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Endovascular Surgery Milford Vascular Institute offers a variety of endovascular surgeries, performed by our interventional radiologist, Dr. Paul Davis, and vascular surgeon, Dr. David Esposito, at our Private Outpatient Facility in Milford, Connecticut. Milford Vascular Institute works with Diagnostic Imaging of Milford very closely. This alliance has allowed for the opening of the state-of-the-art Outpatient Based Laboratory at Diagnostic Imagine of Milford . Dr. Paul Davis, our interventional radiologist, and Dr. David Esposito, our cardiac, vascular, and thoracic surgeon, work together to perform minimally invasive procedures to treat vascular diseases. All the procedures done at this office are outpatient, meaning the patients will be able to walk out of the facility and go home the same day. Click on the links below to learn more about the procedures we offer. Angiogram Endovascular Stenting Venogram Fistulagram Angioplasty IVC Filter Placement

Privacy Policy PRIVACY STATEMENT We are committed to protecting your privacy and developing technology that gives you the most powerful and safe online experience. This Statement of Privacy applies to our Practice's Web site and governs data collection and usage. By using this website, you consent to the data practices described in this statement. ​ Collection of your Personal Information This Practice collects personally identifiable information, such as your e-mail address, name, home or work address or telephone number. This Practice also collects anonymous demographic information, which is not unique to you, such as your ZIP code, age, gender, preferences, interests and favorites. ​ There is also information about your computer hardware and software that is automatically collected by this website. This information can include: your IP address, browser type, domain names, access times and referring Web site addresses. This information is used for the operation of the service, to maintain quality of the service, and to provide general statistics regarding use of this Web site. ​ Please keep in mind that if you directly disclose personally identifiable information or personally sensitive data through public message boards, this information may be collected and used by others. ​ This Practice encourages you to review the privacy statements of Web sites you choose to link to from the website so that you can understand how those Web sites collect, use and share your information. This Practice is not responsible for the privacy statements or other content on any other Web sites. ​ Use of your Personal Information This Practice collects and uses your personal information to operate the Web site and deliver the services you have requested. This Practice also uses your personally identifiable information to inform you of other products or services available from this Practice and its affiliates. This Practice may also contact you via surveys to conduct research about your opinion of current services or of potential new services that may be offered. ​ This Practice does not sell, rent or lease its customer lists to third parties. This Practice may share data with trusted partners to help us perform statistical analysis, send you email or postal mail, provide customer support, or arrange for deliveries. All such third parties are prohibited from using your personal information except to provide these services and they are required to maintain the confidentiality of your information. ​ This Practice does not use or disclose sensitive personal information, such as race, religion, or political affiliations, without your explicit consent. ​ This Practice will disclose your personal information, without notice, only if required to do so by law. ​ Use of Cookies The Web site uses "cookies" to help this Practice personalize your online experience. A cookie is a text file that is placed on your hard disk by a Web page server. Cookies cannot be used to run programs or deliver viruses to your computer. Cookies are uniquely assigned to you, and can only be read by a web server in the domain that issued the cookie to you. ​ Security of your Personal Information This Practice secures your personal information from unauthorized access, use or disclosure. This Practice secures the personally identifiable information you provide on computer servers in a controlled, secure environment, protected from unauthorized access, use or disclosure. When personal information (such as a credit card number) is transmitted to other Web sites, it is protected through the use of encryption, such as the Secure Socket Layer (SSL) protocol. ​ Changes to this Statement This Practice will occasionally update this Statement of Privacy to reflect company and customer feedback. We encourage you to periodically review this Statement to be informed of how this Practice is protecting your information. ​ Contact Information Please contact us by phone at 203-882-8346 or by mail at 20 Commerce Park Drive, Milford, CT 06460. ​

