Q with Advanced Veins and Vascular Management A &

Dr. Abushmaies has been providing vascular care to the Hillsdale community for 25 years. As he is celebrating his many years of service to this area, we sat with Dr. Abushmaies to talk about the value and impact of establishing an ambulatory vascular center serving Hillsdale and surrounding counties.

Can you please tell us about your professional background?

I am a board-certified vascular surgeon with 30 years’ experience in this field. I was seeing patients in a small office in Jonesville; it was a clinic operated by Hillsdale hospital at the time. Initially, most testing for vascular disease and procedures were performed in the traditional way with open surgery and patients had to commute to Battle Creek or Kalamazoo for their definitive procedures.

Due to the increasing prevalence of vascular disease and the recent advances in providing minimally invasive procedures on an outpatient basis, the concept of providing ambulatory, quality, safe, and state-of-the-art treatment was born.

Advanced Veins and Vascular Management (AVVM), an ambulatory vascular center accredited by the Joint Commission, was established three years ago, just a few months before the COVID 19 pandemic. There was an outpouring of support from the medical community and positive feedback from patients. That was vital in AVVM’s growth and success in meeting the needs of the community.

Is an ambulatory vascular center a new concept?

The concept was introduced by the Center for Medicare and Medicaid services in 2008. This was born out of the need to meet the increasing demand for vascular treatment due to significant increase of the incidence of peripheral vascular disease (PAD). It reduces wait time and contains the rapidly increasing cost of taking care of those patients in the hospital setting. There are currently over 700 centers in the U.S. specializing in ambulatory vascular care.

With the technological advances such as the invention of small catheters, tools, stents, and balloons, it became safe and feasible to treat venous disease, complex arterial blockages, and dialysis access shunts, in a patient-centered, intimate environment in an ambulatory vascular center, without jeopardizing safety or quality.

What type of services does the AVVM center provide and where do the patients you treat come from?

We provide comprehensive vascular care from the time of the first initial visit to completing the full treatment all in the same location. We have an onsite vascular lab that is fully accredited by the Intersocietal Accreditation Commission (IAC), fully staffed with registered vascular technologists who can perform professionally all non-invasive diagnostic vascular ultrasounds, using the state-of-the-art equipment.

Our center is equipped with the most advanced imaging capabilities, tools, and machines for de-clotting and removing plaque from the arterial system, restoring circulation to the legs to allow help with healing ulceration, and preventing amputation using this non-surgical option. We provide all non-surgical treatments for varicose veins and all vein-related condition such as swelling legs, open wounds, and ulceration.

Our procedures are done in a safe, sterile environment, using conscious sedation that eliminates any pain or discomfort to the patient. Our patients are mostly from the Hillsdale County area. However, being the only ambulatory vascular center operated by a vascular surgeon within a 50-mile radius, we are increasingly serving many patients from Branch, St. Joseph, and Jackson counties. We are seeing more patients from across state lines as well.

How did the COVID 19 pandemic affect your ability to provide services to your patients?

During the lockdown, we had to reschedule most of our elective procedures, complying with performing what was deemed as urgent essential care. However, the pandemic proved the benefit of ambulatory surgical centers and ambulatory vascular centers in providing essential care and urgent procedures where hospital beds were occupied and could not accept those patients.

For example, T.S. presented with clotted dialysis access during the restrictions. We could not find any hospital bed for him to be treated as an inpatient. Our staff were caring and kind to help; we opened the center and performed a de-clotting of the dialysis access, and he was dialyzed the same day and is doing well to date.

Another example is J.R., a 65-year-old man who presented with the limb-threatening situation of complete blockage of the circulation to his leg. There were no beds in any surrounding hospital in Michigan to transfer him, nor even Toledo or Fort Wayne. We were able to remove the clot from his leg using a nonsurgical approach at AVVM, restore his circulation, and save his leg.

What type of set up and expertise is required to be able to deliver such a service?

Treating peripheral vascular disease is demanding and can be very challenging. Most vascular patients have underlying heart and lung conditions which need to be optimized with open procedures. Avoiding open, hospital-based procedures has been shown to reduce complications and infection rates with greater patient satisfaction and quality of outcome. This is especially true when treatment is offered at a dedicated, sterile, intimate environment with a staff that is knowledgeable, trained to a level of expertise, and focused exclusively on the treatment of vascular conditions.

Our team members hold the highest qualifications and certification in the vascular field. In addition, extensive experience, advanced imaging capability, state-of-the-art equipment to navigate the blocked arteries, and removing plaques are vital. Quality measures and safety are equally important. AVVM is proud to be accredited by the Joint Commission and holds the golden seal of approval.

How does your center and the care you provide fit in within the Hillsdale hospital services?

Over the last 25 years I have had a great relationship with and support from the medical community in Hillsdale and I am very thankful for making this project succeed, bringing the community close to home quality vascular care. We use the radiological and laboratory services and complement other services provided by the hospital. I have great collaboration with the wound care clinic, have continued to provide emergency room and inpatient consultation, and done procedures when judged to be appropriate with specific interest and focus on limb salvage and preventing amputation.

Our main goal is to grow this mutually supportive relationship and partnership for the good of the Hillsdale community. I think we share the same vision.