MARK GENNARO, MD, FACS
Patient Centered Vascular Care
We recognize the importance of a patient and family centered medical experience, which inspires my staff and I to create strong and long-lasting bonds with each of our patients. It is a privilege to serve the community of Huntington and the surrounding areas. We strive to provide quality medical care through sound diagnoses and procedures. Our practice manager, Victoria Popolizio, is always available for our patients, and may be reached at 631-385-7258.
Our Staff
Here for you
Janice Lercara
Administrative Assistant
Amanda Caggino
Medical Assistant
Nicole Salinas
Medical Billing
Insurance Authorization
Contact Us
We love helping our patients feel healthy and happy. Patients can access their medical records 24/7 on our Patient Portal, simply log onto : www.yourhealthfile.com.
Contact our office for your unique user name and password.
270 Pulaski Rd, Greenlawn, NY 11740, USA
(631) 385-7258
1-877-787-4680
ICAVL Accredited Vascular Laboratory
Diagnostic Excellence
Our fully accredited vascular laboratory is open Monday thru Friday and offers state of the art non-invasive vascular imaging and diagnostic testing.
Examinations Performed
Carotid Duplex
Upper and Lower Extremity Arterial Duplex
Upper and Lower Extremity Venous Duplex
Aortic Duplex
Mesenteric Duplex
Renal Artery Duplex
Upper and Lower Extremity PVR Examinations
Temporal Artery Duplex
ARDMS Registered and ICAVL Accredited
Your Health is in Good Hands
Services Provided
ICAVL Accredited Vascular Laboratory
Diagnostic Excellence
Our fully accredited vascular laboratory is open Monday thru Friday and offers state of the art non-invasive vascular imaging and diagnostic testing.
Examinations Performed
Carotid Duplex
Upper and Lower Extremity Arterial Duplex
Upper and Lower Extremity Venous Duplex
Aortic Duplex
Mesenteric Duplex
Renal Artery Duplex
Upper and Lower Extremity PVR Examinations
Temporal Artery Duplex
ARDMS Registered and ICAVL Accredited
Complete Vascular Health Diagnosis and Treatment
Vascular surgery is a surgical specialty in which diseases of the vascular system (arteries and veins) are managed by medical therapy, minimally invasive catheter procedures and surgical reconstruction. Vascular surgeons may work to restore blood flow to an area of the body after trauma, disease or another issue which damages blood vessels.
After the age of 50, most people experience some form of vascular problem. For some it may be little more than an elevated cholesterol level. For many, however, there are vascular problems or complications such as cardiac disease, hypertension, diabetes, kidney disease or lipid disorders.
Our practice diagnoses and performs procedures to treat conditions affecting the circulatory system, including venous disease, vascular access, aortic and peripheral artery aneurysm repair and diabetic foot conditions.
The vascular procedures I perform include:
Relieving the effects of blocked blood vessels
Treatment of aneurysms of the aorta (and other blood vessels)
Vascular access procedures (long term IV treatments and hemodialysis fistulas and grafts) as well as
Varicose vein treatment
For the diagnosis of vascular conditions, we have an ICAVL Accredited Non-Invasive Vascular Laboratory on site.
For vascular procedures, especially those where vascular surgery is required for correcting problems, when possible, I rely on state of the art minimally invasive endovascular techniques to improve both short and long-term recovery.
Diabetic Vascular Disease Treatment
According to the American Diabetes Association, more than 60 percent of all lower-limb amputations occur in people with diabetes. The Amputee Coalition of America reports that up to 55 percent of those who have had an amputation will experience the loss of their second leg within two to three years. Our patients can receive regular consultation, treatment and education to prevent foot problems and amputation whenever possible. Patients can meet with a vascular surgeon, and have peripheral arterial testing. This comprehensive approach allows for better management of any foot issues relating to diabetes.
Sclerotherapy
Sclerotherapy effectively treats varicose and spider veins. It's often considered the treatment of choice for small varicose veins.