Angiogram Milford Vascular Institute performs angiograms at our Outpatient Based Laboratory to diagnose peripheral arterial disease. What is an angiogram? An angiogram is a diagnostic test that uses x-rays to take pictures of your blood vessels. A long flexible catheter is inserted through the bloodstream, usually from the groin, to deliver contrast dye into the arteries making them visible on the x-ray. Why do I need to have an angiogram? Having an angiogram is the best method for diagnosing atherosclerosis in the arteries. Atherosclerosis is the hardening of arteries due to plaque buildup within the walls of the arteries. What can I expect when having an angiogram? (203)882-VEIN When you come in for the procedure, you will be greeted by one of our friendly nurses. She will help you dress and prepare you for the procedure. Then, the CRNA will come in and meet with you to go over the medications you will be receiving and their side effects. Finally, the doctor will come in and discuss the procedure with you one last time. You will then be brought into the operating room. Our medical assistant will begin to prepare you for the procedure and simultaneously, our CRNA will begin to administer the anesthesia. Angiograms are performed under twilight sedation. You should expect to have amnesia after the procedure; you will have no memory of it even happening. After the procedure, we will move you to a recovery room. You will stay in the recovery room for at least 2 hours to allow for the anesthesia to fully wear off. Once our nurse has determined you are fully recovered, you will be able to walk out of the building with minimal limitations. What to expect after an angiogram? You may experience some soreness after the procedure. If the provider had to place a stent or perform an angioplasty, you may experience some tingling. This is normal; the blood flow has simply been restored to your extremity. The sensation should not last more than a few days. Things to watch for after an angiogram: If at any point you begin to feel coldness or see discoloration in your extremity, call the office immediately or if there is any bleeding at the insertion site. It is recommended to keep your legs straight and rested after the procedure and shower the next day and can remove any bandages at that time. No major lifting after the procedure as well and hydrate.

Meet the Team Milford Vascular Institute's strongest asset if our team. Together we are able to provide state-of-the-art care to patients suffering from venous insufficiency and other forms of vascular disease. Nicole, RVT, RDMS, BR Sonographer Nicole completed the Diagnostic Medical Sonography Program for the Institute of Allied Medical Professions in 2013, addition to receiving an associates degree from Gateway Community College. Nicole holds credentials in Registered Diagnostic Medical Sonography and as a Registered Vascular Technologist. Nicole is the lead vascular sonographer at Milford Vascular Institute. Nicole has vast experience working in hospital and outpatient office settings. Prior to working at MVI, she was a sonographer at Milford Hospital and Diagnostic Imaging of Milford. TAYLOR, RVT Sonographer Taylor is a registered vascular sonographer at Milford Vascular Institute. She received her degree in Diagnostic Medical Sonography from the American Institute in West Hartford, CT. Prior to this, she lived in Boston, where she completed a Bachelors in Health Psychology as well as a graduate degree in Nutrition. Taylor is passionate about her role at Milford Vascular as she loves providing good care for patients. She lives locally with her husband and daughter. Chelsea, RVT Sonographer Chelsea is a part of the Milford Vascular Ultrasound team. She received her ultrasound degree from American Institute, in West Hartford, CT. She began her ultrasound career scanning Transcranial Doppler Ultrasound and then decided to fulfill her passion in vascular ultrasound at Milford Vascular. Prior to ultrasound she completed an undergraduate degree at Central Connecticut State University where she majored in Communications. Chelsea was born in Milford and remains a resident with her husband and children. Kaitlyn, RVT Sonographer Kaitlyn joined the Milford Vascular ultrasound team in 2022. She completed her ultrasound degree from American Institute in West Hartford, CT. She always excelled in Vascular Ultrasound and decided to make a career in the field. Previous to a degree in ultrasound, she received a Bachelors of Science in Public Health, from Southern Connecticut State University. Sheri, RN, BSN Registered Nurse Sheri received her associates in Nursing from Coastal Georgia Community College. A Connecticut native, she resides in West Haven. Sheri has over 20yrs of experience in the nursing field and went on to further her nursing education with a Bachelor's degree from Chamberlain University. Working for Milford hospital, gave her the tools to oversee a variety of patient population, including medical/surgical and cardiac care. Sheri's focus is on outpatient based surgical lab at MVI and takes pride in making every patient feel as comfortable as possible. KAYLA Medical Assistant Kayla is a graduate of Platt Technical High School. After graduating she wanted to pursue a career in the medical