Vascular surgery is a surgical speciality where diseases of veins and arteries are treated through open surgery and/or endovascular (inside the vessel) surgery. With recent medical advances, many conditions can now be treated through endovascular surgical intervention which means reduced time in hospital and faster recovery times for patients.
North Coast Vascular offers a comprehensive range of vascular surgeries. North Coast Vascular Services are:
When there is a weak spot in a section of an artery, vein or part of the heart (cardiac chamber) a blood filled bulge or swelling can form. These are called aneurysms.
Aneurysms can form in any blood vessel in the body. Doctors refer to the type of aneurysm based on the location of the aneurysm in the body. In this practice we primarily treat:
Aortic aneurysms – The aorta is the large blood vessel that carries oxygen containing blood away from the heart through to other parts of the body. The most common aneurysm in the aorta occurs in the abdomen and is called abdominal aortic aneurysms.
Peripheral aneurysms – These aneurysms are formed in arteries other than your aorta.
Popliteal aneurysms – are aneurysms in your popliteal artery which is the major artery that runs down the back of your lower thigh and knee.
Femoral aneurysms – are aneurysms that form in your femoral artery in your groin.
Carotid Artery Disease is where the major arteries in your neck become clogged or blocked; it results in reduced blood circulation to the brain and head.
Carotid Artery Disease often doesn’t produce any symptoms in the early stages. This is called Asymptomatic.
Where symptoms are experienced, they can include:
Transient Ischemic Attacks (TIA) are mini-strokes and symptoms can last from a few moments to an hour, followed by a full recovery within 24 hours. During a TIA you may:
Remember the FAST test as the easy way to recognise the common signs of a TIA or stroke. If the person has a problem with any of these things, call 000 immediately (do not drive yourself!)
Carotid Artery Disease complications include stroke and death. This is a serious disease and needs immediate attention.
Causes of Carotid Artery Disease
Carotid Artery Disease occurs when plaque builds up on the walls of your carotid arteries, causing them to narrow and harden. This is called atherosclerosis or hardening of the arteries.
The artery may become totally blocked, or a piece of the plaque may break off and form a blood clot that travels through your bloodstream and causes a stroke by blocking an artery in your brain.
Treatment options depend on the severity of the disease and whether or not you are experiencing any symptoms.
If your Carotid Artery Disease is asymptomatic, you will generally be asked to address lifestyle issues such as smoking and obesity, ensure you eat a healthy diet and get regular exercise.
You may also be advised to take high blood pressure medication, blood thinning medication, medication to reduce cholesterol or other medication to reduce the risk of blood clots.
If you have symptoms of Carotid Artery Disease or if your carotid arteries are severely narrowed without any symptoms, then we will generally recommend surgery.
Depending on your symptoms and a range of other factors, you will undergo a Carotid Endarterectomy and patch.
Carotid Endarterectomy is where Dr Williams makes an incision in your neck and removes the plaque contained in your artery.
Dr Williams will discuss the procedure and its complications in detail with you during your consultation.
Peripheral Artery Disease (PAD) has a number of different names: Peripheral Artery Occlusive Disease; Arterial Occlusive Disease; Peripheral Vascular Disease; Lower Extremity Arterial Occlusive Disease; Occlusive Disease; Aortoiliac Occlusive Disease; Leg Artery Disease.
When the arteries in your legs become clogged or blocked, it results in reduced blood circulation to the muscles and tissues in the surrounding area. This is called Peripheral Artery Disease.
Symptoms depend where the artery is blocked or clogged, and the extent of the blockage. They can include:
Complications depend on the extent of the blockage and the length of time of the blockage. If the reduction of blood flow is severe and prolonged, it can cause Acute or Critical Limb Ischaemia. In these situations, the loss of circulation can be so severe that the limb may need to be amputated or may even cause death.
Peripheral Artery Disease occurs when plaque builds up on the walls of your arteries, causing them to narrow and harden. This is called atherosclerosis or hardening of the arteries.
