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Varicose veins

 

Varicose veins refer to swollen and enlarged veins that can be seen on the surface of the skin. These can cause blackening of skin in the leg, long standing ulcer and occasionally, heavy bleeding with minor trauma. They also predispose a patient to have Deep Vein thrombosis (clotting of deep  veins).

Numerous treatment options are available to treat varicose veins. They can be treated by latest modalities like Endovenous Laser Ablation Therapy (EVLT), glue, RFA, Injection treatments. The beauty of these treatments is that these are done under local anaesthesia, patient can walk after 2 – 3 hours of procedure and can return to work very same day / next day.

 

Deep Veins Thrombosis

Deep Veins Thrombosis (DVT) refers to a condition where blood clot forms in one of the deep veins (blood vessels carrying blood from lower limbs or upper limbs to heart). If DVT left untreated, it could cause life-threatening complications like pulmonary embolism.

DVT can be managed with blood thinning medications. If there is severe swelling and patient is young, we also offer immediate relief of symptoms with thrombolysis. This may also help to reduce the possibility of long term complications.

In today’s world, there are very few indications of IVC filter. But, if there are any, we are adept at inserting and removing IVC filters.

 

Chronic swelling of leg / foot or long standing ulcers.

Usually caused due to an old DVT, this may cause long standing ulcers to form and give lot of grief to the patient. Other causes may be due to compression of veins by other structures in the body or due to lymphedema. All these are treatable. If caused by DVT / compression of veins, angioplasty (balloon expansion of veins) +/- stenting (metal tube that keeps the veins open). Lymphedema can be treated by a variety of compression modalities and a few open surgeries.

Diabetic foot

If you’re suffering from PAD or diabetes, then it’s important to make special efforts and follow some special precautions to take good care of your feet. These patients have diseased and deformed muscles, bones, nerves and blood vessels. Among the correctable causes of diabetic foot, the most rewarding is correcting the blood supply to the foot. We are one of the few centers in North India who provide angiogram, angioplasty, stenting, bypass surgeries and deformity correction for the diabetic foot.

Treatment of blocked arteries (Peripheral arterial disease)

It refers to a condition in which narrowed blood vessels reduce or stop the blood flow to the limbs. As a result, you may experience or go through a lot of pain while walking. It may complicate to non healing ulcers, gangrene of the foot or leg and if infection sets in, it may also cause life threatening complication of sepsis.

Treatment involves a number of blood thinning and cholesterol reducing medications, angioplasty, stenting, bypass surgeries, etc.

Dialysis access services- AV Fistula, central venous catheters and complications

AV fistula is a critical surgery. It can be done by many people. However, it is precious surgery. If it is done in such a way, so that, in future, if this fistula fails, other options are still available, it is a boon for the patient. Therefore, fistula surgeries are very delicate surgeries which should be done in such a way so as to preserve other possible fistula sites.

Perm cath and temporary catheter insertion is another mode of dialysis. If inserted improperly, these catheters can become occluded or infected and may lead to life threatening conditions due to sepsis / improper dialysis

If the fistula is blocked, it is important to immediately come to a vascular surgery unit to save it by immediate angiogram. The sooner you come, better are the chances to save it.

Swelling of the fistula arm can also be managed by angiogram and angioplasty of the central veins in the chest.

Aneurysms / Dissection

Aortic Aneurysm is an enlargement, and bulging of the main artery that carries blood from the heart to the limbs. It may be asymptomatic or may cause vague symptoms like pain abdomen or back pain. It is important to consult a vascular surgeon as, he is the best guide to tell you when it is time to treat them and when to manage medically. Aneurysms are at risk of rupture which is a life threatening condition. Mortality rate is 90% among those who come to hospital with ruptured aneurysm of the aorta. Majority of the patients don’t even make it to the hospital. We have all the modalities of modern treatment – open surgery, endovascular interventions and hybrid facilities.

Aortic dissection means that blood is flowing through the layers of the aorta (main blood vessel from heart). This also, predisposes to rupture of the aorta which is again, a life threatening condition. These patients are also treated by a number of open surgical or endovascular options.

Carotid artery disease

Carotid artery disease is a disease of the blood vessels supplying blood to the brain. If narrowing is very severe, or clots go in to the brain, they can cause stroke.

We provide both surgical management as well as carotid stenting for carotid arterial disease.

A patient who has suffered stroke due to carotid artery disease should be immediately referred to Vascular surgeon as repairing his carotid artery disease early, especially within the first 14 days, can reduce his chances of recurrence of stroke drastically.

Thoracic outlet syndrome

Thoracic outlet syndrome refers to a group of disorders that happens due to the compressed or injured blood vessels or nerves between the first rib and collarbone.

In many of the Thoracic Outlet Syndrome cases, it is improved by medicines, physical therapy, and sometimes surgeries also required to treat Thoracic outlet syndrome.

Mesenteric arterial disease

Mesenteric arteries are the blood vessels which supply the intestines. Narrowing of these blood vessels can cause severe pain abdomen especially on intake of food. Also, it may cause gut gangrene leading to a life threatening situation which needs emergent surgery. There are endovascular and surgical methods of treatment both of which are available with us.

Renal artery stenosis

Renal artery is the blood vessel supplying the kidneys. Narrowing of these arteries can lead to raised BP which may not be controlled with drugs or the patient may require 3 or 4 drugs to treat. These patients are at risk of heart failure, development of aneurysms, renal failure and other problems due to persistent raised BP. These patients are best treated with renal artery stenting which helps to reduce the BP and control it with lesser number of drugs.

AV malformations

AV malformations are one of the most ignored problems and one of the trickiest problems to treat. These are abnormal blood vessels that can cause swelling over the limbs or face and can be unsightly and cause functional impairment. Rarely, they may also cause severe bleeding or predispose to heart failure. They can be treated by endovascular methods to close of the blood vessels that cause them or by surgical methods to excise them.

 

Vascular Trauma

Vascular trauma refers to a severe injury to a blood vessel because of accident / fracture. It needs emergent intervention and in the right hands of a vascular surgeon, the results are very good. Time is very important for these patients. Early intervention to repair a damaged artery can be the difference between salvage of limb and amputation.

Lymphatic disease

The lymphatic disease affects the lymphatic system. This condition occurs when a fluid called lymphatic fluid builds up in the soft tissues of your body. Most often, it occurs in the arms and legs.

The most common causes of this disease are – surgery or radiation treatment for specific cancer.

This disease can be managed by

  • Leg or arm care
  • Manual lymphatic drainage
  • External pumps or
  • Surgery

 

Acute vascular issues

Acute limb ischemia is sudden occlusion of blood supply of a limb. This should be immediately restored with surgery or endovascular techniques. Otherwise the patient may lose his limb or life.

Ruptured aortic aneurysm, as mentioned above, also needs immediate intervention.

Acute DVT (within 14 days) with severe pain (and / or compartment syndrome of the leg) should always be considered for thrombus suction and thrombolysis to remove the clot and relieve the symptoms / save the leg.

Wet gangrene / Diabetic foot infection is an infective emergency which is not easily recongnized as the pus may be hidden deep in the planes of the foot. What appears to be a small wound on the top of the skin can be a limb threatening of life threatening condition. These patients need to be carefully evaluated and infection or pus needs to be immediately removed in operation theatre as these patients deteriorate very quickly and can lose their limb and life.

Sudden closure of AV fistula is another emergency which should be treated immediately with suction of the clot and doing angioplasty of the chronically diseased AV fistula. The longer it takes to do the procedure, less are the chances to salvage the fistula.

 

 

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