field. She attended Porter and Chester in Branford, CT where she graduated with her medical assistant certificate. She joined the team at Milford Vascular Institute in 2016 and works hands-on with the patients. Working at Milford Vascular Institute has inspired Kayla to continue her education. She is now attending school for Diagnostic Medical Sonography. PJ Medical Assistant Pasquale (PJ) graduated from East Haven High School in 2013. Following graduation, he attended Branford Hall Career Institute where he received his Medical Assistant License and Certification. Pasquale has prior Medical Assistant experience working for the Yale Health Plan assisting patients in the Student Health and Athletic Medicine fields. Pasquale jointed the Milford Vascular Institute team in October of 2016. He hopes to pursue a nursing career in the future. SHAUNA Medical Assistant Shauna is a registered medical assistant specializing in surgical assisting. She enjoys making sure patients feel comfortable and cared for during their procedures. STephanie Medical Assistant Stephanie is a graduate of Jonathan Law High School. She is currently enjoying her role as a medical assistant where she gets to put into action her passionate care for others and her goal is to always put a smile on someone's face. She's excited to explore the endless possibilities in the medical field. She lives locally in Milford, loves to travel and adventure! Ethan Medical Assistant Ethan graduated from the University of Connecticut in 2021 with a degree in physiology and neurobiology, with a minor in chemistry. He grew up in downtown Milford his entire life, and attended Joseph A. Foran High school before college. His intention is to attend medical school in the near future, but without plans of what specialty to go into yet. Ethan joined Milford Vascular in 2019 as a student intern and has worked as a Medical Assistant since Summer of 2021. Johnae Medical Assistant Johnae is a medical assistant for MVI. JADA Clinical & Admin Supervisor Jada is a graduate of Platt Technical High School and grew up in Bridgeport. Following graduation, she attended Gateway Community College where she received a degree in General Studies. She has a background knowledge in Emergency Medical Technician training and medical terminology. She is currently attending Gateway Community College nursing program. Her main roles at Milford Vascular include overseeing the Medical Assistants and Administrative staff on a day to day operation. EMMA Administrative Assistant Emma is a graduate of Platt Technical High School in Milford. She is also a graduate of the American Institute of Healthcare and Technology where she earned her certification in Medical Billing and Coding. Kassandra Administrative Assistant Kassandra is an administrative assistant at Milford Vascular Institute. MELODY Greeter Melody is one of our friendly greeters at Milford Vascular Institute. She is the first and last face you will see during your visit at Milford Vascular Institute. Melody strives to make every patient feel like they are a part of our family. SUE Greeter Sue is one of our friendly greeters at Milford Vascular Institute. She is the first and last face you will see during your visit at Milford Vascular Institute. Sue strives to make every patient feel like they are a part of our family. DANA Vein Coordinator Dana was born and raised here in Milford and is a Foran High School graduate. She attended Southern Connecticut State University. Dana worked for many years as a certified nursing assistant and greatly enjoys helping patients. She is looking forward to helping you have a great experience here at MVI! REBECCA Surgical Scheduler Rebecca graduated from Southern Connecticut State University with a BS in Business Management. She brings years of experience from the Radiology and Vascular fields and coordinates the Office Based Lab schedule as well as obtains authorizations for our office procedures. She will be happy to assist scheduling your surgical procedure or help explain your insurance benefits! TINA Accounts Receivable Tina is the Accounts Receivable Manager at Milford Vascular Institute. MARY Insurance Coordinator Billing, collections and insurance have been Mary's areas of expertise for many years. She enjoys providing help to the patients and her team members how ever she can. Mary resides in the local area with her two wonderful children and ever supportive husband, Tim. Marie Insurance Coordinator Marie is an insurance coordinator for MVI. She graduated from Central Connecticut State University with a degree in Computer Science Programming. For the past 25 years, Marie has worked in various Front Desk and Administration Assistant roles in Milford where she raised her children with her husband. She is a people person who always puts the customer first. ASHLEY Operations Manager Ashley is the Operations Manager at Milford Vascular Institute. She graduated from Loyola University Chicago in 2017 with a Bachelor's of Science in Mathematics. Ashley has been working at Milford Vascular Institute in various roles since 2010. She lives locally, in Milford, with her son, Thomas, and her fiancé, Jack.

