Vascular Surgery

Medical Conditions

• Peripheral vascular disease
  Arteries carry blood from the heart to the rest of the body. Atherosclerosis is the process where these vessels become narrowed and blocked by fatty cholesterol deposits. As the vessels narrow people may get pain in a limb when they excercise it. A patient with a narrowed leg artery may get calf pain when they walk. This is called intermittent claudication.
  As these narrowings worsen, pain may occur at rest.
  Finally if an artery blocks completely the part of the body supplied by that artery may be irreversibly damaged. If this occurs to a limb it will become pale, pulseless, cold, numb and paralysed.
  Vascular surgeons specialise in treating these narrowings.
• Aneurysms
  Some blood vessels, particularly arteries bulge and may even burst like a balloon. These localised arterial bulgings are called aneurysms.
• Leg ulcers
  Leg ulcers are often associated with poor blood supply. They may become infected and require surgical treatment. Again vascular surgeons specialise in this.
• Venous disease.
  Veins carry blood from the peripheries back to the heart. Problems with veins include bulging - varicose veins and vascular surgeons can operate to repair or remove these abnormal veins.
• Abdominal aortic aneurysm
• Buerger’s disease
• Carotid artery disease
• Critical limb ischaemia
• Deep vein thrombosis
• Peripheral vascular disease
• Raynaud’s phenomenon
• Renovascular hypertension
• Varicose veins
• Vascular malformation

Specialty Areas of Interest

• Angiography, angioplasty and stenting
• Carotid surgery
• Peripheral vascular disease
• Diabetic ulcers
• Peripheral venous disease

Associated Tests

• Angiography
  An angiogram is a picture of blood vessels.
  Usually a needle is placed into the upstream end of a blood vessel and radio-opaque contrast injected. The blood carries the contrast into the vessel and an image (X-Ray or CT scan) is taken. The lumen of the vessels is outlined and one can determine where narrowings lie.
• Ultrasound
  Ultrasound is a noninvasive, painless way of getting information about blood flow within vessels. The information may supplement that provided by the angiogram.
• Ankle brachial indices

Procedures

• Angioplasty
  This involves unblocking a narrowed or blocked blood vessel.
  Generaly a wire is passed through the narrowing in the artery. A small deflated balloon is then threaded over the wire to the site of maximal narrowing. It is inflated when in the narrowest section and this opens up the vessel.
• Stenting
  This involves a similar procedure except that a tiny wire cage is place over the balloon as it is passed into the area of greatest narrowing. As the balloon is inflated it expands the cylindrical wire cage and this holds the vessel open after the balloon is deflated and removed.
• Embolectomy
  This involves removing a clot from within a blood vessel. It is usally an open surgical technique.
• Bypass operation
  When a vessel is irreversibly narrowed or blocked a surgical bypass is often performed. A new segment of vessel (often a vein or another artery) is attached to the original vessel at either side of the narrowing and literally bypasses the blockage.

What to expect

History

A vascular surgeon will ask questions about your symptoms - what problems you are getting. They should ask about risk factors for vascular disease (like smoking, high blood pressure, diabetes, high cholesterol and a family history of vascular disease).

Examination

A vascular surgeon will generally examine your blood vessels, feeling for pulses, checking blood pressure and looking for evidence of vascular disease.

Training and Qualifications

• Basic medical training
• Internship
• Residency
• Specialty Training

Links

• Find a Vascular Surgeon
• The Australian and New Zealand Society for Vascular Surgery
• Vascular Disease Foundation
• Wikipedia – Vascular Surgery