Vascular Surgery

Vascular Surgery

What is Vascular surgery?

Vascular surgery is a specialty discipline in surgery that deals with diseases of the vascular system. This is the circulatory system in the body and it comprises the blood vessels, lymph vessels, and the lymphatic system. The blood vessels include the arteries, veins, and capillaries. The arteries carry blood away from the heart while the veins carry blood to the heart. The capillaries distribute oxygen-rich blood to the body.

The lymph vessels transport the lymphatic fluid, which has blood cells. The lymphatic system draws lymph away from each part of the body. The vascular system can have problems causing diseases. These diseases affect the working of the vascular system. A vascular disease can be treated through vascular surgery.

A vascular surgeon is one who is trained in using surgical techniques to treat different kinds of vascular diseases. The vascular surgeon is responsible for the diagnosis, treatment, and overall management of all vascular diseases.

Why NH?

Narayana Institute of Vascular Sciences is Narayana Health's commitment to providing latest and world-class tertiary level vascular care, education and research to the people of India and beyond.

It is based on the principles of prevention, surgical and endovascular treatments and strict follow-up of vascular patients endeavoring to prevent strokes in high-risk groups, deaths due to Aneurysm ruptures, Limb Amputation in Diabetics and clotting in lower limb arteries and veins and their sequels.

The department performs over 1200 open and 800 endovascular procedures each year. We also perform large volumes of Aortic Aneurysm Repairs in India, both open and endovascular with results on par with the top institutes of United States of America. We have a dedicated Hybrid Operation Theatre to perform major arch, thoracic and thoracoabdominal hybrid and fenestrated graft repairs at Health City, Bangalore.

We collaborate among the different specialties dedicated to providing comprehensive and interdisciplinary care to patients with atherosclerosis, the process in which fatty materials, cholesterol, and other substances, collectively known as plaque, accumulate in the lining of an artery. When plaques become fragile and rupture, they cause blood clots that can block blood flow or break off and travel to another part of the body, causing a heart attack, limb loss or stroke.

Our Institute's emphasis on collaboration has shown to greatly improve the care patients receive allowing both established and emerging diagnostic and therapeutic methods to be applied, increasing efficiency and reducing risks to patients. Multi-disciplinary team meetings and protocol development an important part of a close partnership with specialties involved in the direct care of our vascular patients.

With the establishment of a non-invasive vascular lab at NH Health City, equipped with the latest multi-lab II and acquisition of TcPO2 machine, we are able to diagnose and treat diabetic feet with vascular compromise.

Convatec and Narayana Health have embarked on an ambitious Diabetic Wound Care and Amputation Prevention Centre at NH Health City, with the latest equipment to assess diabetic wounds and care for them.

The presence of Thrombosis Research Institute at Health City in Bangalore is a great source for detailed investigations of a cause of vascular clotting disorders and research into solutions for better vascular care in India.

Vascular Diseases

The arterial disease affects most people with age, especially in those who have high-risk factors that include patients who suffer from diabetes, high blood pressure, heart disease, a sedentary lifestyle, a family history of vascular disease (e.g. Aneurysms), poor nutritional habits or heavy smokers.

Patients with poor circulation usually have diseased arteries all over their body. Arteries usually affected are in the legs, heart, and neck. The severity of the disease and length of time it goes untreated can make a tremendous difference in the clinical outcome of a vascular disease, characterized by stroke, limb amputations, or death.

Vascular diseases can affect any of the components of the vascular system. Some of the key diseases affecting the vascular systems are:

• Peripheral artery disease: This disease causes a blockage of arteries in the legs causing pain in the leg and obstructs circulation. It can cause sores and even lead to gangrene.
• Renal artery disease: In this disease, the arteries in the kidney can be blocked. This can cause high blood pressure, kidney failure, and can even lead to heart failure.
• Raynaud’s phenomenon: The arteries of the finger are affected and can cause spasms. This happens usually due to cold weather.
• Intestinal ischemic syndrome: This is a disease where the blood vessels in the intestine are blocked. It can affect the functioning of the digestive organs.
• Buerger’s disease: This affects arteries of the arms and legs, which may be blocked. As a result blood supply to the hands and feet can be affected leading to pain and may even cause gangrene.
• Carotid artery disease: The carotid arteries that supply blood to the brain can be blocked. This can cause a stroke.
• Carotid artery dissection: happens when there is a tear in a layer of the artery wall. It can cause blood leakage.
• Carotid artery aneurysm: An aneurysm is caused when the blood vessel wall bulges, thus weakening the wall. It can even lead to a rupture of the aneurysm, which can lead to loss of consciousness.
• Aortic aneurysm: is an aneurysm or bulge that occurs in the aorta, the main blood vessel in the heart. It can cause chest pain, breathing problems, loss of consciousness, and even death if the aneurysm bursts.
• Varicose veins: The veins can have damaged valves and as a result, the veins bulge and appear purple. It can cause pain and swelling in the legs.
• Spider veins: These are caused by capillary swelling, most commonly seen on the legs and feet. While they are not harmful, they may lead to bruising.
• May-Thurner syndrome: It is also called iliac vein compression syndrome and refers to compression of the venous outflow tract in the lower extremities. It may cause swelling pain, or even lead to deep vein thrombosis.
• Deep vein thrombosis: This is the formation of a clot in a vein, usually in the legs. Limited movement of the leg or injury can lead to the clot formation. It can cause swelling, pain, and cramps. If the clot breaks off and moves to the lungs, it can cause serious problems.
• Pulmonary embolism: When a blood clot travels to the lungs, it causes pulmonary embolism. It can cause chest pain, breathing difficulty, and coughing up blood. If the clot is large, it can even lead to death.
• Lymphedema: This is a condition when fluid builds up in the lymphatic system due to abnormalities. It can lead to swelling and pain. If not treated properly, it can lead to complications.

