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Department of Vascular & Endovascular Surgery

Vascular & Endovascular Surgery – Overview

The vascular system consists of all the blood vessels that carry blood throughout the body and the lymphatic system. Oxygenated blood is carried away from the heart and lungs through the arteries and deoxygenated blood is carried back to the heart and lungs through veins. Vascular and endovascular surgery deals with the diagnosis and treatment of disorders of the vascular system. Vascular surgery comprises of the traditional open surgical techniques used to treat vascular diseases. Open surgical techniques may be used for wall repair, clearing obstruction or reconstruction. Endovascular surgery consists of endoscopic and minimally-invasive techniques performed to treat vascular diseases. Patients may require vascular or endovascular surgery to treat peripheral artery disease, vascular malformations, varicose veins, aortic aneurysms and diabetic foot disease. The surgical approach is carefully chosen based on the patient’s diagnostic tests and their general health.

Department Overview

The Department of Vascular and Endovascular surgery at Global Gleneagles Health City is recognised as one of the leading vascular health-care providers in India. The department provides specialised vascular diagnostics and treatment to patients with peripheral artery disease, varicose veins, atherosclerosis, arteriovenous malformations and other vascular disorders. The surgical team consists of experienced, highly-skilled surgeons, who have been trained at premier international medical institutes. The doctors combine their medical knowledge and experience with the latest cutting-edge medical research to create specialised and effective treatment plans for their patients. The surgical team is assisted by an efficient support team consisting of nurses, laboratory technicians and assistive staff.

Precautions to be taken for Healthy Legs

  • Maintain a healthy weight – You spend a lot of time on your feet and obesity can put a lot of pressure on the circulation to your feet.
  • Don’t sit for too long – Keep the circulation to your feet pumping by taking periodic breaks from sitting to take a little walk.
  • Exercise regularly and stay active – The key here is regularity. Working out intensely at sporadic intervals will not help much.
  • Wear the right footwear – The right footwear provides support to your arches and keeps your feet healthy. This is crucial especially while you exercise.
  • Wear compression socks – Compression socks can help improve circulation in the legs and prevent varicose veins and spider veins.
  • Try massage – Foot massages can help improve circulation and reduce pain, when performed by a licensed massage therapist or a physiotherapist.
  • Elevate your legs above your heart – Prop your legs up above your heart for a few minutes every day. The calves should be raised as well. This helps improve circulation and relieve swelling.
  • Reduce the temperature of your showers – Hot water can increase swelling, so shower with cold water, especially after workouts.
  • Quit smoking – Smoking damages the vascular system and makes you more susceptible to blood clots.

Why Choose Us?

Excellent Doctors

The doctors and surgeons in our medical team are highly-skilled and experienced in the field of vascular and endovascular surgery, with educational qualification and training programs completed at some of the most advanced medical institutions in the world. Trained to tackle a wide range of complicated cases, our doctors bring all their knowledge and compassion to every consultation. The doctors collaborate with other allied departments to develop a holistic treatment plan for the patient.

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World-class Infrastructure

The hospital is equipped with modern facilities, advanced biomedical diagnostics and streamlined administrative processes to help us treat patients quickly and effectively. We provide interdisciplinary medical care with advanced, minimally-invasive therapies, with the aim of giving our patients the best possible treatment and to maximize the possibility of full recovery. We bring international quality medical care to Chennai, at humane, affordable prices.

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Latest Technology

The hospital is tech-forward, taking great pains to constantly update the technological abilities and functioning of the hospital. We strive to provide universal access to advanced healthcare through the use of streamlined diagnostics and customised treatment methods. We are research-oriented and stay abreast of the latest medical developments to give our patients the care and treatment they deserve.

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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.

Vascular and Endovascular Procedures

Open Surgical Procedures

AV Access procedures

Arteriovenous (AV) Fistula

An arteriovenous fistula is an abnormal connection between an artery and a vein, by-passing certain capillaries. This results in reduced oxygen and nutrient supply to the tissues accessed by those capillaries. Arteriovenous fistulas occur commonly in the legs, but may develop anywhere in the body. Arteriovenous fistulas could be caused by a piercing injury (like a gunshot or a stab wound). They could also be congenital in nature. In patients with end-stage kidney failure, an arteriovenous fistula may be surgically constructed in the forearm for easier dialysis treatment. A series of imaging tests including duplex ultrasound scans, CT scans and MRI scans are used to diagnose arteriovenous fistula. Once diagnosed, it may be treated with ultrasound-guided compression, catheter embolization or surgical intervention.

