MAITLAND—When Manuel Perez, MD, joined G. Kendrix Adcock, MD, and Rob Winter, MD, in private practice at Florida Vascular Consultants in Maitland in 2002, the trio knew they had assembled a team ready to advance the minimally invasive treatment of  abdominal aortic aneurysms (AAAs) in Central Florida.

 

In January 2000, just two years before Perez joined the practice, and a few months after the FDA approved the devices used in the endovascular aneurysm repair (EVAR) procedure, Adcock and Winter, collaborators for nearly two decades, were the first vascular surgeons in the region to use EVAR to treat patients with AAA.

 

"The existing alternative treatment is open surgery, during which a surgeon makes an incision the length of the abdomen to repair the AAA," explained Winter, who instead of open surgery makes a 1-inch incision, and threads a catheter through the blood vessel to repair it from within. Survival rates are near 100 percent and complete recovery time is only a few days.

 

Also, Perez, who had trained for two years in endovascular techniques at Newark Beth Israel in Newark, N.J. before joining the practice, and has been involved with clinical trials evaluating new generation devices, performed the first endovascular repair of thoracic aortic aneurysm (TAA) in Central Florida with Adcock. Since Perez joined the practice, the group has performed approximately 1,000 EVAR cases.

 

Perhaps because Florida Vascular Consultants has more experience with this technology than any other practice in the metro area, the mortality rate for aortic surgery is the lowest in the area, lower than the national average. In the past year, Florida Hospital, where Winter is chief of staff, has logged 143 AAA repairs—"a significant number," noted Adcock, an executive board member of the Florida Vascular Society, pointing out the mortality rate for AAA repairs at Florida Hospital is 2.71 percent, compared to the national average of higher than 5 percent.

 

"AAAs occur when a section of the body's main blood vessel weakens and creates a dangerous bulge that can rupture," said Adcock, noting that some 15,000 people die annually from AAAs in the United States, a preventable problem with EVAR. "AAAs often develop without noticeable symptoms and can be fatal if the bulge ruptures. Traditionally, they had been treated with open surgery. However, we've found that AAAs can be easily treated by EVAR if detected early, and it's important for Florida citizens to know this, as there are many seniors in the area and AAAs primarily affect those over age 60."

 

"Our practice has been awarded two clinical trials for EVAR devices, meaning that industry manufacturers view our practice as forward thinking and highly skilled, and they want their devices in the hands of skilled experts. We currently have access to all the FDA-approved endografts, as well as two experimental grafts," said Winter, past president of the Florida Vascular Society and current president of the Florida Vascular Foundation, a newly formed non-profit organization dedicated to educating the public on vascular disease and encouraging young medical students and residents to launch careers in vascular surgery. The foundation provides scholarships for participants to attend educational conferences on the specialty.

 

The team's practice, which covers the entire spectrum of vascular disease including arterial and venous problems, draws patients from as far south as Lake Okeechobee, to as far north as Ocala, as well as cities on the coast. Individuals from smaller communities where advanced vascular surgical services are not available are referred to Florida Vascular Consultants. Apart from the endovascular therapy, the team has access to cutting edge technology in the surgical management of hypertension, as participants in the Rheos carotid baroreceptor stimulator trial.

 

"We're fortunate to enjoy the confidence of referring physicians," said Perez, "and are very proud to have physicians refer complex cases to our practice."