Vascular surgery
Vascular surgery and vascular pathology is largely devided in two major areas:
-Arterial
-Venous
These areas are subdivided into different pathology
Arterial Pathology
Arterial dilating: (weak spots (aneurysms) in the artery with enlarging and thinning of the wall creating the chance for rupture and bleeding.
Arterial obstructive: narrowing of the vessels due to different factors, including fatty calcification (atherosclerosis), leading to blood and oxygen shortage (ischaemia) in tissue, most commonly the legs, feet and toes.
Treatment of arterial pathology starts with prevention of contributing factors that cause vessel damage (artherosclerosis), this means adaptation of lifestyle with prevention of smoking and eating habits to prevent, high cholesterol and diabetes.
Once the vessel damage is extensive it leads to obstruction of blood flow by narrowing of the passage through the vessel. Treatment consists of creating a better passage by balloon dilatation with or without stenting, this is called percutaneuous angioplasty, these procedures can be done through daycare or short stay setting.
If the damage is more extensive and the whole passage is occluded over a longer trajectory, a bypass has to be created with the patients own material (a harvested vein) or synthetic material (a graft). Bypass operations are operations for which patients need to be admitted to the hospital for a couple of days to recover after surgery.
Classification Surgery: Minor-Medium for angioplasty, Major for central femoral, iliac, aortic or carotic interventions
Anesthesia: Local, regional or general (Full intubation and sedation)
Expected hospital stay: daycare or short stay (2 days) hospitalization or longer
Complications and preventive measures
All surgery under general or regional anesthesia carries systemic risks such as deep venous thrombosis, lungembolus, cardiovascular complications: These risks are minimised through preoperative screening procedures and prophylactic(preventing) measures (anticoagulation agents, antibiotics on indication)
Specific complications due to this surgery:
-Cardiovascular and thrombotic events (low to intermediate depending op predisposing atherosclerotic condition)
-Postoperative bleeding (low chance to intermediate, because of anticoagulation measures)
-Wound infection (low chance, less than 10%)
Obstructive vascular disease
Dilating Disease: Aortic Aneurysm
Venous pathology
Venous pathology is also subdivided, the pathology mostly encountered and discussed here is (chronic) venous insufficiency of the legs in which blood is sequestered in damaged veins with damaged valves and walls giving rise to skin problems and wounds (chronic venous insufficiency or CVI)
The venous anatomy consists of a deep and superficial system. The deep system is vital to circulation, the superficial system is not. By different factors the systems can become insufficient. Insufficiency of the superficial system can lead to chronic venous insufficiency or CVI which can cause wounds and skin ulceration if left untreated for a longer period. Venous insufficiency of the legs can be readily treated.
Prevention of CVI lies in early recognition and adequate treatment
Treatment possibilities consist of:
-Injections with sclerosing agents which close the insufficient veins from the inside
-Compression therapy with bandages or stockings
-Excluding main supplying veins of the superficial system through excision (stripping), laser or foaming.
Depending on the level of insufficiency that is determined clinically or with additional testing such as a duplex ultrasound examination, the surgeon can advise one or more of these treatment possibilities
Classification Surgery: Minor-Medium
Anesthesia: General (Full intubation and sedation) or regional
Expected hospital stay: Ambulatory , daycare or short stay (2 days) hospitalisation
Complications and preventive measures
All surgery under general or regional anesthesia carries systemic risks such as deep venous thrombosis, lungembolus, cardiovascular complications: These risks are minimised through preoperative screening procedures and prophylactic(preventing) measures (anticoagulation agents, antibiotics on indication)
Specific complications due to this surgery:
-Postoperative bleeding (low chance, less than 10%)
-Wound infection (very low chance, less than 5%)
Example of open source video explaining treatment of varicose veins.
You can watch this video and others on YouTube by searching 'Treatment for Varicose Veins'
