Vascular Sciences Services
Acute Limb Ischaemia (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.
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.
Aortic Wall Diseases (for aortic occlusions, aortic aneurysms)
An aneurysm is a localized 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.
Carotid Endarterectomy & 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.
Understanding normal leg veins
Veins are blood vessels which take blood back to the heart. Blood flows up the leg veins, into larger veins and towards the heart.
There are three types of veins in the legs:
• Superficial veins - just below the skin surface. You can often see or feel the larger superficial veins. The superficial leg
veins are the ones that may develop into varicose veins.
• Deep leg veins - pass through the muscles. You cannot see or feel these.
• Many small communicating (perforator) veins - take blood from the superficial veins into the deep veins.
There are one-way valves at intervals inside the larger veins. These valves prevent blood flowing back in the wrong direction. When we stand there is quite a height of blood between the heart and legs. Gravity tends to pull the blood back down but is prevented from doing so by the vein valves and by the normal flow of blood towards the heart.
Understanding Varicose Veins
While there is no way to confirm the exact number of people suffering with varicose veins, some studies suggest that 3 in 100 people suffer from them at some time in their lives. Most people with varicose veins do not have an underlying disease and they usually occur for no apparent reason.
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.
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.
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.
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.
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.
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.