Vascular surgeon
 Vascular Sciences
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Useful Information

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What is the Vascular system?

The system of arteries and veins in our body is called the vascular system Arteries supply good blood (oxygenated) to various organs and veins carry the bad blood (deoxygenated) from various organs. While the heart pumps blood through the arteries , the lungs purify deoxygenated blood into oxygenated blood.

What is Vascular surgery?

Vascular surgery deals with the diseases of all the blood vessels (arteries, veins and lymphatic) in the body except those in the brain which are dealt by neurosurgeons and those around the heart which come under cardiac surgery. Though the term cardiovascular surgery was commonly used, in the past, now vascular surgery has emerged as a separate superspeciality. Vascular surgeon deals exclusively with the treatment of blood vessel disease, whether it requires medical therapy, surgery or newer minimally invasive endovascular procedures.

What are Vascular Diseases ?

Vascular surgery deals with the diseases of all the blood vessels (arteries, veins and lymphatic) in the body except those in the brain which are dealt by neurosurgeons and those around the heart which come under cardiac surgery. Though the term cardiovascular surgery was commonly used, in the past, now vascular surgery has emerged as a separate superspeciality. Vascular surgeon deals exclusively with the treatment of blood vessel disease, whether it requires medical therapy, surgery or newer minimally invasive endovascular procedures.

Thrombosis:
Thrombosis is a term that describes the presence of a blood clot (thrombus) attached to the inner wall of an artery (intima). Thrombosis creates reduction in the blood flow and creates similar problem as described earlier.

Embolism:
The blood flow in the vessel is sometimes obstructed by small particles (embolus) of fat, air bubble or usually blood clot. This process of obstruction is called embolism.

Dilation of blood vessels:
Blood vessels are constructed in layers made up of tissues. Tissues strengthen and preserve the integrity of the blood vessels.

Certain conditions such as hypertension, atherosclerosis, trauma or infection can disrupt the integrity of blood vessels. As a result, the blood vessel wall could weaken causing the vessle to bulge outwards. This is called an aneurysm. When an aneurysm ruptures blood leaks out of the vessel (hemorrhage). This affects the blood flow to the relevant part of the body and creates a life threatening situation.

 

What are the risk factors?

Following are the physical traits and unhealthy habits which  may be risk factors:
Diabetes

  • Smoking
  • Eating food high in fat
  • High blood pressure
  • Ageing
  • Heredity

Symptoms of leg attack:

Peripheral artery disease is silent in its early stages but walking even short distances become painful for the patients as it worsens. This pain is relieved after rest but resurfaces again when walking. This pain cycle which makes one stop every now and again during walking is the first warning sign of the disease.

  • Symptoms of the disease as it progresses
  • Leg and foot become cold
  • Blue/red discoloration of the foot or toes
  • Numbness, tingling or pain in the leg, foot or toes
  • Paleness of the leg or foot if elevated
  • Dry, fragile or shiny-looking skin
  • Wounds/ulcers that do not heal         
  • Symptoms of brain attack or stroke
  • Sudden, temporary weakness or numbness of the face, arm and/or leg on one side of the
  • body: temporary loss of speech or trouble speaking or understanding speech.
  • Unexplained dizziness, unsteadiness or sudden falls
  • Temporary dimness or loss of vision, particularly in one eye

REMEMBER: An early diagnosis and treatment can prevent amputation and stroke

 

What happens if I donít treat these symptoms?

Any disease, if not treated at the initial stage, becomes increasingly complicated and difficult  to manage. When a vascular disease becomes incurable, your doctor may even recommend amputation of the diseased arm or leg, or you may sustain a stroke, leaving a part of your body paralyzed.

What to do ?
If you have the symptoms mentioned above, contact your doctor or vascular surgeon. If vascular problems are suspected, your doctor may order Doppler scan (like ultrasound) or angiography. Based on the reports, further treatment or even bypass surgery may be needed to improve blood flow. Just as heart attack may require angioplasty or bypass, similar treatment may be needed for vascular disease.

 

What is angiography?

