Vascular surgeon

• Varicose veins

  What are varicose veins?

  Varicose veins are enlarged and swollen veins, usually forming in the legs and feet. Often they can appear as lumpy, blue or purple and bulging. Although varicose veins are frequently a cosmetic concern, for some people they can also cause pain and discomfort, and can sometimes lead to more serious problems.

  There are different types of varicose veins, including:

  • Reticular – red and grouped closely together.
  • Trunk – close to the skin’s surface and very thick.
  • Telangiectasia – also known as spider veins, they appear as small groups of blue or red veins that do not bulge. 

  

  What are the symptoms of varicose veins?

  The main symptoms of varicose veins include:

  • heavy, aching legs
  • burning or throbbing in the legs
  • dry, itchy skin on the affected veins
  • cramps in the legs, especially at night
  • swollen ankles and feet

  What causes varicose veins?

  Varicose veins occur when the valves inside the veins malfunction. Blood should flow smoothly to the heart, but if a valve is weakened or damaged, blood can flow backwards and collect in the veins. This eventually results in swollen, varicose veins.

  There are certain risk factors associated with developing varicose veins, including:

  • older age
  • pregnancy
  • being female
  • being overweight
  • having family members with varicose veins
  • standing for long periods over time

  How can varicose veins be prevented?

  There is little evidence that indicates varicose veins can be prevented, however, techniques that improve circulation are thought to reduce the risk of developing them.

  There are also measures that can help relieve the symptoms caused by varicose veins:

  • Exercising regularly, to maintain a healthy weight and to improve circulation.
  • Avoid standing for long periods, and to move around frequently.
  • If there is pain, raise the legs on pillows throughout the day to relieve the discomfort.

  What is the treatment for varicose veins?

  Initially, treatment for varicose veins is usually the use of compression socks or stockings, exercising regularly and elevating the legs when in discomfort. 

  However, if they are still causing pain and discomfort or have caused complications, then there are other treatment options, including:

  • Sclerotherapy – special foam is used to close the affected veins.
  • Endothermal ablation – heat is used to seal the veins.
  • Ligation and stripping – the affected veins are removed. 
• Peripheral arterial disease

  What is peripheral arterial disease?

  Peripheral arterial disease is the obstruction of the arteries that do not supply the brain or the heart. It is most common in the legs but other arteries can be affected as well. The arteries narrow and harden (arteriosclerosis) making blood circulation difficult. It is a common pathology that affects, above all, men over the age of 50.
   

  What causes peripheral arterial disease?

  Risk factors for peripheral arterial disease are:
  
  • High cholesterol
  • Diabetes
  • Heart disease
  • Hypertension
  • Haemodialysis patient
  • Smoking
  
  Peripheral artery disease occurs when a narrowing of the blood flow caused by an excess of cholesterol and other fats that accumulate on the walls of the arteries occurs. The cause of this disease occurs when plaque remains in the artery wall, blocking the passage of arteries to carry blood to the arms and legs. There is no clear cause of plaque buildup, but there are some conditions that increase the risk to suffer. Smokers or former smokers, as well as diabetics, those with a blood pressure or high cholesterol. Failure to address these episodes can lead to having to amputate the foot or leg.
   

  How is peripheral arterial disease diagnosed?

  Some of the tests carried out by the doctor for diagnosis may include:
  
  • Physical examination – the doctor will check to see if there is a weak pulse below a narrowed area of the artery and if there whooshing sounds that can be heard with a stethoscope. They will check for decreased blood pressure in the affected limb.
  • Ankle-brachial index (ABI) – this common test compares the blood pressure in the ankle to the blood pressure in the arm. The doctor may use a regular blood pressure cuff and an ultrasound device to evaluate the blood pressure and flow.
  • Ultrasound – these help evaluate the blood flow through the vessels and can identify blocked arteries.
  • Angiography – A dye is injected into the blood vessels and allows the doctor to view the blood flow through the arteries. The flow is traced using imaging techniques such as an X-ray. • Blood tests – this is done to measure cholesterol and triglycerides levels to check for diabetes.
   

  How is peripheral arterial disease treated?

  There are different types of medications used to treat PAD. These can include cholesterol-lowering medications, high blood pressure medications, medication to control blood sugar levels, to prevent blood clots and there are symptom-relief medications also.
  
  In some cases, surgery or angioplasty may be needed. During an angioplasty, a small hollow tube (catheter) is threaded through a blood vessel to the affected artery. Then a small balloon is inflated to reopen the artery to flatten the blockage and stretching the artery to increase blood flow. Other procedures may include bypass surgery and thrombolytic therapy.

   

• Deep vein thrombosis

  Deep vein thrombosis occurs when a blood clot forms in a vein deep in the thigh or calf. It causes swelling, a red patch or an ache in the leg, and can be dangerous if the clot reaches a vital organ. It can be treated with anticoagulant medication.

• Radiofrequency ablation

  What is radiofrequency ablation?

  Radiofrequency ablation (RFA) is a minimally invasive procedure performed under local anaesthetic, which uses the application of heat to minimise or completely stop pain transmission. The nerve causing the pain is burned, or ablated, using an electrical current to target a specific area. This ablation stops the transmission of nerve signals to the brain, thus providing relief.

  Why undergo radiofrequency ablation?