Vascular Disease Milford Vascular Institute specializes in the treatment and prevention of vascular diseases affecting the arteries in the legs, like atherosclerosis. (203) 882-VEIN What is atherosclerosis? Atherosclerosis is the buildup of plaque in the walls of arteries. This build up causes the artery to narrow which restricts the flow of oxygen rich blood. What causes atherosclerosis? The exact cause of atherosclerosis is unknown. However, studies show that atherosclerosis is a slow, complex disease that may start in childhood. It develops faster as you age. There are certain risk factors associated with the development of atherosclerosis. The number one risk factor is smoking. Other factors include high cholesterol, high blood pressure, and diabetes. Where can atherosclerosis form? Atherosclerosis can form in any artery in the body. Plaque build up in the arteries around the heart is called coronary artery disease. When plaque build up occurs anywhere else in the body, it is called peripheral arterial disease. Blockage in the arteries in the neck is called carotid artery disease. ​ Plaque build up in the aorta tends to lead to a different problem called aneurysm. The pressure in the aorta is so great that when the arterial walls become more rigid from this disease, the walls begin to swell like a balloon. How is atherosclerosis diagnosed? Atherosclerosis is typically first diagnosed during a physical exam with a primary care doctor. When your doctor is listening to your arteries, they may hear a whoosh sound, called a bruit. This sound is an indication of the presence of atherosclerosis. The doctor may then order an ultrasound or CT scan to confirm the atherosclerotic build up. A test called an angiogram is considered the gold standard for diagnosing the disease.

Spider Vein Treatments Milford Vascular Institute specializes in the treatment of small varicose and spider veins. Weeding the Garden Analogy: Long term treatment of varicose veins is similar to managing a garden. In a garden, we first spend a lot of time removing the large weeds. Often, once the larger weeds have been removed, we see smaller weeds that were not apparent in the beginning. We then take the time to remove even the smallest weeds so that they do not grow larger in time. If we ignore the small weeds, they will grow into large weeds and we will have to start all over again. ​ This is why we spend so much time in follow up performing ultrasound exams to find those small veins that were not apparent in the beginning. You may need injections of veins that you do not even see on the surface but that we can see on ultrasound. If we ignore these veins and wait for them to become visible, then we may need to start all over with larger procedures. ​ This is why it is important to continue to follow up with ultrasound exams on a regular basis even if your legs feel and look great. Consider it maintenance of your garden to keep it looking healthy and beautiful! FOAM vs Visual Sclerotherapy: A week after the venous ablation procedure, an ultrasound is done to assess the results of the procedure and to see if any smaller veins are present that could lead to recurrence of the insufficiency. If left untreated, these veins can enlarge over time and lead to a recurrence of the symptoms. Therefore, we recommend that these veins be treated immediately to ensure a long-lasting result. The treatment for these veins is called foam sclerotherapy. The veins are identified with ultrasound and a tiny needle is inserted into the vein. Medication is injected to the vein. The medication causes the veins to shrivel up and be absorbed by the body. This procedure is quick and relatively painless. Multiple sessions may be required if multiple veins are discovered on ultrasound. ​ The final step of the process is to address the spider veins visualized on the skin. This procedure is called visual sclerotherapy. During this procedure each individual vein is punctured with a tiny needle and medication is injected into the veins causing them to disappear. Initially there may be some redness as the veins naturally become inflamed in the process of resolving. Multiple sessions may be required. (203)882-VEIN What to expect following the treatment & after care instructions: Wear knee or thigh high stockings for two to three days during waking hours. You may resume normal activity the same day. Walking is encouraged! Do not perform any high impact activities for 24 hours after treatment. Do not soak in a bathtub, a jacuzzi, or pool for three days after treatment. You can fly the next day. ​ ​ You may notice minimal bruising or redness around the injection site. This is normal. ​ ​ After treatment you may have a slight tingling sensation. This is normal. ​ ​ ​ We recommend waiting 2-4 weeks between injections to aid in the healing process. ​ ​ If you experience any discomfort, you may take Vasculera, Ibuprofen, Aleve, or Motrin. If you are unable to take NSAIDs, you may take Tylenol. If you experience any bruising, apply Emla Cream. ​ ​ ​ Got veins? Schedule a new patient consultation. Call Now