Arteriovenous (AV) Graft

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 (AV) Graft Repairs

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.

Varicose Veins Surgeries

RF Ablation

Varicose veins are enlarged, twisted veins that often appear blue or black. They occur commonly in the feet and legs. They occur when faulty valves in the veins allow blood to flow in the wrong direction or pool in one area. Radiofrequency (RF) ablation is a minimally-invasive procedure to treat varicose veins. The radiofrequency waves produce heat which damages the walls of the varicose vein and trigger the formation of scar tissue. The scar tissue closes up the damaged valve and cuts off the varicose vein. During radiofrequency ablation, a catheter is inserted into the leg through a small skin incision. The radiofrequency waves are fired through the catheter for ablation. The procedure is performed using local anaesthesia or a mild sedative. The patient will be able to walk after the procedure, and recovery is usually quick. The patient will have to wear compression socks after the treatment.

Microwave or Laser Ablation

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

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.

Phlebectomy

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.

Peripheral Vascular Disease

Peripheral Artery Bypass Surgery

Peripheral arterial disease is a condition characterised by the narrowing of the arteries that supply blood to the limbs. This is usually caused by the build-up of plaque in the blood vessels, hardening the walls of the arteries. The plaque could accumulate and cause an arterial obstruction. A surgical by-pass re-routes the blood flow around the obstruction, to restore oxygen supply to the affected tissues. Surgical by-pass is recommended to patients who are not good candidates for minimally-invasive approaches such as stenting or a balloon angioplasty. The surgery is performed under general anaesthesia. The surgeon may opt to use an artificial graft or the patient’s own veins to create the by-pass.

Femoral Popliteal Bypass

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

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.

Stroke Prevention Surgery

Carotid Endarterectomy

Carotid endarterectomy is a surgical procedure to treat carotid artery disease. The carotid artery is the primary blood vessel that carries oxygen to the brain. Carotid artery disease causes a narrowing or obstruction in the carotid artery, depriving the brain of oxygen. This is dangerous and requires immediate medical attention. A carotid endarterectomy is an open surgical procedure, during which the surgeon accesses the carotid artery through a neck incision and removes the plaque build-up inside. The artery is then repaired with stitches or a graft patch. In some cases, the surgeon may opt to use a different technique called eversion carotid endarterectomy. This technique involves creating an incision in the carotid artery and turning it inside out for easier removal of plaque. Once all the plaque is removed, the artery is returned to its original position and repaired with stitches or patch grafts.

Carotid Angioplasty and Stent Placement

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.

Others

Carotid Body Tumour Removal

Carotid body tumours, also known as chemodectoma or paraganglioma, are abnormal tissue growths on the carotid arteries on either side of the neck. Carotid arteries supply blood to the brain. The tumour may not cause any symptoms but can be felt on the side of the neck. The tumour can press on the nerves and blood vessels in the neck and cause complications if it grows very large. Carotid body tumours may be treated with a minimally-invasive or open surgical techniques. The blood flow to the tumour may be reduced or cut off by a procedure called a transcatheter embolization. This is a minimally-invasive procedure, in which embolizing chemicals are injected into the tumour through a catheter. The chemical reduces the blood supply to the tumour and causes it to shrink. For small carotid body tumours, this may be sufficient. Larger tumours will be surgically removed after transcatheter embolization. The embolization reduces the chances of bleeding out during the surgical procedure.

Thoracic Outlet Procedures

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.

Covid and Thrombosis

Embolectomy and Thrombectomy procedures

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.

Endovascular Procedures

Endovascular Procedures

Peripheral Artery Angioplasty

A peripheral artery angioplasty is a minimally-invasive procedure performed to treat peripheral artery disease of the limbs. The procedure widens narrowed or blocked arteries in the pelvis and leg to restore adequate blood flow. The procedure is performed under mild sedation. The surgeon inserts a catheter into an artery in the groin or leg and manoeuvres it to the site of the plaque build-up. A dye is injected into the catheter to allow for better X-ray visualisation. Once the exact location of the plaque is identified, the balloon catheter is inflated to push against the plaque and expand the artery. A stent (a mesh reinforcement) may be inserted to hold the artery open. After the procedure, the patient will be advised to take it easy for a few days and wear a compression dressing.

