Click on the topics below to find out more about common vascular conditions from American Society of Vascular Surgeons website.
What’s New in Vascular Surgery?
Vascular surgery is the branch of surgery that occupies itself with surgical interventions of arteries and veins, as well as conservative therapies for disease of the peripheral vascular system. Surgery of the heart is the specialism of the cardiothoracic surgeon.
Arterial diseases include
- Aneurysms
- Ischaemia
- Extracranial cerebrovascular disease
Venous disease include
- Varicosities
- Venous malformations
Varicose Veins
Varicose veins are dilated tortuous superficial veins occurring usually in the lower limb. They are common and run in families and tend to affect women more than men. Varicose veins are causes by the development of faulty valves in the veins of the leg.
In health there are two vein systems in the lower limb:
- Deep
- Superficial
Conventional treatment of varicose veins involved surgical removal of the defective veins under general anaesthetic. Significant post-op pain and bruising were commonly seen and for this reason we do not use this technique.
Leg Ulcers
These are mainly due to
- Venous insufficiency (that is badly functioning veins)
- Arterial insufficiency (blocked arteries)
- Peripheral neuropathy ( most commonly seen in diabetes)
Leg ulcers are most commonly due to varieties of varicose veins. In some cases they result from previous deep vein thrombosis. Venous ulcers usually improve rapidly with compression bandaging treatment.
Diabetic feet
Diabetic patients are prone to foot deformities leading to ulceration and infection of the foot which may progress to tissue necrosis requiring amputation. This is due to a combination of vascular disease and neuropathy. Diabetes impairs the function of the nerves and blood vessels supplying the feet. This makes them prone to small cuts and pressure ulcers which allow infection to enter and spread through the foot.Good diabetic control helps reduce the severity of foot complications. There is no specific treatment for neuropathy. Localised infections should be treated with debridement Plain X-rays may show evidence of osteomyelitis and MRI is an accurate way of defining the extent of infection in the foot.
Atherosclerosis
Atherosclerosis is a disease affecting blood vessels and means literally "hardening of the arteries". Large and medium sized arteries are most commonly affected. The inside wall of the artery becomes furred up with deposits of cholesterol and calcium causing the blood vessel to become narrowed or blocked.
- Restriction of blood flow
- Embolisation (a blood clot forms, breaks off and lodges downstream)
- Thrombosis (the artery clots and blocks)
Thread Veins
Thread veins are purple coloured prominent veins in the skin seen most commonly in the legs. They are harmless but are sometimes uncomfortable and may be very unsightly. They can be very easily treated by sclerotherapy (injection). This is done under bright light and low magnification using tiny needles which are barely felt.
Before treating thread veins it is necessary to make sure there is no underlying problem affecting the major veins in the leg. A duplex scan (doppler-ultrasound) is usually arranged for this. If a larger vein is malfunctioning, this should be corrected before embarking on treatment of thread veins. These techniques are explained in the Services and Treatments section of the website (see Laser treatment of varicose veins for varicose veins).
Popliteal Aneurysm
The popliteal artery is behind the knee joint and carries blood from the upper to lower part of the leg. A popliteal aneurysm is an abnormal bulging of the popliteal artery. The risk factors are the same as for other arterial aneurysms, namely family history, smoking, blood pressure etc. Popliteal aneurysms are different, in that the main problem is not rupture, but rather blockage of the aneurysms causing severe shortage of blood supply to the lower leg and foot. If left too late the problem may be difficult to salvage and there is a high risk of amputations. For this reason popliteal aneurysms should be treated.