Vascular Surgery is a surgical specialty that deals with disorders of the blood vessels namely arteries, veins, and lymphatics. This commonly sees an ulcer in the skin especially in the legs or claves areas if venous related. Varicose veins being the most common disorder.
The department of vascular surgery manages effective treatments for these disorders in the form of medications, open surgery like bypass procedures, or endovascular and endo-venous (laser or radiofrequency ablation for varicose veins) procedures.
Complications like ulcers, infections, and reduced blood flow are also dealt with in vascular surgery which is common for diabetic patients.
Vascular access procedures like the creation of arterio-venous fistulae (AVF), perm-cath insertion, and management of various vascular complications are also handled by vascular surgery.
The most common causes of vascular diseases include Smoking, hypertension, high cholesterol levels, long-standing diabetes are the common causes for the development of arterial diseases.
Signs and Symptoms:
- Venous Insufficiency due to venous congestions and venous stasis:
- Venous ulcer is seen as leg or ankle ulcer(malleolar ulcer)
- Leg ulcer (calf ulcer0
- Wound healing is affected
- swelling of the legs or ankles (edema)
- pain that gets worse when you stand and gets better when you raise your legs.
- leg cramps.
- aching, throbbing, or a feeling of heaviness in your legs.
- itchy legs.
- thickening of the skin on your legs or ankles
- Painful cramping in your hip, thigh, or calf muscles after certain activities, such as walking or climbing stairs (claudication)
- Leg numbness or weakness.
- Arterial ulcer
- Coldness in your lower leg or foot, especially when compared with the other side.
Diseases of arteries include conditions causing blockages and clots in the arteries leading to pain in the muscles on walking, gangrene of the toes/fingers with severe pain on rest. Strokes are very common if arteries to the brain get narrowed or abnormal balloon-like dilatations called ‘aneurysm’ with the risk of bursting can be a predisposition to a life-threatening condition.
Diseases of Veins due to venous congestion include conditions like varicose veins (abnormally dilated veins on the legs), swelling with discoloration of the ankles and legs, wounds/ulcers over the ankles and feet. Clots can develop in the deep veins and known as Deep Vein Thrombosis (DVT), a potentially life-threatening condition if the clots migrate to the lungs causing Pulmonary Embolism.
Diseases of the lymphoid system can lead to massive swelling of your legs with thickening and folding of the skin called ‘Elephantiasis’.
Complications of Vascular Diseases:
It is important to be aware of the following in order to consult a vascular surgeon:
- Upper and lower limb swelling
- Upper and lower limb pain
- Ulcers on foot, calf, and ankle
- Non-healing ulcer
- Deep venous thrombosis
- Coldness of limb
- Diminished hair or nail growth
- Claudication / rest pain
- Raynauds phenomenon
- Weakness of extremities
- Syncope or loss of sudden consciousness
- Sudden Blindness
In a nutshell, the department of vascular surgery specializes in managing and treating. Vascular surgery has become a highly specialized area where the vascular surgeon uses his specialized clinical skill to assess and treat vascular diseases along with the help of open surgical, endovascular, and other surgical modalities.
- Symptomatic relief from peripheral arterial and venous diseases
- Healing venous leg ulceration
- Promoting cardiovascular health
- Improving the quality of life in patients with vascular disease
- Multi-disciplinary management of the vascular complications of
- Diabetes and renal disease
- Providing a renal access service for patients requiring hemodialysis
- Preventing mortality from an abdominal aortic aneurysm
- Preventing stroke due to carotid artery disease
- Preventing irreversible damage to the limbs
- Diabetic foot surgeries
- Thoracic outlet surgeries- Scalenectomy/ cervical rib excision
- Carotid endarterectomy – Surgery for Stroke Prevention
- Bypass Surgery for Leg Arteries (fem-pop, fem-fem, fem distal)
- Management for gangrene of limbs to prevent amputation
- Surgery for Aortic Aneurysm / Aortic occlusion (open aortic repair/Aorto-femoral bypass)
- Vascular control for bleeding vessels.
- Vascular malformation excision
- AV access surgeries (brachiocephalic, brachio basilic fistula with transposition, and AV grafts)
- Endovascular aneurysm repair for Thoracic Abdominal Aortic Aneurysm (EVAR/TEVAR)
- Radiofrequency Ablation of varicose veins
- Injection treatment (sclerotherapy) for Varicose Veins
- Carotid/Renal/ Subclavian angiography and angioplasty with stenting
- Peripheral angiography with balloon angioplasty and stenting of arm or leg arteries
- Aorta and Visceral artery angioplasty
- Venous angiography with IVC filters placement and angioplasty of stenotic veins.
- Management of Deep Vein Thrombosis (including placement of IVC filters/stents and catheter-directed thrombolysis)
- Covered Stent Grafts for Trauma, Arterio-Venous Fistulae, and Aneurysms
- Chemo port and PICC line insertion
- Permcath insertion
The range of diagnostic tests and treatment is also increasing.
Non-invasive investigations :
- Ultrasound: Arterial and venous duplex scans
- ABI : Ankle Brachial Index
- Angiograms ( CT, MRI, Radioisotope )
Invasive investigations :
Conventional Angiography: X-ray images of blood vessels taken after injection of radio-opaque contrast
- Stop or avoid smoking
- Keep fit and adopt a healthy lifestyle
- Loose weight
- Eat a healthy and balanced diet
- Take a preventive health check-up and monitor heart parameters and blood sugar.