot of our patients have chronic conditions that we have to treat. I love that I get to interact with and learn about our patients. There’s a lot of interaction. And I love the surgeries that we do. There’s a lot of anatomy involved. And the minimally invasive aspect has really come around. Some of my mentors had only learned open surgery when they were in training, but they learned these new techniques well into their careers. So that was very encouraging to enter a field that’s willing to change and evolve and figure out the best way to do things for patients.
Lifelines
Name: Brittany C. Montross, M.D.
Position: Clinical assistance professor and attending vascular surgeon with the department of surgery at UBMD. Clerkship director at Jacob’s School of Medicine.
Hometown: East Aurora
Affiliations: Buffalo General Hospital, Millard Fillmore Suburban Hospital, ECMC, Niagara Falls Memorial Hospital
Organizations: American College of Surgeons; Society of Vascular Surgery; Western New York Vascular Society
Family: Husband, two children
Hobbies: Buffalo Bills fan, skiing