Vascular Surgery

What is vascular surgery?

Vascular surgery is a surgical subspecialty in which diseases of the vascular system, or arteries and veins, are managed by medical therapy, minimally-invasive catheter procedures, and surgical reconstruction.

 

What are the major arteries and veins in our body?

  • Arteries carry blood away from the heart; the main artery is the aorta.
  • Smaller arteries called arterioles diverge into capillary beds, which contain 10-100 capillaries that branch among the cells and tissues of the body.
  • Capillaries carry blood away from the body and exchange nutrients, waste, and oxygen with tissues at the cellular level.
  • Veins are blood vessels that bring blood back to the heart and drain blood from organs and limbs.
  • Capillaries have one layer of cells (the endothelial tunic or tunica intima) where diffusion and exchange of materials takes place.
  • Veins and arteries have two more tunics that surround the endothelium: the middle tunica media is composed of smooth muscle that regulates blood flow, while the outer tunica externa is connective tissue that supports blood vessels.

 

What are the diseases treated under this speciality?

  • Aortic aneurysm: a dilation or ballooning of a weakened part of the aortic artery wall.
  • Carotid Artery disease: The carotid arteries are the two major arteries in the neck, located on either side of the windpipe, that provide most of the blood supply to the brain. Over time, these arteries may become narrowed or blocked due to a process called atherosclerosis or "hardening of the arteries". The build-up may obstruct the blood flow to the brain, leading to a stroke or a "mini" stroke (TIA).
  • Deep vein thrombosis (DVT) and thrombophlebitis are conditions that involve inflammation and blood clot formation in the veins
  • Thrombophlebitis refers to inflammation and blood clot (thrombus) formation occurring in the superficial veins..
  • Peripheral Arterial Disease (Lower Extremity Arterial Occlusive Disease) Atherosclerosis, or hardening of the arteries is caused by the accumulation of a fatty substance called plaque on the inside of the walls of arteries. Narrowing of the arteries in the lower extremities of the body decreases the blood supply to the muscles and tissues in the surrounding area.
  • Renal/Mesenteric Artery Occlusive Disease: Atherosclerosis, or hardening of the arteries, is caused by the accumulation of a fatty substance called plaque on the inside of the walls of arteries.
  • Vein Disease: Small spider veins, •Larger bulging varicose veins
  • Chronic venous insufficiency (CVI), which is impaired vein function that can cause swelling, discoloration, and increased risk of infection and ulcers
  •  Venous leg ulcers, which can be painful and difficult to heal;
  •  Deep vein thrombosis (DVT)
  •  Pelvic vein disease, also called pelvic congestion syndrome, which is the development of varicose veins in the pelvis.

 

What are the general symptoms that a patient can have with this disease?

Venous Insufficiency:

  • 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

 

Arterial Insufficiency:

  • Painful cramping in your hip, thigh or calf muscles after certain activities, such as walking or climbing stairs (claudication)
  • Leg numbness or weakness.
  • Coldness in your lower leg or foot, especially when compared with the other side.
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FAQs

What is the function of your vascular system?

Your vascular system is made up of vessels that carry your blood throughout your body. Arteries carry oxygen-rich blood away from your heart. Veins carry oxygen-poor blood back to your heart. Your blood leaves the left side of the heart and is pumped out to the rest of your body.

What is Atherosclerosis?

It is a disease process leading to hardening and narrowing (stenosis) of your arteries. The build-up of fat, cholesterol, calcium and other substances creates plaques inside arteries, which can lead to serious problems including heart attack, stroke, amputation and death.

What is carotid artery disease?

Carotid arteries disease occurs when the main blood vessels to the brain develop a build-up of plaque caused by atherosclerosis, or hardening of the arteries. When the build-up becomes very severe, it can cause a stroke.

When does a stroke occur?

A stroke occurs when part of the brain is damaged by these vascular problems; 80 percent of strokes are “ischemic strokes” where part of the circulation to the brain is cut off, usually due to blockages in the carotid arteries. The process is similar to the build-up of plaque in arteries in the heart that causes heart attacks.

What are the complications of Abdominal Aortic Aneurysm?

