Kurtis Kim, MD, vascular surgeon, director of the vascular laboratory, and clinical lead for research and quality assurance at Mercy Medical Center in Baltimore, talks about the benefits of using newer ultrasound technology.
I wanted to ask you, Adrian was talking about the carotid tumor. Can you tell me a little bit more about what she had?
KIM: Sure, sure. It’s a neurovascular tumor that grows around bifurcation of the common carotid artery. And there’s a nerve bundle there that regulates the blood pressure to the brain. Very rarely people develop a tumor growth on it, and in most cases it’s very benign. It’s not a metastatic disease. But it is best to remove them, as sometimes they can be a neuro-active, meaning that they secrete some hormones that will activate other systems. And so – again, that’s pretty rare. But once you see them, it’s best to take them out.
Was Adrian’s benign?
KIM: It was benign. She had a relatively small size, which makes it easier to resect them. Sometimes in a bigger size, we see that – see the tumor really kind of wrapped around the arteries to dissect it off the artery, which makes it a little more difficult. But in Adrian’s case it was small enough that we were able to do that without much difficulty.
And you did use the Resona 7 for real-time visualization?
KIM: Correct.
Can you tell me, from your perspective, how that benefits during the surgery?
KIM: Right. So, the ultrasound for a carotid body tumor is fairly specific because, if the tumor is in the bifurcation or forking of the artery – tumor grows on the middle of it, and so it tends to flay open the bifurcation more versus the normal angle that it will bifurcate. So that’s one of the signs that we look for. And then one of the better signs is that you look at it with an ultrasound and there is a vasculature going through that tumor – so there is a blood flow going through that tumor. Vascular ultrasound is very good at looking at if there is an active blood flow going or not, as we are looking at these active blood flows in different parts of our bodies. And so those would be very diagnostic. Yeah.
I want to also ask you just the benefit for other conditions of having this tool at your disposal?
KIM: Sure. Vascular disease, like some of other disease – some are very silent. They grow silently. For example, chronic disease – not the one that Adrian had, but carotid disease that narrows the blood vessels just like you would have, heart disease – coronary artery disease that narrows the blood vessels. The only reason why we can’t really ultrasound coronary arteries is because we have our our ribs and the chest bones over top of that ultrasound cannot penetrate. So a lot of parts of our body that we don’t have a overlying bone, for example, in the abdomen and especially in the neck and in the legs where arteries are not really underneath the bone and that covers it, we are able to really take a very good look at it. And especially when the disease is silent, until it creates a bigger problem down the road – we call that more surveillance program. So these people who have a carotid disease that are mild to moderate undergo routine surveillance program to check for them to follow their progression. We hope that with medical management and with good health, their progression is minimized. But then we are ready to catch if the progression goes into enough of a narrowing that puts them at a risk for stroke. So, there are some people – actually, a fair amount of people we get to see after the stroke. And so, you have to think that, well, couldn’t we have sort of done something about this if we had screening – easily screening tool for this? And certainly, sometimes we get to find out through different doctors where they get CT scans and whatnot, but ultrasound has become a very, very nice tool. One of the things about special – that’s special about my specialty as a vascular surgery is that we are look – we want to look at active blood flowing pattern. We’re not just taking a snapshot of one moment in time as you would get for, let’s say, MRI or CT scans or X rays. And so, ultrasound is a real, live-time observation of the blood flow and measuring how fast, slow, narrowing the blood vessels are and making a determination of how healthy they are, how narrow they are, or diseased they are, or too big they are. So, another example would be abdominal aortic aneurysm. That’s something we treat routinely. But this is a disease that is completely silent until it ruptures. My mentors used to tell me it’s kind of like a submarine, right? You have to detect by radar. It’s silent, and it’s deadly. So, ultrasound has become such a wonderful tool to screen for those. And in our institution, we have primary care physicians and we work together to really screen them for their risk factors so that we don’t have these patients who go undetected and then present with a rupture, which usually translates to poor surgical outcomes and whatnot. So oftentimes we’re able to scan them routinely, follow them and check their growth. And then, at a certain size where it’s indicated where the benefit is more than the risk of surgery, and then we offer operations for that. And for – operations for aneurysms now has evolved tremendously. I mean, we do a small needlestick procedure, really no incisions now instead of a big mid-abdominal incision that we used to make, and they go home the next day. And so that’s surveillance program for these other diseases that continue to deteriorate, that be vascular surgeries where, once you have the disease, it continues to deteriorate at a different rate depending on your medical conditions. It’s a very nice tool to – for us to employ that and be able to kind of follow them to make sure they’re doing OK, ask them questions about how they were doing. If their walking is good, sometimes people have a leg pain or severe leg disease based on the vascular issues, and those are the things that we track, follow and eventually see them. And hopefully, with the best medical management, that they go through it without any surgeries as we know about them and we know how to best to prevent them as much as we can. But then when the need for surgery comes in, we know very much about the patient and how things have evolved.
Doctor, which patients would you use the Resona 7? Is it patients where doctors expect that there might be something else going on? Or is it used pretty universally as a screening tool? Or, again, reserved just for those patients where you think, we’re going to benefit with a deeper dive?