Sclerotherapy involves injecting a solution directly into the vein. The sclerotherapy solution causes the vein to scar, forcing blood to reroute through healthier veins. The collapsed vein is reabsorbed into local tissue and eventually fades.
After sclerotherapy, treated veins tend to fade within a few weeks, although occasionally it may take a month or more to see the full results. In some instances, several sclerotherapy treatments may be needed.
Carotid Endarterectomy
A carotid endarterectomy is a surgical procedure to open or clean the carotid artery with the goal of stroke prevention. It is a durable procedure but not a cure; though rare, blockage can accumulate again.
Endovascular Repair of Abdominal Aortic Aneurysm
Endovascular repair is a preferred treatment for many people with an abdominal aortic aneurysm (AAA), and an alternative for some who do not qualify for open surgery.
How an AAA is repaired varies depending on location, which then classifies the procedure as either STANDARD or COMPLEX
In deciding whether to recommend repair your surgeon will consider the size of the aneurysm, its location, how fast it is growing, how complicated it is to repair and your overall health.
STANDARD repair for an aneurysm located below the arteries to the kidney:
Through a needle puncture or small incision in one or both of your groin arteries and guided by X-ray images, a thin tube (catheter) is inserted and advanced to the aneurysm site.
A guide wire and an expandable stent graft (a fabric-covered wire frame) are advanced through the thin tube.
When positioned correctly, the stent graft is allowed to expand within the artery. The wire frame pushes against the healthy portion of the aorta to seal the device in place.
Once in place, blood flows through the stent graft and cannot enter the aneurysm.
Some patients may also require a puncture or small incision into an artery in the upper arm.
The procedure usually takes 1.5–2.5 hours and most patients leave the hospital in 1–5 days.
COMPLEX repair for an aneurysm affecting one or more of the important arteries that branch off the aorta:
Following the same steps as above, a different type of graft is placed.
A fenestrated graft gets its name from tiny cutouts that allow the graft to flex and align with the branching of arteries, and also be modified to accommodate your specific anatomy.
It is important that the graft fit your anatomy. Sometimes a standard commercially manufactured, FDA-approved device can be used. If you are not eligible for a standard device, you may qualify for a research device that is custom-made specifically for you.
The procedure usually takes from 3–8 hours.
Varicose Vein Treatment - VNUS Closure
VEIN TREATMENT WITH
THE VNUS CLOSURE® SYSTEM
The VNUS Closure procedure has become a useful alternative method for the treatment of varicose veins. Vein Closure can usually be used to treat those patients who would have previously been treated by vein stripping. Closure of the greater saphenous vein is the minimally invasive alternative to vein stripping. Instead of stripping the vein, the Closure device seals the vein shut.
Vein Closure is not a procedure for every varicose vein or every patient with varicose veins. We use the Closure procedure most often to close suitable great and small saphenous veins. The use of the Closure process has now been extended to treat several other veins such as anatomically suitable anterior accessory saphenous veins, and some perforator veins. Usually the GSV cannot be seen with the naked eye by simply looking at the leg of a patient with varicose veins. Often it is the source of many of the varicosities in the affected leg. Its location and the role it plays in varicose vein formation can be shown with ultrasound examinations. The greater saphenous vein is located on the inside of the thigh. The vein starts at the groin and goes down the inside of the thigh and leg to the ankle.
The Catheter closes the greater saphenous vein (GSV). The GSV runs from the groin to the ankle. Electrical energy is applied to the catheter electrode in order to heat the vein wall and shrink the vein closed. The VNUS catheter is placed inside of the greater saphenous vein usually below the knee. Since the vein cannot be seen by the naked eye, it is entered under ultrasound guidance or with a small incision.