Pneumothorax Milford Vascular Institute specializes in treating thoracic diseases, including collapsed lungs. What is a pneumothorax? A pneumothorax is a collapsed lung. A pneumothorax occurs when air leaks into the space between your lung and chest wall. This air pushes on the outside of your lung and makes it collapse. Pneumothorax can be a complete lung collapse or a collapse of only a portion of the lung. What are the symptoms of a pneumothorax? Symptoms usually include sudden chest pain and shortness of breath. What causes a pneumothorax? Pneumothorax can develop from a blunt trauma to the chest. Certain medical procedures may induce this condition. Patients with lung disease are more likely to have their lung collapse due to the damaged tissue. Small air blisters (blebs) can develop on the top of the lungs. These blebs sometimes burst — allowing air to leak into the space that surrounds the lungs. Pneumothorax can also develop for no obvious reason. Who is at risk for pneumothorax? Anyone can develop a pneumothorax, however, generally, men are at higher risk than women. The type of pneumothorax caused by ruptured air blisters is most likely to occur in people between 20 and 40 years old, especially if the person is very tall and underweight. People also put themselves at higher risk for developing a pneumothorax if they smoke. What is the treatment for a pneumothorax? Treatment for a pneumothorax usually involves inserting a needle or chest tube between the ribs to remove the excess air. Milford Vascular Institute can place chest tubes at our Outpatient Based Laboratory. A small pneumothorax may heal on its own. Call Now

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The Leg Swelling & Lymphedema Center The Leg Swelling & Lymphedema Center at Milford Vascular Institute is a state-of-the-art treatment clinic for patients suffering from extremity swelling and lymphedema. The Leg Swelling & Lymphedema Center at Milford Vascular Institute was founded to aid an under served community of people suffering from leg swelling and lymphedema. The Center uses a holistic approach to treating and healing edema. Complete Decongestive Therapy (CDT) is the standard of care for the treatment of lymphedema. CDT is performed by a Certified Lymphedema Therapist (CLT). What Causes Leg Swelling? There are many different potential culprits for swelling in a person's extremities. To achieve an accurate diagnosis, our experts at Milford Vascular Institute use a variety of diagnostic tests. The most common causes for lower extremity (leg) swelling are: Lymphedema NIVL/May Thurner Syndrome Congestive Heart Failure (CHF) Venous Insufficiency Infection Liver Disease DVT Renal Disease Medications Meet Jen MEET JEN JENNIFER PASSONI, DPT, CLT Jen is the Center's Certified Lymphedema Therapist. She is dedicated to helping patients improve their quality of life. Through counseling, Jen and our patients at the Leg Swelling & Lymphedema Center build individualized programs to work for their personal needs and goals. Read More MEET SARAH SARAH OKAMOTO, PTA Sarah is a physical therapy assistant for the Center. She works along side Jen to help improve the quality of life for patients suffering from leg swelling and lymphedema. Read More What to expect There are 6 key components to complete decongestive therapy (CDT); the gold standard of treatment for patients with leg swelling & lymphedema. Manual Lymph Drainage Skin & Nail Care Education Compression Bandaging Self-Care Training Exercise Therapy Compression Garments & Devices Manual Lymph Drainage Manual Lymph Drainage (MLD) MLD is a light massage that focuses on skin-stretching to help promote the movement of lymphatic fluid out of the swollen extremity. For optimal benefits, patients should be scheduled for this therapy 3 to 5 times a week for 4 to 6 weeks. Compression Bandaging Compression Bandaging Bandaging is an important part of lymphedema therapy. A variety of bandages and wrapping techniques are used during therapy to help move the fluid out of the tissues. This technique is used during appointments with the our lymphedema specialist and as part of the maintaince care program. Exercise Therapy Exercise Therapy Exercise therapy is an important aspect of lymphedema rehabilitation. Some studies have even shown that patients who incorporate exercise into their therapy for lymphedema have a reduced incidence for lymphedema flare-ups. This is why we incorporate exercise therapy in our treatment protocol for lymphedema patients. Therapy includes in-office, lymphedema therapist monitored exercises, like walking on a treadmill and pedaling a stationary bike, and an at home exercise regime. For optimal benefits, patients should perform at home exercises daily. Monitored exercise therapy should be scheduled 3 to 5 times a week. Skin & Nail Care Education Skin & Nail Care Educaton Proper skin care education is incredibly important for lymphedema patients. During their initial meeting with our lymphedema therapist, patients will be instructed to keep their skin clean and to moisturize daily with a gentle moisturizer (such as Eucerin). Additionally, since lymphedema patients are at high risk for developing infections, patients are instructed to