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Vascular and Endovascular Surgery

Vascular and Endovascular Surgery

Arteriovenous Access

Patients with end-stage kidney failure require 3-4 haemodialysis treatments every week. The treatment is performed by connecting a vein and artery in the arm to the machine through flexible tubes, to purify and recirculate the blood. For regular haemodialysis, an access site to fix the dialysis tubes is needed. This is usually an arteriovenous fistula or an arteriovenous graft. An arteriovenous fistula is a direct connection that is created between an artery and a vein, without any intermediate capillaries. This is surgically created in the upper arm or forearm for the sole purpose of regular, long-term dialysis treatments. An arteriovenous graft is a flexible tube connecting an artery and vein directly. This is an alternative access site for haemodialysis.

Varicose Veins

Varicose veins are twisted, enlarged veins that typically occur in the lower legs and feet. They are typically bulging and blue beneath the skin. Standing or sitting for long periods of time increases the blood pressure in the veins and this causes the walls of the veins to stretch and become less elastic. The valves weaken, and blood starts to pool in the veins, causing pain and swelling. In severe cases, the varicose vein may rupture and develop into an ulcer. Varicose veins can be treated with radiofrequency ablation, sclerotherapy, laser ablation, transilluminated power phlebectomy or open surgical removal. The doctor will consider the patient’s options based on the extent of varicose veins, immediate risk of complications and the patient’s general health.

Diabetic Foot Disease

Uncontrolled or long-term diabetes can cause diabetic neuropathy and peripheral nerve disease. The neuropathy damages nerve cells in the feet, causing the patient to lose sensation. The patient may not realise when they have foot infections, cuts and sores, leading to complications. In addition, diabetic patients also tend to have poor circulation and peripheral artery disease. Thus, there is reduced oxygen supply to the feet, and the injuries sustained do not heal well. Common foot problems such as calluses, blisters, fungal infections, athlete’s foot, bunions and diabetic ulcers can turn into serious complications like abscesses and gangrene requiring amputation of the foot. Early detection and treatment of diabetic foot diseases is crucial.

Peripheral Vascular Disease

Peripheral vascular disease is a slow, progressive circulation disorder, in which the arteries supplying blood to different parts of the body become narrow and blocked due to the build up of plaque. Plaque consists of fat, cholesterol, calcium, and waste products from a clotting agent called fibrin. This disrupts normal blood flow to different parts of the body, resulting in oxygen deprivation. The condition commonly affects the lower legs and feet. However, it can also affect the arms, abdomen, brain and the internal organs. The primary goals of treatment of peripheral vascular disease are to stop progression of the condition and relieve symptoms. Medication and lifestyle changes are usually tried first. If that is ineffective, other minimally-invasive or surgical options such balloon angioplasty, stent insertion and femoral by-pass surgery.

Stroke and Carotid Surgery

Carotid Artery disease occurs when plaque clogs and reduces the flow through the blood vessels to the brain. This deprives the brain of oxygen, resulting in a stroke. If deprived of oxygen for more than a few minutes, brain cells begin to die. The condition develops over time. The first signs of carotid artery disease may be a transient ischemic attack or mini-stroke, which is a temporary shortage of oxygen to the brain. A transient ischemic attack only lasts a few minutes, and typically doesn’t cause any long term damage; however, it must not be ignored. If Carotid artery disease is diagnosed early, it can be managed with medication and lifestyle changes. If there is severe narrowing or blockage in the carotid artery, surgical intervention may be required to restore adequate blood flow to the brain. The surgeon may perform a carotid endarterectomy or carotid stenting to remove the plaque. The doctor will evaluate each case and recommend the appropriate course of action for that patient.

Thoracic Outlet Syndrome

The thoracic outlet is a ring formed by the top-most ribs, beneath the collar bone. Thoracic outlet syndrome occurs when the blood vessels and nerves that pass through the space between the thoracic outlet and the collar bones become compressed. The pressure causes pain, numbness and impairs nerve function and circulation. Thoracic outlet syndrome could be caused by a traumatic accident like a car crash or a fall. It may also be caused by a congenital abnormality, bony and soft tissue abnormality, or pregnancy. Thoracic outlet syndrome is of multiple types – neurogenic, venous and arterial. Neurogenic thoracic outlet syndrome affects the nerves of the brachial plexus, and is the most commonly occurring form. Venous thoracic outlet syndrome occurs when a vein is compressed and arterial thoracic outlet syndrome causes compression of an artery. Thoracic outlet syndrome is treated with a combination of physical therapy, medication and surgery.

Arteriovenous (AV) Malformations

An arteriovenous (AV) malformation is an abnormal tangle of blood vessels, which disrupt the normal flow of blood through the body. In an arteriovenous malformation, the artery is connected directly to the vein, causing oxygenated and deoxygenated blood to mix. Certain tissues may become deprived of oxygen because of this. The abnormal vessels are also weak and pose a risk of rupture. The cause of arteriovenous malformations is unclear. Many AV malformations do not produce symptoms and are hence never identified. The treatment protocol program focuses on relieving symptoms. There are no medications to treat this condition. . The malformation may be corrected using sclerotherapy or embolization.

Covid and Thrombosis

Covid-19 is a new disease in humans, and researchers are still learning about the different ways in which it affects people. Some patients appear to develop dangerous blood clots as a result of a covid-19 infection, especially in the veins. When the immune system mounts a response against the infection, it produces antibodies and also generates clotting substances like fibrin. The high concentration of fibrin in the blood increases the risk of blood clots. It is advised to remain as mobile as possible during the covid-19 infection to reduce the risk of blood clots. The clots can be treated using medications, minimally-invasive procedures and open-surgical procedures. A Thrombectomy may be performed to remove the clots and restore a healthy blood supply to the affected parts of the body.

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