KIM: No, that’s a really great question. There are sometimes that patients come in and ask for some evaluation. So those would be more leg swelling – kind of what Adrian talked about. I feel something in my neck that just doesn’t feel very well. Or they feel some lump in the back of the knee that could be a popliteal artery aneurysm or, you know, this may be some – this is a more extreme example. But I had a patient where he’d like to read, but whenever he puts his book on his belly, the book will bounce. So that was a clear indication that he had some pulse… Mass in the abdomen, whether it be abdominal aneurysm or any other aneurysms. And from there, then that’s one way to kind of – then next step would be the ultrasound. Sometimes we employ a CT scan further, but that’s one way that patients present. The other one is we look for risk factors. Have they smoked in the past? Do they have diabetes? Do we have cholesterol issues? Do they have hypertension? Do they have a family history of early cardiac coronary disease? Family history of aneurysms? And those are another method in which we – as we see the patients, we keep those in mind and say, you know, for screening purposes – or end stage renal disease patients who usually can develop lower extremity arterial disease. And so there are risk factors associated with certain disease that, when we hear certain words from them – yeah, I was a smoker for the past 20 years, I quit several years ago. Still, let’s do some screening tests. And then the other last part would be they presented with symptoms that are not clear based on the ER doctor’s or medical doctor’s findings. And as the specialist for vascular disease, we get to examine their body and then we feel for the pulses. And when you feel absent pulse, still blood’s flowing, but it’s not very strong, or you feel that bounding pulse, that’s when we say that it needs to be looked further. Is it an aneurysm? Is there some narrowing of the arteries in different parts of the body? Is patient presenting with what’s called food fear? And so, whenever they eat, they are having a lot of abdominal pain because they’re mesenteric blood vessels – which is a blood vessel that feeds to the stomach and intestines – are narrow enough that, when they eat the food, your stomach and your intestine needs to churn, but they’re not getting enough blood supply, so then they get pain in the abdomen. So over time, they lose interest in eating because of that fear of having severe abdominal pain. And so, talking to the patient and getting a very good story of what has happened to them in the past several months to a year and then doing a good physical exam in combination of that and the risk factors, we’re able to do a fairly good job of screening them out. for the most part.
And it sounds like a simple question, but really the benefits of you and your colleagues catching the condition early. What are the benefits?
KIM: With any disease process, you could imagine that it’s nice to know about your disease despite the fear of knowing our disease. And it’s – better news is that, OK, you don’t have any disease, but you do have a risk factor, so let’s see you in a couple of years to make sure you’re OK. But best scenario is that you have a very mild disease that does not need operation compared to – let’s say you come in with a very severe disease that really requires surgery for, let’s say, limb salvage or trying to minimize a stroke risk or rupture or anything like that. So this really reassures…you know, this has – this reassures the patients a lot. I have patients who – in our routine, let’s say, I see them six – every six months. They want to come more often. It would really not indicate it, but I tell them that I’m – that should be perfectly OK I see you every six months just so that they feel assured that there’s nothing that has progressed. And so our ultrasound techs who actually do the ultrasound develop really deep rapport with our patients. I mean, some patients – more than some come in and say, hey, I’d like to have that ultrasound with this tech that I had before. So it it becomes a relationship where they get to see them over years and years, especially here at Mercy, we have a very long follow-up with our patients that we see them over 20, 30 years. And so that relationship becomes very special and that’s where the trust and reliance and having ease of mind as you leave the office comes in. After getting ultrasound done, otherwise, you would have gone through a lot of radiation – which is needed at times, but a lot of radiation or invasive procedures that might have needed for diagnosis. Ultrasound has replaced it significantly.
Is there anything I can ask you, doctor about something that you want to be sure that people know?
KIM: Yeah, the ultrasound technology has changed significantly. I would even compare this to iPhone. You know, iPhone ten years ago or any other phones that are smartphones 10 years ago is very different from the phones that we have now. Certainly, ultrasound has gone through even similar, if not some more recent developments that makes it very different from the traditional ultrasounds that we had. We were fortunate to be designated as the only one luminary site for minority in the nation, and that translates to us working with them together with using their new technology. What – can we use this technology to better image or better serve the patients and to predict some things earlier or to detect something at a better imaging rate or even finding out small clots down in your leg that other ultrasound would not be able to see and even measure tensions on the vessel wall. That – this has been fascinating for me, that you’re able to measure tension of the wall as a measure of how the aneurysm might behave down the road. And we’re certainly looking into looking at that. And so there’s a tremendous amount of new frontier out there for vascular ultrasound that our team and the ultrasound techs and our department at Mercy with the Resona Seven, we’re going to be writing some nice academic papers based on these to demonstrate that there’s some – new technology really benefits that takes out some of the human errors and takes off some of imaging difficulty that we’re – used to be limited to doing vascular ultrasound, now we’re able to really employ more so of that and cover some of the CT quality images. And so that’s been very – a fascinating journey for me for the last three years. We are gathering a lot of data and exciting data at this point and ready to publish in near future, and so that’s exciting. And I think that translates to better patient care. You know, we are local hospital in Baltimore, but I take great pride in that we provide really, really great care. Our patients trust us and and we should provide that care based on their trust. And so that’s been wonderful journey. Yeah.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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