Abdominal Aortic Aneurysm is an enlargement or “bulge” that develops in a weakened area within the largest artery in the abdomen. If the condition remains undetected, the aortic wall continues to weaken, and the aneurysm continues to grow. Eventually, the aneurysm becomes so large, and its wall so weak, that rupture occurs causing internal bleeding.

What are the causes of peripheral vascular diseases?

Peripheral arterial disease occurs due to hardening of the arteries, causing a build-up of plaque in the blood vessels that carry oxygen and nutrients to all the tissues of the body. As these plaques worsen, they reduce essential blood flow to the limbs and can even cause complete blockages of the arteries.

What are the complications of peripheral vascular disease?

Early on it may cause difficulty walking, but in its most severe forms, it can cause painful foot ulcers, infections, and even gangrene, which could require amputation. Heart attacks or strokes can occur because of PAD.

Are women at a greater risk if they have peripheral artery disease?

Women don’t always experience the symptoms of peripheral artery disease the same way as men, so the disease may not be discovered until it is more advanced. If a woman has peripheral artery disease, it means that she probably has arterial disease in other parts of the body. Women with peripheral artery disease are at a much greater risk for heart attack, stroke and cardiovascular death.

What are the common causes of varicose veins?

Veins are responsible for bringing blood back to the heart, sometimes working against gravity. When you walk, muscles in your leg squeeze the veins and help blood flow back into the heart. In normal veins, a series of valves assist this process. In chronic venous insufficiency, poorly functioning valves allow the blood to pool in the lower leg and cause symptoms.

What are the symptoms of varicose veins?

Pain, itching, swelling, burning, leg heaviness or tiredness, skin discoloration. Symptoms typically worsen throughout the day and are partially relieved by elevation or wearing compression socks or stockings.

What is the treatment of varicose veins?
  • Knee-high compression stockings, usually that provide 20-30 mmHg of compression, will often help relieve symptoms such as aching or swelling.
  • Ablation therapy (laser, radiofrequency, or mechanical injection) is another option. A tube is advanced through the entire vein and then all the surrounding skin is numbed. The ablation catheter is then started and the vein treated. This part of the procedure is painless and typically takes 20 minutes. After the procedure the leg is wrapped with a compression bandage.
  • If the affected veins are twisted and are not sufficiently straight, sclerotherapy may be recommended
Why is quitting smoking so important for vascular health?

Smoking damages the blood vessels, making them more likely to spasm and develops fatty plaque build-up. Smoking is also a risk factor for atherosclerosis (hardening of the arteries).

What are some causes of deep vein thrombosis?

DVT forms when your blood flow becomes very slow.

  • Inactivity, such as after a major operation or during a flight.
  • Damage to a vein can cause a clot to form - especially damage from a catheter, like those used in dialysis, or from a PICC line.
  • Cancer and certain other diseases and genetic conditions, called
  • Medications, especially hormones.
What are some symptoms of DVT?

Discomfort along the vein where there is Swelling, pain, redness or warmth along the vein that has the clot.

What is the treatment for Dvt?
  • DVT is usually treated with medication such as BLOOD THINNERS, also known as anticoagulants, are the most common medicines used for treating DVT. They prevent blood clots from getting larger by decreasing your blood's ability to clot.
  • Another option is THROMBOLYTIC THERAPY is sometimes used to quickly dissolve a blood clot, especially if the clot is large and causing severe symptoms.
What are some methods to relieve DVT?
  • Make sure you stand up, stretch and walk several times and avoid sitting for longer time to assist circulation in legs
  • Wear compression stockings, which help reduce swelling and the chances of a blood clot
  • Make sure you drink plenty of water. Dehydration puts you at a greater risk for developing a blood clot.
What are some common investigations used to detect these diseases?
  • Angiogram
  • Ankle-Brachial Index or ABI Test
  • Carotid Duplex
  • Computed Tomography Angiography (CTA) and Magnetic Resonance Angiography (MRA) Tests
  • Duplex Ultrasound
Who will perform these surgeries?

Vascular surgeons are specialists who are highly trained to treat diseases of the vascular system.. A vascular surgeon ensures that these patients with vascular health issues know and understand all their options. In short, vascular surgeons can do surgery, but they see and treat many patients who don’t require surgery.

Is surgery always a line of treatment?

Many vascular problems can be treated with medication or exercise alone and do not require surgery.

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