Peripheral Angiogram
Peripheral Angiogram is a broad term used to describe a study of the peripheral circulation. This test is usually performed when your doctor suspects that you may have a significant blockage in one or more of the arteries of your peripheral circulation. Specifically, the arteries of the aorta (Aortogram), renal arteries (Renal angiogram), legs (Lower Extremity Angiogram), or arms (Upper Extremity or Subclavian Angiograms) may be studied. It is a common, relatively painless, nonsurgical procedure performed by a Vascular Surgeon.
The information provided by this procedure provides details about the function and patency of the specific arteries being studied. It is used to diagnose and treat Peripheral Artery Disease (PAD), and may also diagnose thoracic (TAA)and adominal aortic aneurysms (AAA).
How Is a Peripheral Angiogram Performed?
A thin flexible tube (catheter) is inserted through an artery in your groin (femoral artery), wrist (radial artery) or arm (brachial artery). To make the arteries visible on x-ray, dye is injected through the tube into the target arteries. An x-ray camera films the arteries as they pump blood. These x-ray images can be viewed right away so treatment decisions can be made quickly.
NOTE: Be sure to tell your doctor or nurse if you are allergic to x-ray dye (contrast) or shellfish, or if you are allergic to Aspirin, Plavix, Effient or Brilinta.
Before Your Peripheral Angiogram
Pre-Admission Testing
Prior to your procedure, you will be required to have routine pre-admission testing performed.
During this appointment, you will be interviewed by a nurse, who will review your medical history and medications.
Bring all medication bottles in a zip lock bag or a detailed list of what your medications including dosage and frequency.
Fasting or non fasting blood work may be performed at this appointment.
The Night Before your procedure:
• Patients who are on anti-thrombotic medications (warfarin, Pradaxa, Xarelto, Eliquis, Savaysa): You should have been given a stop date. If not please call the office.
• Drink plenty of water during the day before your test as you need to be well hydrated. If you are on a fluid restriction (ordered by a physician) due to a medical condition please inform us immediately.
• No solid food or drink after midnight including gum or candy. You may take your usual medications with a sip of water the morning of the procedure. (Except diabetes medications or insulin, see below).
• Diabetic patients: Do not take your diabetes medications/insulin the morning of your procedure.
• You CAN NOT drive yourself the day of your procedure.
• If you develop symptoms of a cold, flu or fever or if you have been exposed to any communicable diseases (chicken pox, shingles, mumps, measles or tuberculosis) since your preadmission visit, immediately notify us.
• If your procedure is scheduled at Huntington Hospital, you will receive a call between 4:00 - 5:00 p.m. the day prior to your scheduled procedure (Mon-Fri ) to verify your arrival time: 631-351-2560.
• Be prepared to stay overnight as there is always a possibility you will be admitted following your procedure. If you are discharged the same day, you MUST have someone to stay with you that night.
ALLERGIES- FOR PATIENTS WITH IVP DYE, IODINE, OR SHELLFISH ALLERGY (i.e., lobster, crab, mussels, oysters, clams, and shrimp)
Take Prednisone 50mg at 8am the day before your test.
Prednisone 50mg at 8pm the day before your test.
Prednisone 50mg at 8am the morning of your test.
In addition, take two Benadryl 25 mg tabs (available over the counter at your pharmacy) the evening before your procedure
The Day of the Peripheral Angiogram
Before Leaving for the Lab
A doctor or nurse will explain the procedure, its purpose, benefits and risks.
You will be asked to sign a consent form.
An IV (intravenous) line will be started in your hand or arm.
You will be asked to empty your bladder.
Family members and friends are not allowed in the lab. They will be told where they can wait.
It will be cool in the lab. You will be helped onto the table. You will lie flat so that the x-ray machine can rotate around the upper part of your body. If you have back problems, tell the staff so that they can help you find a more comfortable position. ECG patches (electrodes) will be placed on your shoulders, chest arms, and legs. These patches are hooked to equipment that monitors your heart.
Points of Insertion
The area that will be used for the procedure will be shaved and cleaned to remove any bacteria that is on the skin.
