Vascular Surgery

This is a diagnostic procedure where contrast media (dye) is administered under X-ray guidance to assess the arteries or veins in question. Angiograms are performed to assess peripheral vascular disease, arterial aneurysms and venous disorders such as extensive deep vein thrombosis.

This is an interventional procedure to treat peripheral vascular disease. This can manifest as claudication (cramping in the leg when walking), severe rest pain in the foot or leg, ulcers that fail to heal or gangrene. Following examination of the artery or vein with contrast dye, the proceduralist will use balloons and stents to open up the narrowing in the vessel.

Embolization is a minimally invasive technique performed to prevent blood flowing to a particular area of the body. The most common reasons for doing this are:

• To control or prevent bleeding
• To block an aneurysm, or
• To shrink a tumour.

An interventional vascular specialist will prevent blood flow by placing medications or synthetic materials through a catheter directly into the blood vessel.

This is a procedure that is undertaken to capture dislodged blood clots in the inferior vena cava. The Inferior Vena Cava is the vein that returns blood to the heart after it has travelled through the legs and lower torso. The filters are used to capture these blood clots to prevent them travelling to the lungs.

The abdominal aorta is the large artery that carries blood from the heart to the torso and legs. If there is a widening of the aorta, referred to as aneurysm, then an endoluminal repair can be performed. This involves the transluminal placement of a graft within the aneurysm to prevent it from rupturing, by excluding the aneurysm from the normal circulation of blood.

The mesenteric vessels are the blood vessels that supply the stomach, liver and the intestines. There are usually three mesenteric vessels:

• The celiac trunk
• The superior mesenteric artery, and
• The inferior mesenteric artery

Severe narrowing of these blood vessels can result in symptoms, due to a lack of blood supply. This is known as mesenteric vascular disease.

People with mesenteric vascular disease require treatment if they have severe symptoms. Sometimes the narrowing can be treated with balloons (angioplasty) and stents. Sometimes the narrowing needs an operation to remove the plaque (endarterectomy) or to bypass the narrowing. The bypass operation can be performed with a vein or with a plastic tube, depending on the circumstances.

Reference - St George Vascular Services

Carotid artery stenting is used to treat carotid artery disease. A narrowing of the carotid artery can cause small clots to travel to the brain and potentially cause a stroke.

This is an endovascular procedure where a small, expandable wire stent is deployed into the lumen of the carotid artery through a small incision in the groin. This procedure is usually performed on those patients where carotid endarterectomy is considered too risky.

Thrombolysis is a form of emergency therapy used to break down blood clots that are blocking the arteries or veins. The administration of drugs to dissolve these blockages is done through an intravenous (IV) line or through a long catheter. This treatment helps to improve blood flow to the affected tissues.

Veins are the blood vessels that carry blood from the body to the heart. Veins have valves which ensure that blood only flows in the correct direction. In patients with varicose veins these valves are incompetent or leaky. Chronic high pressure in the veins from incompetent valves results in varicose veins and their complications.

Varicose veins can be treated using compression stockings, sclerotherapy, endovenous laser ablation or surgery.

Surgery is performed when varicose veins on the leg have become very twisted and enlarged. This procedure is performed in the operating theatre usually under general anesthesia. Endovenous laser therapy can also be used to treat large varicose veins, and involves fewer scars and a faster recovery than surgery.

Peripheral Vascular Disease is the result of narrowing that forms within arteries, the blood vessels that carry blood away from the heart. The plaques that cause the narrowing consist of cholesterol deposited in the wall of the blood vessel. Arterial Bypass surgery or Endarterectomy can be performed to unblock the arteries, when the blockages are extensive.

Endarterectomy involves removing the narrowing in the artery and closing the artery with a patch of vein or prosthetic material. In an arterial bypass procedure the narrowing in the artery is bypassed with a vein harvested from the legs or arm, or with a plastic tube.

Reference- St George Vascular

Carotid Artery Disease is the blockage of the carotid artery due to plaque or fatty deposits. The brain receives its blood supply from four major arteries, two carotid arteries at the front of the neck, and two vertebral arteries at the back of the neck.

Ulcers can form on the surface of the plaque, which can release the contents of the plaque into the circulation. The debris from the plaque travels to the brain and blocks the small arteries supplying the brain, causing a stroke or a mini-stroke / transient ischaemic attack (TIA).

A Carotid Endarterectomy is the procedure that the surgeon will do to remove the plaque inside the carotid artery to prevent cholesterol debris from travelling to the brain.

Reference- St George Vascular Services

Patients who have developed kidney failure require dialysis to maintain their health. Dialysis removes the impurities and fluid from the bloodstream that are normally removed by the kidneys. Dialysis can be administered in the abdominal cavity (peritoneal dialysis) or via the circulation (haemodialysis).

In order to receive dialysis, a vascular access needs to be created. This can be done in four different ways:

• Arteriovenous Fistula: An artery and vein are sewn together in the arm, or occasionally the leg. The vein enlarges with the increased blood flow, and when the fistula is mature, needles can be placed in the fistula to connect the patient to the dialysis machine. This is the preferred method for haemodialysis as fistulas tend to last longer and cause fewer complications than other methods of haemodialysis.
• Arteriovenous Graft: This is an alternative procedure to the fistula for patients that have veins that are too small to allow for successful fistula creation. It involves placing a prosthetic graft (plastic tube) between the vein and artery.
• Peritoneal Dialysis: A peritoneal dialysis catheter (small tube) is placed in the lining of the abdominal cavity, known as the peritoneum. Peritoneal dialysis can be performed at home by performing multiple exchanges of fluid through the catheter daily.
• Vascath: A vascath is a tube placed in the large veins of the neck to allow rapid commencement of haemodialysis. It is usually a temporary option until an arteriovenous fistula or graft is created.

Reference- St George Vascular Services

Long term central lines that can be placed into large veins by the surgeon / interventionalist include:

1. PICC lines
2. Portacaths
3. Hickmans Catheters

The above lines are larger than the conventional drip, can stay in for longer periods of time and are used for long term Antibiotic therapy, Chemotherapy and Stem Cell/Bone Marrow transfusions.

People with diabetes are prone to ulceration of the feet. This is due to multiple effects that diabetes has on the body:

• Diabetes damages the peripheral nerves
• Diabetes damages the blood vessels
• Diabetes interferes with the body's ability to fight infections
• Diabetes causes deformity of the feet

Chronic foot and lower limb ulceration, including ulcers that develop due to diabetes, are mainly due to disorders of the veins, arteries and nerves. The underlying cause of the ulcer needs to be identified so that an appropriate treatment regimen can be instituted. Occasionally if the ulcer is large or becomes very infected, debridement or cleaning up of the ulcer is required.