Angiography is the imaging of the vascular system using X-rays. In normal X-rays, you cannot see the blood vessels, hence  a special dye (contrast) is injected into your blood.
To inject the contrast into the blood vessels, the doctor makes a small hole (approx. 2 mm diameter) usually in the groin (thigh) and pushes a very thin wire (guide wire) into the blood vessel using the Seldinger's technique.

The doctor navigates through the vessels of the body by using X-ray images taken from time to time. Over this guide wire, the doctor pushes a very thin plastic tube (catheter) into the blood vessel. The contrast is then injected in the blood vessel through this catheter.

The contrast travels in the vessels along with the blood and images are taken using X-rays which are generated through a Fluroscope. The Fluroscope is an X-ray machine that allows your doctor to see the contrast move and also take moving and stationary pictures, if required.
The patient is usually sent back the day after angiography.

 

Can Vascular disease be completely cured by medicines?

No . There are no medicines which can effectively treat these diseases.

What are the various treatment options available?

"By pass Surgery" is the time tested and well established treatment of blocked arteries. This is performed by a vascular surgeon using either your own vein or artificial tube made of synthetic material. The blood flows through the newly created channel beyond the blocked artery, carrying essential nutrients and oxygen, thus preventing an amputation or stroke.

The vascular surgeon may also perform "endarterectomy" in certain arteries, which means removal of diseased inner layer of the artery without performing a bypass. This technique is usually applied in relieving the blocked "carotid" arteries in the neck and is extremely successful in preventing strokes. "Embelectomy" and "thrombectomy" are the terms employed when fresh clots are removed from the arteries. These are usually emergency procedures done to prevent an amputation.

 

What is Endovascular surgery?

Endovascular surgery is the name given to minimally invasive vascular surgery. This involves correction of arterial blocks or aneurysms either with small catheters and wires placed through needle punctures in arteries or through small incisions.

These procedures require very short hospitalization and quick return to normal lifestyle All arterial blockages and aneurysms are not amenable to these treatments and patients have to be slected carefully., the cost of these procedures is still high. Endovascular surgery is a relatively new and progressive branch of vascular surgery and over next few years many more vascular diseases will be treated this way. Balloon angioplasty and stenting are the common endovascular procedures.

 

What is balloon angioplasty?

If the blood vessels have become very narrow, the doctor will push a balloon catheter (a catheter which has a balloon at one tip) up to the obstruction site. The ballon is then inflated to break up the hard plaque (substance which narrows the blood vessel) and thus re-establish the blood flow.

This procedure is called percutaneous Transluminal Angioplasty (PTA) . Percutaneous through the skin, Transluminal through the channel of the blood vessel and Angioplasty-shaping of the vessel.

 

What is a stent?

Stent is a tube made of metallic wire, which lends support to diseased blood vessels. A stent is placed inside the blood vessel, by using guide wires, catheters and balloon catheters.

 

Why is a stent required?

As blood vessels become narrower, sometimes they lose their elasticity. In such case, even after balloon angioplasty, the blood vessel does not remain open and collapses back to its previous narrow position. The stent is placed to provide support to the vessel walls.

 

Will These Symptoms re-occur after sometime?

If you do not take the precautions as prescribed by your doctor, the symptoms could occur again.

Reducing Risk factors:

Peripheral artery disease does not go away. Although angioplasty or bypass surgery may improve blood flow in damaged arteries, they cannot cure the disease. Only patients have the power to slow the disease process. You can do this by controlling your risk factors (like stopping smoking and monitoring your diet and blood pressure) . For even better or overall health, make a commitment to good foot care and daily exercise.

 

 

What are varicose veins?

Veins carry impure blood to the heart. They have valves to help the blood move against gravity in the legs. When these valves are absent or destroyed from any reason, the one way flow of blood becomes two way movements especially on standing and walking.

This causes veins under the skin (called superficial veins) and certain briding veins (called perforators) to become distended and tortuous and these are called varicose veins. Sometimes valves in the veins inside muscles in the leg (called deep veins) do not function properly resulting in vein problems.

 

Can these varicose veins cause problems?

