Specialty: Vascular Surgery
Title: Vascular Surgeon and Director of the Laser Vein Center at Westchester Medical Center (WMC), the flagship of the Westchester Medical Center Health Network
Hospital: Westchester Medical Center
If there’s a particularly harrowing aneurysm surgery to be performed in the greater Westchester area, there’s a good chance that case will be sent to Dr. Arun Goyal, Director of the Laser Vein Center at Westchester Medical Center (WMC). “It has only been within the last few years that we’ve gained access to devices that allow us to treat the more complicated cases,” Goyal says.
Goyal recalls that when he started practicing in 1996, “We were doing open operations and treatments which were very tough for my patients to recover from.” Around 2000, he says there was a huge shift in his field, “from open to minimally invasive vascular surgeries, and from there, the technology has continued to take off.”
When Goyal isn’t treating the most critical aneurysm patients, he can often be found treating varicose veins, which he says are more than a cosmetic problem. “Over the years,” he says, “I’ve operated on thousands of patients, and, for me, the most rewarding part is witnessing the tremendous improvements to their lives once they’ve made a full recovery.”
How is the newest generation of endovascular technology changing patients’ chances of surviving an aneurysm?
The most exciting advances in this field are happening within the treatment of aneurysms. Not too long ago, patients had a much higher morbidity and mortality rate associated with aneurysm surgery. Nowadays, aneurysm procedures can be done using endovascular treatments, the minimally invasive procedures done inside the blood vessels. Patients don’t even need to have skin incisions to complete the treatment!
How are the more complicated cases treated?
Every few years, the whole vascular community comes up with better ways of treating patients. [Some of the devices mentioned earlier include] those in aortic aneurysm repair requiring a stent graft. We have a specialized hybrid room that combines digital imaging technology and a fully functional operating room all in one room. So, overall, we are seeing huge improvement in outcomes and recovery for even our most complex cases.
What are the most common problems you see daily?
Day-to-day, one of the most common complaints I see is varicose and spider veins in the lower extremities. Before minimally invasive surgery, patients had to stay overnight in the hospital, and their mobility was restricted for two to three weeks. Today, my patients with clinical symptoms can have one treatment in the office, using local anesthesia, and get back on their feet and back to their daily routine immediately following the procedure.
When are varicose veins more than just a cosmetic nuisance?
When the veins are truly harming body image or if the patient has underlying medical issues — such as achy or cramping legs, pain at night which wakes them, legs that feel heavy and tired most of the time, swollen feet and ankles at the end of the day, or ulcerations — we need to proceed with treatment.
What are some of the risk factors for varicose veins?
Heredity and genetics are by far the largest risk factors. However, lifestyle does come into play for those who already have varicose veins. For example, weight gain, an overly sedentary lifestyle, or for patients with occupations requiring them to do a lot of standing, varicose veins will become much more symptomatic and advanced. Particularly during pregnancy, we recommend the use of a compression stocking for anyone with a tendency to develop varicose veins. Compression helps with both symptoms and progression of veins.