Joseph J. Fulton, MD

Specialty: Vascular Surgery

MidHudson Regional Hospital

Westchester Medical Center

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Please tell us about your work in sub-Saharan Africa.

Since 2011, I have been helping to educate Malawian medical students and general surgery residents. My main role has been doing operations to provide permanent access for dialysis — arteriovenous fistulae. Currently there is no one else in Malawi who can do this. While there, I have had the opportunity to treat quite a few unique cases, such as arrow injuries, crocodile and hyena attacks, and very advanced tumors.


What are some important things about your field that you didn’t learn until after medical school?

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I actually didn’t choose vascular surgery in medical school. I started with a five-year residency in general surgery, and during my different rotations decided to pursue a fellowship in vascular surgery. As in most medical professions, the learning process is constant and ongoing. Procedures are continually being developed and refined. Deciding which patients will benefit, and which ones won’t from operative interventions is also critical.


What are some recent advances in the treatment of varicose veins?

Some recent advances in varicose veins involve treatment of veins with dysfunctional valves, called venous reflux. Sometimes when the valves are not closing fully, or slowly, pressure can build up in the veins in the legs and lead to symptoms such as swelling, heaviness, throbbing, burning or itching. It can result in varicose veins. Just having varicose veins does not mean you have venous reflux. Different modalities have been developed to “close down” superficial veins with dysfunctional valves such as using a laser, radio waves, or even injecting glue. While not yet available, different types of replacement valves are being developed to treat deep vein reflux.


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How can you treat aneurysms without major invasive surgery?

Aneurysms, enlargements of an artery (blood vessel), can be treated without any major incisions. The principle is to place a covered stent, or tube, inside the artery to depressurize the aneurysm and prevent rupture. Most of these stent grafts can be delivered percutaneously, or through needle access through an artery in the groin. Depending on which artery is involved, some are done as outpatients, or have one overnight stay in the hospital.


When it comes to your work, what might surprise your patients?

I think that the amount of training that is necessary might be surprising to some people. Following college, I worked for several years as an electrical engineer with IBM and then went to medical school, which is four years, then five years of general surgery, a year of research, and then two years of vascular surgery. In total, this was 12 years of training.


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