Initially these may not cause problems. Over the years if untreated they can cause swelling of the leg especially on walking, pain and heaviness. If still neglected they can cause discoloration around the ankle, thickening of the skin then leading to skin breakdown and to ulceration. This stage is called 'chronic venous insufficiency'.

 

What is the treatment for varicose veins?

The mainstay of treatment of early varicose veins is a customized compression stockings , which can apply prescribed pressure to the legs as advised by the vascular surgeon. This cannot cure the varicose veins, but will prevent progression in most of the patients.

 

Is surgery necessary for varicose veins?

The mainstay of treatment of early varicose veins is a customized compression stockings , which can apply prescribed pressure to the legs as advised by the vascular surgeon. This cannot cure the varicose veins, but will prevent progression in most of the patients.

 

What is deep vein thrombosis/ DVT ?

DVT means clot formation in the deep veins in the leg and is extremely dangerous since these clots can get dislodged and travel to the lungs (called pulmonary embolism) . The only symptoms are rapid onset of swelling in the leg and pain.

What causes DVT?
Commonest cause of DVT is prolonged bed rest from any reasons. Certain operations (eg. hip surgery, cancer operations) are accompanied by higher incidence of DVT.

 

What causes DVT?.

Yes by early ambulation (walking) after any operation or illness. Certain blood thinning drugs (heparin) and more recently refined form of this called low molecular weight heparins are very effective in reducing the chances of DVT and pulmonary embolism.

 

Is DVT preventable?

Yes by early ambulation (walking) after any operation or illness. Certain blood thinning drugs (heparin) and more recently refined form of htis called low molecular weight heparins are very effective in reducing the chances of DVT and pulmonary embolism.

 

How is it diagnosed?

The best way to diagnose suspected DVT is by Duplex scan, also known as color Doppler scan. Another test venogram-which involves injecting dye into the leg veins and then obtaining X-rays is rarely used today.

 

How do you treat DVT?

By the same medicines mentioned, but in a higher dose and by hospitalization.

 

What happens if DVT is not treated?

It may result in clots traveling to the lungs (pulmonary embolism) which can be fatal. Long-term complications can be destruction of vein valves resulting in chronic venous insufficiency and varicose veins.

 

Can these clots be dissolved ?

In a few selected patients, if seen early certain drugs ( thrombolyotic agents ) can dissolve the clots. Most of the time the human body dissolves these clots to varying degrees.

 

What is an IVC filter?

It is a metallic filter, which is placed through minimally invasive technique either from the neck or groin, into a large vein (inferior venacava), inside the abdomen. It traps the blood clots and prevents them from going to the lungs. It should be used in few selected patients.

 

Neuropathy

What is neuropathy?

Neuropathy is the gradual loss of nerve function in the feet and legs due to diabetes, leprosy, pressure area on feet and others. The most common and significant change is loss of feeling or touch sensation.

How do I know if I have neuropathy?

Neuropathy usually comes on slowly. You may not notice it at first because it is the absence or reduction of sensation. It is hard to be aware of something you cannot feel. A physical examination by your doctor or foot care specialist and sometimes special tests can help in making the diagnosis.

If neuropathy causes loss of feeling, why do my feet sometimes hurt or tingle?

Neuropathy can cause the nerves to charge or transmit impulses that you can experience as numbness, tingling, shooting pain, burning sensation, pins and needles, electric shock sensation of any combinations or the above.

 

Do all diabetics get neuropathy?

The likelihood of getting neuropathy increase with age. The longer you have diabetes, the increased chance you have of developing neuropathy. Many causes are mild, but some are severe. The severity of the neuropathy does not necessarily correspond to the severity of diabetes. Some people with mild diabetes can have severes neuropathy and vice versa.

 

What can happen to my feet if I have neuropathy, because of loss of sensation?

You can injure your feet without knowing it. For example, a person with neuropathy may let a cut or sore of the foot get out of hand simply because it does not feel painful, and not realize it is there.

 

In what ways can neuropathy hurt my feet?