Peripheral Arterial Stent

Peripheral arterial stents are usually inserted in conjunction with a peripheral artery balloon angioplasty, to treat peripheral artery disease in the arms or legs. The stent is a metal mesh tube that reinforces the artery walls. It holds the artery open and ensures that blood continues to flow through to the leg muscles. The stent is left in place permanently. In certain cases, specialised stents called drug-eluting stents (DES) are used. These stents are coated in medication that prevents plaque from re-accumulating at the same site, preventing future blockages. The procedure is performed while the patient is awake but sedated. The procedure is minimally-invasive, and hence all the instruments are inserted through a microincision in the leg. The entire procedure is performed under X-ray fluoroscopy.

Inferior Vena Cava (IVC) Filter Insertion

An inferior vena cava (IVC) filter is a small biomedical implant that stops blood clots from travelling to the lungs. It is surgically implanted in the inferior vena cava, a large vein that carries blood from the lower body to the heart. Blood clots from the legs or pelvis can travel up to the heart and lungs through the inferior vena cava and cause a pulmonary embolism or blockage in the lungs. The IVC filter’s main function is to prevent this. It is recommended for patients who cannot be given blood thinners. The IVC filter does not prevent the formation of blood clots in the leg; it only prevents them from reaching the heart and lungs and causing dangerous complications. During the procedure, the surgeon inserts a flexible catheter into a small incision in the neck or groin and manoeuvres it into the inferior vena cava. The filter is then placed in position, where it expands and attaches itself to the walls of the inferior vena cava. The IVC filter can be left in permanently or removed after a period of time.

Arteriovenous (AV) Fistulaplasty

An arteriovenous (AV) malformation is an abnormal connection between an artery and vein. AV malformations are the ideal access-site for long-term haemodialysis treatment. An AV fistulaplasty is a surgical procedure to relieve blockages in the haemodialysis access site. The procedure is performed by an interventional radiologist, under X-ray fluoroscopy guidance with a contrast dye to visualise the blood vessels in the arm. The procedure is performed under local anaesthesia or mild sedation. An inflatable balloon catheter is inserted into the AV malformation and inflated to stretch the narrowed portion.

Endovascular Aneurysm Repair (EVAR)

An endovascular aneurysm is a stretched, bulging section of the artery wall, typically the aorta. An aneurysm in the aorta can rupture and cause internal bleeding. Endovascular aneurysm repair (EVAR) is a minimally-invasive procedure, to insert a stent-graft to divert blood flow from the aneurysm to decrease the pressure on it.. The procedure is performed using X-ray fluoroscopy to guide specialised instruments to the aneurysm through small incisions in the groin. Endovascular aneurysm repair is effective in treating abdominal aortic aneurysms and descending thoracic aortic aneurysms. The procedure may be performed under general or local anaesthesia, at the physician’s discretion. After the procedure, the patient may require follow-up scans to check for leaks in the stent-graft.

Atherectomy

An atherectomy is a procedure to treat plaque build-up in the arteries. The arteries may be narrowed or blocked, stopping blood from flowing through normally and causing muscular cramps and loss of strength in the lower legs. The procedure uses a catheter with a sharp scalpel on the end to cut and remove the plaque build-up from the artery walls. The catheter has a suction tool that removes the dislodged plaque. The procedure is performed under local anaesthesia. The surgeon may need to pass the catheter through the artery multiple times to remove a majority of the plaque. The atherectomy procedure provides immediate relief from atherosclerosis (build-up of plaque in the arteries); however, the patient will have to maintain a healthy lifestyle to reduce the chances of recurrence.

Our Doctors

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Dr I Rajkumar

MBBS, MRCSEd, DNB (Gen Surgery), FVAS (UK)

Consultant - Vascular Surgeon & Endovascular Surgery

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Dr Bala Kumar
Dr S Balakumar

M.S. (General Surgery), M.CH (Vascular Surgery)

Clinical lead and Senior Consult - Vascular Surgeon & Endovascular Surgery

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