Since the peripheral angiogram is done using sterile technique, the doctors and nurses in the lab will be wearing sterile hospital gowns, hats, masks, and gloves. You will be covered from your chest to feet with a sterile sheet. Once the sheet is placed over you, please keep your arms at your side. If you need to move your arms, ask the nurse in the room to guide you.
Getting Ready
Your doctor will inject a small amount of medicine into the area being accessed for the Procedure(groin, arm or wrist). Although it will sting and burn a little, it will quickly numb the area. This will prevent you from feeling pain at this site during the angiogram. Your leg or hand may feel numb as well.
You will feel pressure, pulling and tugging at the site where the tube is inserted. You will be given IV pain medication and light sedation. You will be sleepy but able to communicate with your doctor and nurse.
Placing the Catheters
The doctor will make a tiny incision in your skin. A small hollow tube (a sheath) will be placed through the incision and into the artery . The catheter is then passed through the sheath, deeper into the artery being studied. The blood vessels don’t have nerves on their inner linings; therefore the procedure causes minimal discomfort.
During the procedure, a dye that shows up on x-ray is rapidly injected into your arteries. As the dye is injected, you may experience a sensation of warmth or flushing, but this is a normal reaction, and will last only 20-30 seconds. The movie of the dye flowing through the arteries is called a peripheral arteriogram.
After The Procedure
Your recommended treatment depends on the type and severity of the peripheral artery disease (PAD). Once diagnosed, treatment may include:
Medicine to help reduce symptoms of leg pain, or claudication
Peripheral artery bypass surgery to detour around the blockages
Peripheral angioplasty, atherectomy, and stenting
Renal artery stenting
Subclavian artery stenting
Abdominal aortic aneurysm (AAA) stenting
In angioplasty, a special catheter with a small balloon at the tip is passed into a narrow portion of the artery and inflated. This compresses the plaque against the walls of the artery.
The angioplasty is often followed by the placement of a “wire coil” or stent. The stent, an implant, will remain in the artery. Within weeks, new tissue will grow and cover the stent.
A stent can be implanted at the location of a AAA, preventing rupture
After your procedure, you will return to a room to recover. You be on bed rest for two to several hours. This depends on what you had done, and the size, type, and location of catheters used. The staff will keep you comfortable with the use of medicines and position changes. Some patients are discharged the same day, but if you received a stent, angioplasty, or atherectomy, you may stay overnight.
If a stent is placed, you will be started on antiplatelet medication (Plavix and remain on it for a minimim of 1 month, depending on the type of stent used. You should also remain on aspirin. These medicines help to prevent a clot from forming on the stents. Do not stop your medication without first talking with your physician.
Blockage can reoccur with the stent. This may happen within the first 3-6 months. This blockage occurs slowly, and you may have a return of symptoms (claudication). If this should happen, please contact your doctor soon after you notice the symptoms.
What are some possible complications?
If there is swelling or bleeding from the angiogram site, or if the extremity becomes cold, pale, or numb following discharge, you must immediately contact your physician.
The risks of peripheral angiogram include the possibility of a blood clot forming that causes a stroke or heart attack, bleeding, damage or obstruction of a blood vessel, or even death. However, in medically stable patients undergoing elective peripheral angiogram for the evaluation of peripheral artery disease, the risk of a potentially fatal result is less than 1 in 500 cases
Follow- Up Care : Post Peripheral Angiogram
DressingIf the band aid was not removed in the hospital, you may remove it once you get home, unless otherwise instructed. It is less painful if you remove it while in the shower.
BathingYou may shower the day after the procedure. Gently cleanse the site with soap and water 24 hrs after the procedure. You may not take a bath, swim, or soak in a hot tub or Jacuzzi until after your office follow-up appointment.
ExerciseYou may resume walking at home. After 24 hours, you may walk the distance at which you are accustomed. If you have not been walking, you may start at a low level. If your procedure was performed via your radial artery (wrist): Do not hyperextend your wrist (radial artery approach) for 7 days
Sexual ActivityYou may resume after 48 hours, unless advised otherwise.