  Patients who suffer from chronic pain, or conditions such as arthritis and spondylosis, may benefit from immediate pain relief with little to no recovery time. RFA is performed as a day case so there is no need for overnight hospital stay. It can provide relief to those with neck, back, knee, pelvic, and nerve pain. Pain can be debilitating and RFA allows increased function, meaning the patient’s quality of life is significantly improved.

  What does it involve?

  The procedure is performed while the patient is awake, as a local anaesthetic is given to numb the particular area where treatment will be applied. A fluoroscope (an imaging technique that allows the doctor to obtain real-time X-ray images during the procedure) is used to help insertion of a needle into the target area. The fluoroscope allows the doctor to make sure the needle reaches the correct location.

  When the needle is in the right place, a radiofrequency (electrical) current is passed through the needle, which is hollow inside, burning the required area. The burn is very small and the needle allows the doctor to be accurate. This current destroys the part of the nerve which produces pain signals. Multiple burns can be made in order to fully destroy the nerve. After the procedure is finished, patients can return home, but they should make arrangements for someone to escort them.

  Pain may be felt after the procedure, usually for around two weeks. However, after this, pain should be significantly reduced or relieved completely. A follow-up appointment will be scheduled to check progress and discuss further treatment, if necessary.

  How to prepare for radiofrequency ablation

  Before the treatment, a medical history will be taken to see if the patient is suitable, and where the procedure should be performed. Medication will also be discussed, and those who take aspirin or blood-thinners (such as ibuprofen) as long-term medication will be told to stop several days before the procedure.

  Post-operative care

  Patients are generally back to work within the next 24-72 hours. Immediately after the procedure they should be escorted home, and once at home they should rest and recovery. RFA is a safe and simple procedure which is usually highly effective. Pain relief usually lasts between nine months and two years, and the procedure can be done again. 

• Aortic aneurysms

  What is it?

  An aortic aneurysm is an abnormal, progressive and permanent dilation of part of the aorta, the largest artery in the body. The dilation of the aorta leads to its weakening over time and, sometimes, to its rupturing.

  An aneurysm can affect the abdominal tract (abdominal aortic aneurysm) as well as the thorax (thoracic aortic aneurysm).

  

  Prognosis

  Aortic aneurysm is a life threatening condition: the affected aorta could suddenly rupture, or it could lead to the formation of an embolism, consequently causing a stroke or a heart attack.

  What are the symptoms?

  An aneurysm doesn't generally cause any symptoms until it has reached a large size, and sometimes there are no symptoms before it ruptures. In these cases, the main symptoms are breathing and swallowing problems, a change in voice pitch, back or chest pain and low blood pressure.

  How is it diagnosed?

  If the aneurysm isn’t big enough to rupture, it can be diagnosed with an abdominal ultrasound (in case of an abdominal aneurysm) or with an echocardiogram (in case of thoracic aneurysm). In other cases you may also require a thoracoabdominal CT scan.

  What causes it?

  The main causes for aneurysm are:

  • hypertension
  • atherosclerosis
  • inflammation of the aorta
  • genetic disorders of the connective tissues

  Your risk of getting an aortic aneurysm increase as you get older, and are higher if you smoke.

  How can it be prevented?

  You can prevent getting an aortic aneurysm by avoiding smoking and by maintaining a healthy blood pressure and cholesterol levels.

  How is it treated?

  If the aneurysm is still small, you should periodically monitor it, treat it with medication and make sure to lead a healthy lifestyle. If it has already reached a bigger size, you may need to have open surgery (resection of the dilated area and substitution with a synthetic graft) or endovascular surgery (implanting a metallic prosthesis).

  Which doctor should I talk to?

  If you have an aortic aneurysm, you are likely to see a range of specialists, including a heart surgeon, a cardiologist, a vascular surgeon and a doctor specialised in internal medicine.

• Endolaser

  What is endolaser?

  Endolaser, or endovenous laser treatment, is a minimally invasive technique for varicose veins. The treatment can be performed under a local anaesthetic, without the need for sedation.  

  Varicose veins can form anywhere but are most common in the legs as the blood is pumped against the force of gravity. Veins contain two valves which allow blood to flow one way but prevent it flowing backwards. These valves can become faulty and fail to close properly causing blood to flow backwards and the vein to become enlarged.

  Why would you do it?

  Endolaser treatment can remove varicose veins. Varicose veins are enlarged veins that often appear as bulges under the skin. Many people feel that varicose veins are unsightly and wish to get them removed for aesthetic reasons. In some cases, varicose veins can cause significant discomfort and so it is desirable that they are removed for this reason.

  What does it involve?

  Endolaser treatment involves shining a laser onto the veins. The heat from the laser damages the vein, causing it to close and eventually disappear. The procedure is minimally invasive and is an alternative to surgical treatments like vein stripping.

  The treatment involves inserting an optical fibre into the vein to direct the laser into the vein. Once the vein is damaged and forms scar tissue, it will eventually die and disappear. The laser is moved along the vein in order to close the entire length. An ultrasound scan is used to guide the laser.

  The procedure is done using a local anaesthetic with the patient awake. Endolaser treatment can be done in under an hour in most cases.

  How to prepare for it

  In preparation for endolaser treatment a doctor will assess each individual case and discuss the risks. Although relatively safe, possible complications include skin burns, skin colour changes, nerve damage and vein thrombosis.

  Post-operative care

  Some discomfort is to be expected after the treatment, and patients are usually required to wear a compression stocking for a week after the procedure, however will be able to resume normal activities very quickly.