check their skin daily for cuts, scratches, irritation, or sign of infection. Self-Care Education Self-Care Education Every patient has a different cause for their lymphedema and different factors which contribute to the worsening of their disease. Self-care training is a very important aspect of our lymphedema program to the team at Milford Vascular Institute. We pride ourselves on having created a practice that is able to care for each patient as a whole person, not just the ailment that brought them to our clinic. Our goal with self-care counseling is to help patients learn how to deal with stress, work toward any necessary weight-loss goals, and build healthy habits they can take with them for the rest of their lives. Compression Garments Compression Garments Compression garments may be prescribed to patients for daily wear and use while not at therapy or using their pneumatic compression device. These garments use gradient compression to prevent and reduce swelling. They are very beneficial for helping fluid move to an area that is draining well. Pneumatic Compression Devices Pneumatic Compression Devices Pneumatic compression pumps are prescribed to patients suffering from leg swelling or lymphedema who have failed perviously prescribed conservative therapies. They are also proposed to supplement standard of care for patients with venous ulcers. A variety of pumps are available; they can be single chamber (non-segmented) or multi-chamber (segmented) and have varying design and complexity. ​ Pneumatic compression devices consist of an inflatable garment for the arm, leg, trunk, chest, or a combination of these pieces, and an electrical pneumatic pump that fills the garment with compressed air. The garment is intermittently inflated and deflated with cycle times and pressures that vary between devices. As the compartments fill with air and the device squeezes the affected area. This increases blood flow through the veins and flushes excess fluid and blood built up in the extremities. Most patients notice a significant decrease in swelling when they couple in-office CDT with at-home pneumatic compression device treatments. Call Now Questions about lymphedema or interested in scheduling an appointment? Call (203)882-VEIN(8346) to schedule a new patient consultation.

Amanda Hershman, RN Injections Specialist located in Milford, CT. Amanda Hershman, RN, has been a member of the MVI family for over five years. She attended Mount Holyoke College where she received a Bachelor of Arts in English with a focus on Pre-Health. She holds her nursing degree from St. Vincent's College at Sacred Heart University. Her goal is to continue her education to eventually obtain her Doctorate of Nursing. Amanda specializes in the art of injections and has extensive knowledge of the vascular system, compound injectables and facial lymphatic drainage. She has a passion for skin care, beauty, health and everything in between. Amanda has always been on the cutting edge of beauty trends and the importance of self-care. Amanda is a lifelong resident of Connecticut and currently resides on the shoreline. She frequents a variety of workout classes, including pilates, Pure Bare, and Orange Theory Fitness. Amanda upholds her family above all else. In her free time, she loves playing with her many nieces and nephews. CALL NOW

DAVID J. Esposito, M.D., FCCP, FACS Cardiac, Vascular, & Thoracic Surgeon Located in Milford, CT. Dr. David Esposito, M.D., FACS, FCCP, is a native of Milford. Dr. Esposito graduated from Foran High School and then from Yale University with a degree in Chemistry. He received his medical training at Duke University School of Medicine in Durham, North Carolina in 1994, and completed a general surgery residency at Rush-Presbyterian St. Luke’s Medical Center and Cook County Hospital in Chicago. Dr. Esposito completed fellowships in vascular surgery and cardiothoracic surgery at Carolinas Medical Center in Charlotte, North Carolina. He also earned a master’s degree in business administration from the Yale University School of Management in 2007. He is one of only approximately 130 surgeons in the United States to be Board Certified in 3 specialties: General surgery, Vascular surgery, and Cardiothoracic surgery. Dr. Esposito is a fellow of the American College of Surgeons and of the American College of Chest Physicians, as well as a member of the Society of Thoracic Surgeons and the Society for Vascular Surgery. He enjoys hospital privileges at the nearby Milford Hospital, where he is the Chairman of the Department of Surgery and Chief of Cardiovascular and Thoracic Surgery. In his free time, Dr. Esposito is active in the community as a member of the Milford Columbus Committee, the Milford Rotary Club, and the United Way of Milford. He is on the Board of Trustees of the Milford Bank. He has a lifelong love of sports, and was captain of the Yale Varsity baseball team in 1990. He is the Head Wrestling coach at his alma mater, Foran High School, and led them to State Championships in 2016 and 2018. He lives in Milford with his wife Suzanne. Between them they have seven children and one grandchild! CALL NOW

