Open Surgical Procedures

An arteriovenous graft is a deliberate connection created between an artery and vein by inserting a graft between them. The graft is a small tube made of flexible material that acts as a connecting conduit. The graft functions as an access site for haemodialysis treatment. An arteriovenous fistula is preferable for the access site, but if the walls of the veins are weak, a graft may be preferred. Before the graft is inserted, the blood vessels are mapped using Doppler ultrasound scans. This helps select the right blood vessels for the graft. The insertion of the graft may be performed as an out-patient procedure, depending on the patient’s condition. The AV graft usually heals completely in 2-3 weeks and can be used as a dialysis access site.

Arteriovenous grafts are inserted to create access-sites for dialysis treatment in patients with end-stage kidney failure. The graft is a flexible tube inserted to connect the two blood vessels. This can get blocked with time and may require a graft repair procedure. The obstruction is usually cleared through a direct puncture into the graft, under x-ray fluoroscopy guidance. The procedure is performed by an interventional radiologist. The entry point and direction of access are carefully chosen based on the individual case. If the patient experiences repeated graft obstructions (restenosis), the doctor may elect to insert a metal mesh cage into the graft to keep the channel open.

Laser ablation is one of the methods available to treat varicose veins. Laser ablation uses a laser beam to burn the walls of the varicose vein and trigger scar tissue formation. The scar tissue seals off the bulge of the varicose vein. Laser ablation for varicose veins may be recommended if the patient has red and swollen varicose veins, or if the skin above the varicose veins is inflamed. The side effects of laser ablation include skin burns, nerve damage, pain and infection.

Sclerotherapy is a procedure used to treat varicose veins. During sclerotherapy, a solution is injected into the varicose veins through a very fine needle. The solution damages the walls of the veins and induces scar formation. This seals off the varicose vein and re-routes the blood flow through adjacent, healthier veins. In some cases, multiple sessions may be required to achieve the desired result. It is recommended to use compression socks after the procedure. Sclerotherapy is often performed to improve the appearance of varicose veins and spider veins.

A phlebectomy is a surgical procedure to remove varicose veins. There are 2 types of phlebectomy procedures – ambulatory phlebectomy and transilluminated powered phlebectomy. An ambulatory phlebectomy involves removing portions of the varicose veins using hooks inserted into micro-incisions in the skin. A transilluminated powered phlebectomy is performed by inserting specialised, lit tools into a microincision to break up and suction out the pieces. A phlebectomy procedure may be recommended to treat large, protruding varicose veins that are close to the surface of the skin. After surgery, the patient will be advised to wear compression socks for several weeks to stabilise the veins and help them heal. Recovery time depends on the patient’s age, general health and the extent of varicose veins treated.

Femoral popliteal bypass surgery is performed to treat a blockage in the femoral artery, which supplies blood to the legs. The obstruction is typically caused by the accumulation of plaque on the walls of the artery, also known as atherosclerosis. Femoral popliteal bypass is an open procedure, performed under general anaesthesia. During the procedure, the surgeon accesses the femoral artery through a large incision in the thigh. A vein is harvested from another part of the leg (known as an autograft) and grafted to form the by-pass for blood to flow around the obstruction. An artificial graft may also be used instead of an auto-graft. The patient must follow recovery procedures for 2-3 months after the surgery.

Femoral tibial bypass surgery, also known as infra-popliteal bypass, is a procedure to treat peripheral artery disease of the lower leg, comprising the calf, ankle and foot. It is an open surgical procedure, performed under general anaesthesia. The surgeon grafts an alternate route for blood to flow around the obstruction. The graft used may be a piece of vein harvested from elsewhere on the patient’s leg, or an artificial, flexible tube made of synthetic materials. The type of graft is chosen based on the individual patient’s condition.

Carotid artery disease causes a narrowing or obstruction of the carotid artery which supplies blood to the brain. Carotid artery disease can cause a stroke. To treat or prevent a stroke or oxygen deprivation to the brain, the doctor may recommend a carotid angioplasty with an optional stent placement. The angioplasty is a minimally-invasive procedure, in which a balloon catheter is inserted into a micro-incision in the neck and guided to the plaque build-up. The procedure is performed under X-ray fluoroscopy guidance, with the use of a contrast dye. The contrast dye is injected through the catheter, and helps visualise the obstruction better on the X-ray. The balloon is inflated at the site of the obstruction to expand the artery, and a stent is placed to hold the walls open.

The thoracic outlet is a ring formed by the top ribs, just beneath the collar bone. Nerves, arteries and veins pass through the thoracic outlet to supply blood to various parts of the upper body. Thoracic outlet syndrome occurs when the nerves and blood vessels are compressed by the ribs of the thoracic outlet, causing pain. Thoracic outlet syndrome may be caused by physical trauma (like a car accident or a fall), a congenital abnormality or pregnancy. In many cases, the condition can be treated with medication and physical therapy; however, if these are ineffective, surgical correction is performed. The surgeon will perform a thoracic outlet decompression to relieve pressure on the nerves and blood vessels. The thoracic outlet may be accessed through an incision above the collar bone (supra-clavicular approach), below the collar bone (infra-clavicular approach) or through the chest (trans-axillary approach), depending on the individual case.

Embolectomy is a surgical procedure for the removal of an embolus, a blood clot or foreign body that has moved through the blood vessels and become lodged in the blood vessels. A thrombectomy is a surgical procedure for the removal of blood clots. Patients with Covid-19 have an increased risk of developing blood clots and emboli as a complication. Blood clots and emboli can cut off blood supply to tissues and cause serious complications. The removal of blood clots and emboli may be performed using minimally-invasive or open surgical techniques. Minimally-invasive removal involves the use of a balloon catheter to clear the obstruction. This technique is preferred compared to the open surgical approach, as it has a shorter recovery time. However, in some cases, especially emergencies, an open surgical approach is preferred so the surgeon has direct visual access of the embolus or blood clot. A large incision is made in the leg, directly above the blood clot through the muscle, and the obstruction is removed.