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Endovascular Stenting Milford Vascular Institute places stents at the Outpatient Based Laboratory and Milford Hospital. What is a stent? A stent is a tiny wire mesh tube. It is used to prop open the walls of a blood vessel. Why do I need a stent? When a blood vessel becomes blocked or collapsed, a stent is used to reopen the vessel to restore blood flow. In arteries, stents are typically placed to reopen vessels clogged by atherosclerotic build up. In veins, stents are typically placed to reopen collapsed or compressed veins. Where can stents be placed in my body? You can have a stent placed in almost any blood vessel in the body. At Milford Vascular, our surgeons place stents in peripheral and mesenteric arteries and iliac veins in our outpatient based laboratory. They also perform endovascular abdominal aortic aneurysm repairs using stenting at Milford Hospital. Stents can also be placed in the coronary arteries around the heart to restore blood flow to the heart tissue to prevent or help patients recover from a heart attack. What can I expect when having a stent placement? Stent in an artery in the leg: To prepare you for the procedure, the area of your groin where the delivery catheter and stent are introduced will be cleaned and shaved. You will meet with the nurse anesthetist who will explain to you what to expect. The nurse with then begin to administer the anesthesia. You will be under twilight sedation. After the anesthesia has taken effect, your surgeon will make a small incision in one of your thighs. The incision will be opposite the side where the stent will be deployed. Using x-rays to see the exact location of the aneurysm, the surgeon will guide the delivery catheter through the vessels to the site of the blockage. ​ X-rays and ultrasound imaging help the doctor make sure that the stent graft is properly placed. ​ After the procedure, you should rest for the remainder of the day. Continue to drink plenty of fluids. Avoid excessive lifting and bending. If bleeding occurs at the puncture site, apply firm direct pressure to the site. If bleeding continues, call your doctor or go to the emergency room. You can resume normal activity the following day. ​ Stent in a vein in leg: To prepare you for the procedure, the area of your groin where the delivery catheter and stent are introduced will be cleaned and shaved. You will meet with the nurse anesthetist who will explain to you what to expect. The nurse with then begin to administer the anesthesia. You will be under twilight sedation. After the anesthesia has taken effect, your surgeon will make a small incision in one of your thighs. The incision will be the same side the stent will be placed. Using x-rays to see the exact location of the aneurysm, the surgeon will guide the delivery catheter through the vessels to the site of the blockage. ​ X-rays and ultrasound imaging help the doctor make sure that the stent graft is properly placed. ​ After the procedure, you should rest for the remainder of the day. Continue to drink plenty of fluids. Avoid excessive lifting and bending. If bleeding occurs at the puncture site, apply firm direct pressure to the site. If bleeding continues, call your doctor or go to the emergency room. You can resume normal activity the following day. ​ Stent in the abdominal aorta: To prepare you for the procedure, the area of your groin where the delivery catheter and stent are introduced will be cleaned and shaved. Then you will receive either local anesthesia, to numb the area of the surgery, or general anesthesia to put you to sleep during the surgery. After the anesthesia has taken effect, your surgeon will make a small incision in both of your thighs. Using x-rays to see the exact location of the aneurysm, the surgeon will guide the delivery catheter through the large vessel in your thigh (iliac vessel) to the aneurysm site in your abdomen. The stent graft is slowly released from the delivery catheter into the aorta. As the stent graft is released, it expands to the proper size so that it fits into the aorta both above and below the aneurysm. The delivery catheter is then withdrawn and removed, leaving the stent graft within the aorta. Depending on the shape and size of your aortic aneurysm, additional stent grafts may be placed to ensure that the aneurysm is completely excluded from normal blood flow. X-rays and ultrasound imaging help the doctor make sure that the stent graft is properly placed and excluding blood flow to your abdominal aortic aneurysm. What to expect after a stent placement? You may experience some soreness after the procedure. If you had a stent placed in an artery, you may also experience some tingling in your extremity. If your stent was placed in a vein, you should see a decrease in swelling in your extremity. In both cases, this is normal; the blood flow has simply been restored. The sensation should not last more than a few days. Things to watch for after having a stent placed: If you experience any of the follow symptoms after your procedure, call the office immediately: numbness, bleeding at the incision site, redness at the incision site, fever or chills, or swelling.

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

Vascular Screening For people at risk for vascular disease, vascular screenings are an easy, non-invasive way to monitor your symptoms. Aortic Ultrasound: This exam is used to monitor and diagnose abdominal aortic aneurysms. The procedure is non-invasive. You will be asked to fast for 4 hours prior to your appointment. When you come in, you will be asked to lie on your back. One of our skilled vascular technologists will ask you to lift up or remove your shirt. She will apply a warm ultrasound gel to the probe. The whole exam should not last more than 30 minutes. Arterial Ultrasound: This exam is used to monitor and diagnose peripheral artery disease in the lower extremities. The procedure is non-invasive. When you come in, you will be asked to change into a pair of blue shorts and to lie on your back. One of our registered vascular technologists will then maneuver your legs as needed to view your arterial system. She will apply a warm ultrasound gel to the probe. The whole exam should not last more than 30 minutes. CAROTID ULTRASOUND Carotid Ultrasound: This exam is used to monitor and diagnose carotid artery disease, plaque build up in the arteries in your neck. The procedure is non-invasive. When you come in, you will be asked to lie on your back. One of our skilled vascular technologists will apply a warm ultrasound gel to the probe. The whole exam should not last more than 30 minutes. Venous Ultrasounds: This exam is used to monitor and diagnose venous insufficiency and blood clots. The procedure is non-invasive. When you come in, you will be asked to change into a pair of blue shorts and to lie on your back. One of our skilled vascular technologists will then maneuver your legs as needed to view your venous system. She will apply a warm ultrasound gel to the probe. The whole exam should not last more than 20 minutes. ​ Call (203)882-VEIN

Karin Augur, PA-C Physician Assistant specializing in Vascular Surgery located in Milford, CT. Karin Augur is a physician assistant practicing at Milford Vascular Institute in Milford, Connecticut. She is board-certified with twenty-five years of clinical experience including cardiothoracic surgery, emergency medicine, cardiology, and vascular surgery. She has devoted her career to the diagnosis and treatment of vein disease. ​ Karin graduated from Columbia University in New York City where she majored in Biology. She returned back to her home state of Connecticut and completed her Physician Assistant training from the Yale School of Medicine in 1995, ranking first in her class. ​ Karin is involved with many professional organizations, both locally and nationally. She is one of the founding members of the PA/APRN section of the American College of Phlebology. She has lectured at national conferences, including The American College of Phlebology Annual Congress and has served as Program Chair as well as participating on an Expert Sclerotherapy Panel. Karin is a lifelong resident of Connecticut and is very active in the medical community educating her peers about the diagnosis and treatment of venous disease. She lives with her husband and two boys and enjoys spending her free time watching her sons participate in their sporting events. CALL NOW