Household ChoresYou may resume household chores (dishes/laundry). Wait 5 days before vacuuming. You may not shovel for 5 days.
LiftingFemoral artery approach (leg/groin): Do not lift over 10 pounds for the first 3 days at home. Radial or Brachial Artery approach (wrist/arm): do not lift over 7 lbs with the affected arm for 7 days
DrivingYou may resume 24 hours after discharge, unless advised otherwise
StairsAs tolerated
WorkDepends on your type of work. Check with your Doctor
MedicationsTake as directed. Do not stop any medications unless you are instructed by your Cardiologist. Contact the office for specific instructions
DietFollow a low fat, low cholesterol diet. If you have any other dietary restrictions (i.e. diabetes), follow your doctor’s recommendations
SmokingSmoking is a major risk factor for most diseases. If you smoke, you are strongly encouraged to quit. Talk to your Doctor for assistance.
Notify your Doctor if:Temperature greater than 101.5. Bleeding at the puncture site. Femoral artery approach (leg/groin): leg is white, numb, cold, very painful, or if a lump appear at the incision site. Radial or Brachial Artery approach (wrist/arm): arm is white, numb, cold, very painful, or if a lump appear at the incision site.
Follow-Up AppointmentsSchedule and keep your appointment for 7-10 days post procedure. We will check your puncture site at this appointment.
Follow- Up Care : Post Angioplasty, Atherectomy or Stent
DressingIf the band aid was not removed in the hospital, you may remove it once you get home, unless otherwise instructed. It is less painful if you remove it while in the shower.
BathingYou may shower the day after the procedure. Gently cleanse the site with soap and water 24 hrs after the procedure. You may not take a bath, swim, or soak in a hot tub or Jacuzzi until after your office follow-up appointment.
ExerciseYou may resume walking at home. After 24 hours, you may walk the distance at which you are accustomed. If you have not been walking, you may start at a low level. If your procedure was performed via your radial artery (wrist): Do not hyperextend your wrist (radial artery approach) for 7 days
Sexual ActivityYou may resume after 5 days, unless advised otherwise.
Household ChoresYou may resume household chores (dishes/laundry). Wait 5 days before vacuuming. You may not shovel for 5 days.
LiftingFemoral artery approach (leg/groin): Do not lift over 10 pounds for the first 3 days at home. Do not lift more than 20 lbs for first 2 weeks at home. Radial or Brachial Artery approach (wrist/arm): do not lift over 7 lbs with the affected arm for 7 days
DrivingFemoral artery approach (leg/groin): You may resume 4 days after discharge, unless advised otherwise. Radial or Brachial Artery approach (wrist/arm): You may resume after 24-48 hrs, unless advised otherwise.
StairsFemoral artery approach (leg/groin): You may resume after 24 hours, as tolerated. Radial or Brachial Artery approach (wrist/arm): As tolerated
WorkDepends on your type of work. Check with your Doctor
MedicationsTake as directed. Do not stop any medications unless you are instructed by your physician. Do not stop your anti-platelet medication (aspirin, Plavix, unless directed to do so by your physician. Contact the office for specific instructions
DietFollow a low fat, low cholesterol diet. If you have any other dietary restrictions (i.e. diabetes), follow your doctor’s recommendations
SmokingSmoking is a major risk factor for most diseases. If you smoke, you are strongly encouraged to quit. Talk to your Doctor for assistance.
Notify your Doctor if:Temperature greater than 101.5. Bleeding at the puncture site. Femoral artery approach (leg/groin): leg is white, numb, cold, very painful, or if a lump appear at the incision site. Radial or Brachial Artery approach (wrist/arm): arm is white, numb, cold, very painful, or if a lump appear at the incision site.
Follow-Up AppointmentsSchedule and keep your appointment for 7-10 days post procedure. We will check your puncture site at this appointment.
