VASCULAR SURGERY

The word “peripheral” means the limbs. The arteries or veins which carry blood are damaged in vascular disease.

Arterial Diseases:

The arteries are tubes which carry blood rich in oxygen throughout the body. Deposits of fatty substances can build up in the artery and cause narrowing resulting in less blood flow to the target organ.

Risk factors for arterial diseases:

• Diabetes
• High blood pressure
• Smoking
• Heart disease
• High cholesterol
• Obesity
• Family history
• Connective tissue disorders

Many diseases may result due to the narrowing of peripheral arteries :

Stroke – narrowing of carotid arteries (which supplies the brain) Kidney failure – narrowing of renal arteries (which supplies the kidney) Abdominal pain and gangrene – narrowing of vessels supplying the intestines Leg pain, ulcers and gangrene – narrowing of vessels supplying the legs

Common symptoms due to arterial diseases affecting the limb:

• Leg pain on walking (claudication)
• Leg pain at rest (rest pain)
• Leg ulcers
• Blackish skin discoloration (gangrene)
  

If attention is sought at the earliest onset of symptoms, conservative management as well limb-salvaging surgery (angioplasty, bypass procedures similar to that for heart diseases) can be performed. At later stages, gangrene may occur and lead to loss of limb (amputation).

Conservative measures in managing peripheral arterial diseases are :

• Stop smoking
• Low fat and cholesterol food
• Exercise – walking is often the best exercise
• Control of diabetes
• Control of blood pressure
  

Medications can also be used to thin the blood and increase its flow.

Aneurysms:

Aneurysms are segmental dilation of arteries. Most commonly aorta (main blood vessel carrying blood from the heart to various organs) is affected. This can occur due to diabetes, high blood pressure, ageing, smoking and connective tissue disorders. Aneurysm can burst and result in alarming internal bleed which may be fatal. If detected early, they can be treated through endovascular method or open surgery.

Veins are blood vessels which carry de-oxygenated blood from the peripheries to the lungs for oxygenation. Valves are present within the veins which prevent backward flow.

Common symptoms of Venous Disorders:

1. Leg swelling
2. Leg pain
3. Non healing Leg Ulcer
4. Skin Pigmentation
5. Tortuosity of veins
6. Bleeding from Veins

Most commonly encountered venous diseases are:

1. Varicose Veins.
2. Deep vein thrombosis(DVT).
3. Chronic Venous Insufficiency(CVI).

Varicose Veins:

Valves are damaged which allows backflow of blood. De-oxygenated blood stagnates and causes the symptoms. There will be tortuosity of Veins in the leg. Early detection results in minimally invasive procedures. (Sclerotherapy, Laser). Later it may need surgical intervention.

Deep Vein Thrombosis:

Cloting of blood in the vein prevents the blood flow to the Lungs and causes symptoms. It can lead to Pulmonary embolism (migration of blood clot from leg to lungs) that may prove fatal.

Chronic Venous Insufficiency (CVI):

The after sequelae of DVT which can result in stagnation of blood and symptomatology.

Early management of venous disorders can be minimally invasive (Sclerotherapy, Laser) and can prevent more invasive surgeries. Prompt Treatment of DVT is important, lest it can lead to Pulmonary Embolism.
Hence early consultation with a Vascular Surgeon would go a long way in the management of venous diseases.