The People Plumber

Minimally invasive procedures drive practice

When people ask Dr. Randy Guzman to explain his work, he simply tells them he’s a plumber – for humans. As a vascular surgeon, Dr. Guzman treats arteries and veins (outside of the chest and head)– the human pipes that keep our blood moving the way it’s supposed to.

Over 20+ years of practice, Dr. Guzman has seen a significant shift toward minimally invasive procedures. Less conventional surgery; more procedures involving stents, wires, and medicines. And the technology is improving all the time.

“Over time, the devices have just gotten smaller and smoother and easier to use,” says Dr. Guzman, a graduate of the University of Manitoba.

“… less stress to the body, less infection, less immobility, fewer blood clots, less anxiety.”

There was a time, he says, where most procedures required large incisions and complex surgery requiring long recovery times. Now patients barely stay in the hospital: “typically a couple of days… They’ve got this tiny incision in their groin. It’s like they didn’t even feel it. That’s pretty cool.”

With minimally invasive techniques, there is “less stress to the body, less infection, less immobility, fewer blood clots, less anxiety.”

Another major evolution, says Dr. Guzman, is how easy it has become to use ultrasound equipment.

“Now instead of these huge machines, they’re portable, like a laptop,” he says of the equipment, funded in part by St. Boniface Hospital Foundation. “I use it every day on almost every patient. That’s point-of-care stuff. That’s just better care. I can look at the veins right before the operation. I can figure out what they look like, where to make my incision, where not to make my incision. It’s really been part of my daily practice. That’s been a benefit from the Foundation.”

Over his illustrious career, Dr. Guzman has so far been published about 50 times and has served as the Principal Investigator for over 35 research projects.

Today, he is active with a number of key, multi-centre studies that will enhance our understanding of vascular surgery and the best approaches for different conditions. One major North American study is comparing “endovascular” therapies (minimally invasive; going through the veins) with conventional surgery for treating critical limb ischemia. Critical limb ischemia is a condition where a patient has a limb at risk because of poor circulation that has led to gangrene or ulcers.

Another multi-centre study with which Dr. Guzman is involved is the CREST study. CREST stands for Carotid Revascularization Endarterectomy versus Stenting Trial. Again, the purpose here is to compare conventional surgical techniques with endovascular techniques, but specifically for the carotid arteries which are located in the neck.

“Endarterectomy” is the conventional surgery that involves scraping the plaque out of neck arteries which, left unchecked, could lead to stroke. Dr. Guzman describes the procedure as “Roto-Rootering out the pipe in the neck.”

Dr. Guzman explains that a follow-up to CREST is also adding a pharmaceutical component.

“Just as the technology has improved, so too has the medicine,” he says. “Sometimes, not doing an operation is actually better than doing an operation. You have to weigh the pros and cons and risks and benefits. This is a case where the benefit of surgery or intervention is unclear, versus best medical therapy, which has improved tremendously over the last 10 or 20 years. For a patient who has a severe narrowing, is it better to intervene or to carry on with medical therapy? That’s the question of that study. That’s an important study.”

For Dr. Guzman, the ability to connect and collaborate around his clinical work and his research interests within the same facility is a huge bonus.

“I think the benefit here at St. Boniface is the infrastructure,” he says. “To be close to full-time research scientists as well as other clinicians is amazing. It’s an amazing space, infrastructure-wise. It’s not found everywhere… It’s pretty special.”

His dream for this amazing space is that one day soon there will be a hybrid endovascular suite that could accommodate high-tech imaging equipment and devices for planned minimally invasive procedures, but could also allow for conventional surgery. “Many of these complex operations require an open component (conventional surgery) and an endovascular component. That’s really the advantage of a hybrid suite,” he explains. He’s hopeful that funding will one day be in place to make this dream a reality.

“The main driver is really better patient care,” says Dr. Guzman. “When you deal with patients and life-threatening, or limb-threatening diseases every day, you constantly look at your own situation. I am grateful every day for the job I’m doing and the position I’m in and where I work and being part of the St. Boniface team. Every day’s a blessing.”

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