When your arteries become blocked, the surrounding muscles or tissue may not receive the blood and oxygen that they need. The lack of oxygen is called Ischaemia and can cause pain.
Risk factors for Peripheral Artery Disease include:
Treatment options depend on the severity of the disease.
Mild – Moderate
If your PAD is mild – moderate, you will be asked to address lifestyle issues such as smoking and obesity, ensure you eat a healthy diet and get regular exercise. You may also be advised to take high blood pressure medication or other medication to lower your cholesterol level, and aspirin to reduce clot formation. You will also be advised to take increased care of your legs and feet and watch for any changes.
Severe
If you have severe symptoms, or your symptoms don’t improve with lifestyle changes, then we will generally recommend surgery.
Depending on your symptoms and a range of other factors, you will undergo either:
A bypass is where Dr Williams will create a new pathway for your blood flow using a graft which connects above and below the aneurysm. Grafts can be from a portion of one of your own veins or a synthetic tube.
Endarterectomy is where Dr Williams makes an incision over the blockage, and removes the plaque contained in your artery, and then closes it with a patch.
Angioplasty is where the artery is stretched by a balloon and a metal support tube (stent) may be inserted into the artery to keep it open. Angioplasty is an endovascular procedure, which means that the surgery is performed inside your arteries using long catheters threaded up through your arteries. It is commonly called keyhole surgery as only small incisions are needed.
Not all patients are suitable candidates for endovascular surgery, and Dr Williams will discuss the advantages and disadvantages of your different options with you during your appointment.
Varicose veins are swollen veins that you can see through your skin. They occur most commonly on the legs, and are more common in women. They often appear darkish blue, lumpy, rope like or twisted.
Symptoms can include:
While not life threatening, overly enlarged varicose veins can rupture and cause bleeding. They can also cause leg ulcers.
The veins in our legs carry blood up our legs and back to the heart. Our veins contain a number of one-way valves to help the blood flow “uphill” against gravity. If the valves don’t close properly, blood pools in the veins closest to our skin. Over time, the affected veins become varicose or distended with blood.
Risk factors for Varicose Veins include:
Treatment options depend on the severity of the disease.
Mild
In mild cases, support stockings can help reduce the symptoms of varicose veins and reduce the chance of complications. Other treatments such as injection sclerotherapy may also be suitable.
Severe
If you have complications from your Varicose Veins, find the symptoms extreme or you are looking for cosmetic improvement, then we will generally recommend surgery.
Within this practice, depending on your symptoms and a range of other factors, you will undergo either:
Varicose Vein Surgery is where the superficial veins are disconnected from your deep veins through a cut in your groin or back of your knee. A number of smaller cuts called avulsions or phlebectomies are then made along the length of your varicose vein, before the main vein is “stripped out”.
Endovenous Ablation (EVA) can be of two types – Laser Ablation or Radio-Frequency Ablation. These are endovascular procedures where catheters are threaded up through your arteries. It is commonly called keyhole surgery as only small incisions are needed. Both forms of ablation cause the walls of the vein to close and seal, but one uses laser fibres and the other uses radio-frequency energy.
Not all patients are suitable candidates for endovascular surgery, and Dr Williams will discuss the advantages and disadvantages of your different options with you during your appointment.
A Deep Vein Thrombosis (DVT) is a blood clot that lodges in a deep vein of the body – usually on the pelvis, calf or thigh.
Symptoms usually occur in one leg, may increase with standing or walking, and can include:
If the blood clot from a DVT breaks off it may travel back the heart or lungs, causing a pulmonary embolism. Pulmonary embolisms can be virtually unnoticed or can cause sharp chest pain, breathing problems or death.
If you suspect you have DVT, you need immediate medical attention. If you have shortness of breath or chest pains, call 000.
If the blood clot remains in the vein, it can block the flow of blood which can cause fluid to build up and the leg to swell. It can also cause leg ulcers.
Risk factors for Deep Vein Thrombosis include:
Once Deep Vein Thrombosis is confirmed, you will usually be placed on anti-coagulant medication and wear compression stockings.