Vascular surgery treatments and procedures

The surgery and procedures involved in the treatment of vascular diseases depend on their type and severity. Narayana Health offers the following treatment options that involve making changes in lifestyle, prescribing medications as well as catheter-based endovascular methods and surgical interventions.

Lifestyle changes

Making changes in lifestyle choices and habits is the first step to deal with the problems of vascular diseases. Individuals have to quit smoking, exercise, maintain a healthy and low cholesterol diet and control diabetes.

Medications

The doctor may prescribe medications depending on the disease. Usually, medications are used to manage cholesterol and platelet function.

Minimally invasive endovascular treatment options

- Thoracic Endovascular Aortic Repair (TEVAR): It is a minimally invasive endovascular procedure used in the treatment of patients with thoracic aortic aneurysms. It can be incisionless, but a small incision is usually made in the groin to advance a catheter followed by a stent-graft to treat the aneurysm.

- Endovascular Aneurysm Repair: It follows a similar procedure like that of TEVAR and is used to effectively treat patients with the abdominal aortic aneurysm.

- Fenestrated Endovascular Aneurysm Repair: A small incision made in the groin helps in the placement of a stent-graft to preserve blood flow to the kidneys, intestines, stomach and liver.

- Angioplasty and Stenting: Here, a catheter-guided balloon is used to open a narrowed artery. Angioplasty and stenting are an effective treatment for cerebrovascular disease, vertebrobasilar diseases and peripheral arterial disease.

- Percutaneous or laser atherectomy: In this procedure, the surgeon inserts a specialised catheter into a blocked artery to get rid of the atherosclerotic plaque build-up from within the vessel.

Surgical treatments

- Open Abdominal Aortic Surgery: An abdominal incision is made to gain access to the abdominal aorta and a fabric graft is fixed into place to treat conditions like abdominal aortic aneurysm and aortoiliac occlusive disease.

- Bypass surgery: Bypass surgery is used to redirect blood flow around an area of blockage. The graft used can come from the patient’s vein or a synthetic material can be used. This surgical procedure is used to treat vertebrobasilar disease, peripheral arterial disease, renal vascular disease and mesenteric vascular disease.

- Open Carotid and Femoral Endarterectomy: The plaque build-up on the inner lining of the artery is surgically removed. The procedure is followed in the treatment of cerebrovascular disease, peripheral arterial disease and vertebrobasilar disease.

Diagnosis, treatment, and prevention of vascular diseases

Some of the ways in which vascular diseases are diagnosed include:

• A physical examination of the affected area.
• For peripheral artery disease, a comparison of blood pressure on the arms and ankles is done.
• Ultrasound scanning helps the doctor to check the blood vessels and observe if there are any blockages or other problems.
• Angiography is a common way of carrying out diagnosis of vascular diseases. Here, a dye is injected into the blood vessels. MRA or CTA scanning is then used to view the blood vessels and find out if blood flow is normal. An angiogram involves inserting a catheter into the blood vessel until it reaches the affected area and a dye is injected. This allows the doctor to diagnose and even treat the blockage through a technique known as balloon angioplasty where the blockage is removed and a stent may be inserted to prevent constriction of the blood vessel.
• Blood tests for cholesterol and triglyceride are used to help the surgeon understand the overall health of the patient.
• Tests may also be conducted on the heart, lungs, kidneys, and the digestive system since vascular diseases can affect the functioning of any of these organs.

The treatment for vascular diseases can involve any of the following:

• Medications to lower cholesterol known as statins may be given to reduce the risk of strokes due to blockage.
• Blood pressure and blood sugar levels can affect the working of the vascular system. It is important to reduce blood pressure and have normal blood sugar levels. Medication for this can be prescribed.
• Blood thinners and other medication can be prescribed to improve the flow of blood and reduce the chances of a clot.
• As discussed in the section on diagnosis, angioplasty is a treatment where a balloon is used to open a blocked artery and a stent fixed to ensure it remains open. This is done when there is significant blockage of the artery.
• If there are blood clots, then medication is given to treat blood clots. This medication dissolves and breaks up the clots.

In some cases, surgery may be needed. This usually is required when blockages are too many or if medication and other treatment does not yield the desired results. Vascular surgery involves any of the following:

• Thrombectomy is a procedure where the balloon catheter is inserted beyond the clot and then expanded and pulled back to bring out the clot.
• Resection is a procedure where an artery that is diseased due to an aneurysm is removed and a bypass is done using a synthetic artery.
• Aortobifemoral bypass is used to treat peripheral artery disease.
• Varicose veins can be treated using surgery.

Vascular diseases can be prevented by lifestyle changes. Following a healthy lifestyle reduces the risks of blockages and other problems in the vascular system. Some of the measures that can be followed are:

• Stopping smoking, which is a main contributor to certain vascular diseases.
• Eating a healthy diet with fruits and vegetables and less fat.
• Exercising is important to keep the circulatory system in good working condition. It also helps to reduce weight that can, in turn, help in controlling blood sugar levels and blood pressure.
• Proper care of the hands and feet is needed as some vascular conditions can lead to gangrene.
• Regular health checkups can ensure any problem is detected at an early stage.

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