Vascular and Endovascular Surgery
Dr. Nupur
Sarkar
– MBBS (CMC
Vellore), MS (General Surgery – CMC Vellore), MCh (Vascular Surgery – Madras
Medical College Chennai), FIVS (Salzburg, Austria)
Vascular Surgery deals with diseases of all the blood vessels of the
body, except for those inside the skull (Neurosurgery) and those of the heart
(Cardiac Surgery). A
vascular surgeon commonly deals with diseases of the arteries and veins. Today
science and technology has advanced to a stage where there are treatment
modalities available to prevent amputation and save many limbs. Just as
angioplasty is possible to remove the blockages in the blood vessels of the
heart and avoid bypass surgery, similarly angioplasty can be done for vessels
going to the hands and legs and even to the brain. This is popularly known as
“key-hole” surgery or minimally-invasive surgery or ENDOVASCULAR SURGERY. A vascular surgeon
is equally trained in both open surgery and so-called “key hole” surgery
(endovascular), so he/she is able to give a better perspective of which
treatment modality or combination is best suited for a particular patient.
Lack of awareness in India regarding the availability of these treatment
options means that many deserving patients are deprived the chances of early
treatment and often lose their legs or lives due to the disease.
The specialty includes treatment for peripheral arterial occlusive
disease (gangrene of the fingers or toes or non-healing ulcers on legs or
hands), carotid diseases, aortic aneurysms / dissections, acute limb ischaemia,
varicose vein surgery, treatment for DVT, arteriovenous malformations, thoracic
outlet syndrome and creation of dialysis access fistulas for renal failure
patients.
Because a
large number of people with diabetes have blocked blood vessels leading to foot
problems, vascular surgeons also deal with infection and gangrene problems of
the foot in diabetics.
a) Limb salvage surgery (treatment for arterial occlusion of legs or hands)
Blocked arteries in the leg
can be treated by either medications or surgery or both. The best method of
treatment can be decided only after a thorough evaluation of the patient.
Surgery commonly involves a bypass operation. Gangrene of the leg is a “leg
attack” just like a block in the arteries of the heart causes a “heart attack”.
If not treated properly, it can be both limb and life threatening.
Some people with blocked
lower limb arteries can be treated with a newer method of treatment called
endovascular surgery (minimally invasive). Here, the morbidity of open
operations can be avoided by performing an angioplasty and stenting of the
blocked blood vessel. Not everyone is a suitable candidate for endovascular
surgery. The vascular surgeon is the best person to decide which form of
surgery (open or endovascular) is best suited to a particular patient.
Vascular surgery is performed
in order to improve the blood flow to the leg and stop further spread of
gangrene. This can be limb saving as well as life saving.
b) Trauma
Many road traffic
accidents result in complicated fractures of the legs or hands where the blood
vessels get severely damaged. These blood vessels if not repaired as an
emergency means that the blood supply to the leg is cut off and the patient may
require an amputation. A specialized trauma team headed by a vascular surgeon
and including an orthopaedic surgeon and plastic surgeon is required to operate
these emergency cases and salvage the limbs.
c) Aortic surgery (for aortic occlusions,
aortic aneurysms)
An aneurysm is a
localised ballooning of the artery. It is deadly because the ballooned out
blood vessel can burst and have fatal consequences. Aneurysms can involve any
blood vessel of the body. Aneurysms of the aorta need special attention – both
open and endovascular options are available and a vascular surgeon is best
qualified to judge which option is the best for any particular patient.
d) Carotid endarterectomy and carotid stenting
Stroke is often caused by
a blockage in the carotid arteries (which supply the brain). The risk of having
a stroke can be decreased by either performing an open surgery or putting a
stent in the carotid artery. Which treatment modality is best suited to a
particular patient requires joint evaluation of the patient by a team led by a
neurologist and including a vascular surgeon, neurointerventionalist and a
neurosurgeon.
e) Varicose vein surgery – open, LASER, RFA
and foam sclerotherapy
Bulged out veins under the
skin are called varicose veins. They are unsightly and cause pain, nonhealing
leg wounds as well as bleeding complications. Treating varicose veins on time
prevents these complications.
Different methods of
treatment exist for varicose veins. The treatments include stockings (special
pressure-gradient compression), injection therapy (sclerotherapy), open surgery
and laser / RFA surgery. Most often these patients need only 1 or 2 day
hospital stay and can go back to their daily work the same week.
f) Creation of arteriovenous access for
haemodialysis – fistulas and grafts
A vascular surgeon can
help renal failure patients by providing a good dialysis fistula/graft. There
are several options available in the forearm, arm or legs. Even children with
weight as less as 15kg can have a successful fistula. There are options
available to salvage failing fistulas and repair them, in certain cases.
g) Diabetic foot care
Diabetics
are known to have a 4-5 times higher risk of blockage of leg blood vessels
compared to normal people of the same age. This is why infections and gangrene
are more common among the diabetics. Hence a vascular surgeon is involved in
the care of diabetic foot diseases through dedicated DIABETIC FOOT CLINICS.
Foot problems in diabetics are very common and can equal or exceed heart
disease in morbidity and mortality. Lack of awareness of this fact is
responsible for a lot of amputations and deaths among diabetics with foot
problems in India.
h) Thoracic outlet syndrome treatment
Many patients with pain
in the hands due to thoracic outlet syndrome are misdiagnosed and
inappropriately treated. A vascular surgeon is able to provide treatment
options for cervical rib and its complications.
i)Treatment
of deep vein thrombosis (DVT)
Deep vein thrombosis
means occlusion of the deep veins or the main veins of the legs or hands.
Treatment options that we can offer include catheter-directed thrombolysis and
IVC filters which can decrease the risk of life-threatening pulmonary embolism
and disability later due to venous ulcers.
j) Miscellaneous
Other diseases that
also come under the specialty of vascular and endovascular surgery include
visceral artery occlusive diseases (mesenteric and renal), arteriovenous
malformations, vasculitis (Takayasu’s arteritis), carotid body tumours, tumours
of the legs or hands involving the blood vessels.
Symptoms
Pain during walking, inability to walk or sleep due to severe pain in leg or hands,
Pain during walking, inability to walk or sleep due to severe pain in leg or hands,
Gangrene of the fingers due to occlusion of arteries of the hand. (Acute limb ischaemia |
CT angiogram showing an aortic aneurysm. |
CT angiogram showing a large carotid body tumour encasing the carotid vessels. |
A middle-aged female patient with deep vein thrombosis of the right leg. |
Schematic diagram showing treatment of an aortic aneurysm by endovascular therapy (EVAR). |
Gangrene of the left third toe in a young male smoker. |
IVC filter used in patients with DVT to prevent life-threatening pulmonary embolism. |
Non-healing ulcer in a young male smoker (Thromboangiitis obliterans / Buerger’s disease) – required femoro-distal bypass for limb salvage. |
CT angiogram showing extensive occlusions of the arteries of both legs. |
Varicose veins of the legs which requires treatment to prevent ulcers of the legs in the future. |
A middle-aged male patient with a large venous ulcer of the left leg. |
No comments:
Post a Comment