If you can’t take anti-coagulants, or the DVT occurs while you are on the medication, then a clot-trapping filter (Inferior Vena Caval (IVC) filter) may be placed in the main vein that connects the lower body to the heart or lungs.
You may also undergo a procedure called thrombolysis, where clot dissolving drugs are injected directly into the clot via a catheter. In certain situations, surgery called venous thrombectomy to remove a severe deep vein clot may be recommended. Dr Williams will discuss the advantages and disadvantages of your different options with you during your appointment.
A wound on the leg or ankle caused by abnormal or damaged veins. Venous ulcers are due to abnormal vein function. People may inherit a tendency for abnormal veins. Common causes of damaged veins include blood clots, injury, ageing and obesity.
Symptoms include swelling, aching and tiredness in the legs. Usually a red, irritated skin rash develops into an open wound. Treatment solutions include leg elevation, compression and wound care. Sometimes surgery is required.
If your kidneys are no longer sufficiently cleaning your blood, then dialysis may be required. Dialysis is where your blood is pumped from your bloodstream into a machine that filters it before it returns it to your body.
For dialysis to occur, access to your bloodstream is needed. This is called vascular access surgery.
The four types of vascular access surgery are:
Dr Williams will discuss the advantages and disadvantages of your different options with you during your appointment.
Whether your access is a fistula, graft or catheter, you should make sure to take good care of it. Your dialysis care team will teach you the steps of good access care. The chart below gives you some general tips about everyday access care and how to prevent problems.
Your dialysis care team will check your access often to make sure it is working well. An access that is not working well can decrease the amount of dialysis you receive. Your dialysis care team will teach you how to check your fistula or graft at home each day. Here are some tips you should follow to help keep a fistula or graft working longer:
Sometimes, even when you are very careful, your access may clot or become infected. If an infection occurs, your doctor will order antibiotics for you. If your access develops a clot, you may need to go to the hospital for treatment. Removing the clot can usually be done on an outpatient basis, and you will not need to stay overnight.
Correct diagnosis is vital and the treatment for arterial ulcers is completely different to treatment for venous ulcers, and can possibly cause additional harm if the wrong treatment is given. To complicate matters further, many patients have a number of causes of their ulcers across both arteries and veins. This means that combination treatments may often be required.
Arterial ulcer treatment is often urgent and can include angioplasty surgery to clear the blocked artery. In some cases bypass surgery of the blocked artery is required. In severe cases, amputation may be required.
Venous ulcer treatment includes cleaning the wound, specialised air and water-tight dressings, compression, painkillers and antibiotics, dietary supplements if required, and hyperbaric oxygen. Treatment may also include surgery to remove dead tissue from the wound, and skin grafts if required.
Dr Williams will discuss the advantages and disadvantages of your different options with you during your appointment.
Non healing wounds can present serious health risks and often require specialised care. Antibiotics and dressings do not cure leg ulcers.
Treatment of underlying problems is the first step in a healing process whose goals are to alleviate pain, speed recovery, regain mobility, and fully heal the wound. Treatment must be directed towards fixing the cause for the ulcer. Patients with peripheral vascular disease (PVD) often have non healing wounds on their extremities. Decreased blood flow results in poor healing. By treating the underlying vascular problem wounds can be treated effectively and heal much faster.
There are many risk factors that can contribute to the development of non healing wounds:
How are wounds diagnosed?
There are 3 main types of wounds on the lower extremities: venous stasis ulcers, neurotrophic ulcers, and arterial ulcers. A thorough examination of the wound needs to be completed and other diagnostic testing done to determine any underlying problems that need to be corrected.
Treatment Options
Wound care begins with treating any underlying problems contributing to non healing. This includes treating any vascular problems that could be impeding blood flow to the affected limb. This may be done by ligation of varicose veins, angioplasty +/- stenting, or bypass surgery. Wound care after revascularisation includes: Debridement +/- skin graft, compression, topical wound care therapies and antibiotics.
Accurate diagnosis is the foundation of ulcer care