Dialysis Solutions Milford Vascular Institute specializes in the placement and removal of catheters and the creation and maintenance of AV grafts & fistulas. What is dialysis? Dialysis is a way of cleaning your blood when your kidneys can no longer do the job. It gets rid of your body's wastes, extra salt and water, and helps to control your blood pressure. What are the different types of dialysis? There are two types of dialysis; hemodialysis and peritoneal dialysis. In hemodialysis, blood is pumped out of your body to an artificial kidney machine, called a dialyzer, and returned to your body by tubes that connect you to the machine. In peritoneal dialysis, the inside lining of your own belly acts as a natural filter. How does hemodialysis work? Should you choose to have hemodialysis, your dialysis center will need to access your blood vessels. There are two methods for gaining access to the blood vessels; via a catheter or a fistula/graft. A catheter is a soft tube that is placed in a large vein, usually in your neck. An AV fistula is an access made by joining a patient’s own artery and vein directly to each other. An AV graft is an access made by connecting an artery to a vein using a plastic blood vessel. Why would I need a catheter placement? A catheter is used when a patient needs immediate access for dialysis, typically because the patient has suddenly found out they have kidney failure. A dialysis catheter can be placed by an interventional radiologist or a surgeon. However, using a catheter puts the patient at a much higher risk for infection, since it hangs outside the body. The longer it is in, the higher the risk of infection. Why should I choose an AV Fistula for dialysis access? An AV fistula is considered the gold standard for dialysis access. With an AV fistula, blood flows from the artery directly into the vein, increasing the blood pressure and amount of blood flow through the vein. The increased flow and pressure causes the vein to enlarge. The enlarged vein will be capable of delivering the amount of blood flow necessary to provide an adequate hemodialysis treatment. AV fistulas are the preferred vascular access for long-term dialysis because they are made entirely of the patient’s own tissues. There is no plastic or foreign material. They last longer than any other dialysis access types, are less prone to infection and clotting, and can be relied upon for predictable performance. Why doesn’t everyone choose to have an AV Fistula Creation? The issue with fistula dialysis access is not everyone is able to have a successful fistula created due to individual anatomy. Usually this is due to small caliber veins. Also, once a fistula is created, it typically takes between 6 weeks and 4 months to mature. This means, if the patient needs dialysis immediately, they will still need to have a catheter placed while they wait for the fistula to mature to functionality. Why should I choose an AV Graft for dialysis access? If your vascular surgeon determines you are an unsuitable candidate for an AV Fistula creation, he may then evaluate you for an AV Graft Placement. A graft is usually about one-half inch in diameter and made of plastic (Teflon), or transplanted animal or human vessels. They are usually placed in the arm, but can also be placed in the thigh. Grafts become functional much more quickly than fistulas; they can typically be used two to six weeks after placement. Why are AV Grafts not the preferred mode of vascular access? Grafts are created from foreign materials to the body. This makes them more prone to clotting or becoming infected. For these reasons, the graft may have to be replaced yearly. However, they are still a much safer alternative to using a catheter. How can you plan to have a fistula created or a graft placed to avoid having to use a catheter for dialysis? When patients find out they are in the advanced stages of chronic kidney disease and will need dialysis, their nephrologist will advise them to be evaluated for a fistula or graft. Having the access in place well before beginning dialysis will give this lifeline time to mature, so it can be ready to use. When patients suddenly discover they have kidney failure, a catheter may be placed to allow for immediate dialysis treatment. In this case, the patient should still schedule an appointment to see a vascular surgeon. The surgeon will still be able to evaluate the patient for the fistula or graft and then perform the surgery. The catheter will be used until the fistula or graft has had time to mature. Fistulagram What is a fistulagram? A fistulagram is an X-ray procedure to look at the blood flow and check for blood clots or other blockages in your fistula. If there is a clot, the surgeon will preform an angioplasty or a thrombolysis to break it up or remove it. ​ Milford Vascular Institute has relationships with many renal specialists throughout the Southern Connecticut area. When a patient suddenly develops kidney failure, MVI has the ability to see the patient within the next business day to both place a catheter and evaluate them for a vascular access. Contact us if you or your loved one may soon require dialysis. ​