By Ravi Veeraswamy, M.D.Dr. Ravi Veeraswamy

As a vascular surgeon, I am frequently asked to perform temporal artery biopsies to make a diagnosis of arteritis.   This is perhaps the most common referral I receive.

Other physicians not familiar with the disease process also often refer vasculitis patients to vascular surgeons.  The physician and the patient are concerned about arterial insufficiency or arteriosclerosis as the cause.  For example, I recently referred a gentleman in excellent health without any risk factors for arteriosclerosis who noted that his fingers became discolored on several occasions in cold temperatures.  The role of the vascular surgeon is to identify the underlying process and refer the patient to an appropriate specialist, usually a rheumatologist.  The most common type of referral in this category is for patients with Raynauds Phenomenon.  Often, the presentation can be confusing and we will perform a diagnostic angiogram to help define the problem and rule out other causes such as proximal aneurysms or other embolic sources.

The other end of the spectrum is when patients are referred to us for “end-stage” disease.  Patients have developed chronic stenosis of vascular beds such as the upper extremities or the carotid circulation and they need bypasses to restore arterial flow.  In this scenario, it is the rheumatologist who sends the patient to us.  Patients typically need bypass grafts placed distal to the areas involved in the inflammation.  For example they may need bypasses from the aorta to the carotid or from the carotid to the brachial and so on.   The decisions on specific bypasses are based on a given individual’s arteriograms and anatomy.

We typically are “repairing damage” rather than preventing it.  There are really no great surgical treatments currently to help prevent damage in the setting of vasculitis.  I first encountered patients with vasculitis in the surgical clinic as a medical student.  I was amazed at how little we knew about the root causes of the problem.  While we have learned a lot since then, there is a long way to go.  My research interest has always been in immunobiology and in managing patients with vasculitis, I am able to combine my clinical and research interests.  Currently, I am establishing research projects to study the role of dendritic cells and T cells in vascular biology and the arterial wall.  Hopefully this will help us understand the process that initiates the inflammatory response and give us insight into how it might be controlled.

On a personal note, I have wanted to be a doctor literally for as long as I can remember.  I used to dress up as a doctor all the time as a kid.  I still find the profession fascinating and consider myself very lucky to be in a field where I can directly help other people.  I think the best relationship is when the doctor and the patient work together with a common understanding of the possibilities of treatment and the limitations of treatment.  The best thing a vasculitis patient can do is find a good rheumatologist with an interest and experience in managing the vasculitis.   

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