Vascular surgical services offered again in T-Bay

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An arteriovenous (AV) fistula is the gold standard for dialysis patients because it allows good blood flow, is less prone to infection, and is less likely than a central line to lead to vein collapse. However, the vast majority of dialysis patients in northwestern Ontario received their dialysis through a central line for one simple reason: there wasn’t a vascular surgeon at Thunder Bay Regional Health Sciences Centre to do the procedure.

That’s changing thanks to the introduction of vascular surgical services at Thunder Bay Regional – offered as part of a developing Cardiovascular Surgical Services Program – and the arrival last year of its first vascular surgeon.

Dr. Yaasin Abdulrehman, who completed his residency last year, started travelling to Thunder Bay in July 2014 to perform dialysis access. He joined full-time in October, becoming the keystone to the new program that will eventually offer comprehensive vascular surgical services.

“In Toronto and Winnipeg, I used to meet a lot of patients from Thunder Bay,” Abdulrehman said. “It was obvious that there was a need for a vascular surgical program here. As someone who’s just starting my career, it seemed like a nice place to get some experience and an opportunity to really help a community that didn’t have access to this particular kind of care.”

Not long ago, general surgeons in Ontario were allowed to practise vascular surgery, including repairing aortic aneurysms and vascular bypasses. In fact, at one point there were five general surgeons in Thunder Bay who practised vascular surgery. Since then, regulations have changed so that only dedicated vascular surgeons can perform these procedures.

That change was a double-edged sword. Few would argue the need to provide the best possible care. But as with most specialities in Ontario – especially Northern Ontario – funding programs and finding those specialists can be a challenge.

Challenging or not, creating a comprehensive cardiovascular surgical program was a necessity in the mind of Arlene Thomson, director of the cardiovascular and stroke program at Thunder Bay Regional.

“It’s part of a standard of care at an academic health sciences centre,” Thomson said. “We have an above-average incidence of vascular disease (in northwestern Ontario) and we have a very high rate of people requiring renal dialysis.”

The region also has one of the highest rates of diabetes, and of diabetes-related amputations – the North West LHIN has 2.7 times the amputation rates compared to the provincial average. Vascular bypass would help reduce the need for amputation in many cases.

A plan is in the works to create a “corridor of cardiovascular surgical services” in collaboration with the University Health Network’s Peter Munk Cardiovascular Centre (PMCC) using a two-sites, one-program model. Thunder Bay Regional will build its local cardiovascular surgical program with the support of PMCC and, for those patients who do need to travel for procedures, provide almost seamless care between facilities through the joint program.

Dr. Abdulrehman is already demonstrating what that collaboration might look like, at least in part. At the end of April, he travelled down to PMCC with five patients – four from Thunder Bay and one from the region – for endovascular aneurysm repair (EVAR), a procedure that inserts a type of stent to help prevent rupture of the aorta. Dr. Abdulrehman is trained in the procedure, but Thunder Bay Regional does not yet have the equipment needed. All patients spent one or two nights in hospital before being discharged home. So although the actual procedure took place in Toronto, all pre-operative tests and post-operative follow-ups took place in Thunder Bay – most importantly, by the same surgeon.

Providing local vascular surgery is also an important part of emergency services, Thomson said.

“We’re a regional trauma centre… we’ll be able to provide complete trauma services.”

Although Abdulrehman is available for some emergency cases, there are times when he is away such as during his EVAR procedures at PMCC. Thomson said the hospital is actively recruiting two more vascular surgeons. The program would also require some more instruments and some renovations to an operating room.

“Then we can offer 24/7 service. We will have a vascular surgeon on call every night, every weekend,” Thomson said. After that, plans are in development for a full open-heart surgery program.

Dr. Abdulrehman’s arrival is a step in that direction. He said that he’s looking forward to being part of creating a program that’s meaningful for patients and the region.

That’s really what drew me to Thunder Bay – the opportunity and potential to build a program where there wasn’t an existing infrastructure.”

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