If you wear a pair of poorly fitting shoes, blisters or open sores (ulcers) can form in less than an hour. At first they can cause small problems which can grow into serious ones.

 

Does this mean I should see a doctor even if I have a small foot injury or a minor infection?

Yes, all too often a patient notices an area of swelling or redness, but fails to seek attention because it does not hurt. This is due to neuropathy. The most dangerous fact about neuropathy is the absence of feeling because this allows the injury to go unrecognized and as a result of this , patient might lose the limb.

 

CIRCULATION

How does diabetes affect circulation?

Diabetes and high blood pressure could contribute to narrowing of arteries and decreased circulation in the upper and lower parts of the leg. However, neuropathy, not circulation, is the main cause of most foot problems.

Does poor circulation affect healing?

Your skin and other tissues depend on good blood circulation for both oxygen and nutrition. Poor circulation can result in skin breakdown and cause minor cuts, bruises, burns, and other injuries to heal poorly. Paying close attention to your feet, primarily by inspecting them twice a day, is the key to preventing serious problems.

Infections

Why do infections cause foot problems?

Infections may spread quickly in the foot, giving little warning. Minor injuries can often become sores and then turn into absyss (deep infection) . Once an infection becomes deep-seated or gets into the bone, you will usually need surgery in addition to antibiotics.

What should I watch out for?

Several warning signs should lead you to suspect infection. rise in temperature of foot , fever coupled with open sores and blisters on your feet may signal an infection. Other warning signs may include blood sugar that is difficult to control in diabetes and which requires a higher insulin dosage. Again inspect your feet regularly to prevent serious problems.

How do I prevent foot problems?

Good care requires daily vigilance. Close visual inspection must substitute for the feeling you have lost in your feet. Look for reddened skin, sores, blister, inflamed nails, bony prominences and changes in the shape of you foot.

 

How do I prevent foot problems?

Good care requires daily vigilance. Close visual inspection must substitute for the feeling you have lost in your feet. Look for reddened skin, sores, blister, inflamed nails, bony prominences and changes in the shape of you foot.

 

How do I do this when I find it hard to get in a position to see the bottom of my foot?

You can place a mirror against a wall near a chair in the bedroom or bathroom to inspect your feet. If you have poor vision, you may find a magnifying glass helpful. Most practically, have a family member inspect for you regularly.

 

What daily care should I take?

Use gentle soap. For wash, use luke warm water (NEVER HOT) because you cannot rely on your feet to warn you that the water is too hot. Test the water temperature with your elbow. Wash with a soft cloth ad mild soap.

 

What else should I do?

Dry thoroughly but gently between the toes. Use a moisturizing lotion or coconut oil for dry skin but do not put it between the toes. Keep dry skin soft and clean.

 

How should i trim my nails?

If you have good vision and can reach them easily, trim nails straight across with a nail clipper. Do not round the corners. However, it is safest to file the nails down frequently with a simple nail file. If you have difficulty or are uncertain, you should have your nails trimmed professionally.

 

Are corns a problem?

Yes corns are hard alluses that form on the top of the foot especially the toes almost always due to the wrong foot wear. Corns indicate that your shoes are too tight and you need to be professionally fitted.

 

How should I treat calluses son the bottom of my feet?

If you wear a pair of poorly fitting shoes, blisters or open sores (ulcers) can form in less than an hour. At first they can cause small problems which can grow into serious ones.

 

How should I trim calluses?

Calluses can be reduced with gentle daily rubbing with a foot file. Do not try to do it yourself. Contact your podiatrist.

What kind of footwear should I choose ?
Choosing good foot wear that allows plenty of room can help prevent foot injuries. Shoes should have cushioned soles with uppers made of soft, breathable materials such as leather, not plastic. Professional shoes fitting are advised.

 

What about sandals?

Sandals can concentrate pressure between or on the toes. The loose fit can also allow the foot to shift and slide leading to abrasions and ulcers.

 

What kind of socks should I use?

Cotton and woolen socks provide the best padding. Avoid synthetic materials holes, wrinkles and lumping stitching. Do not use socks or stockings with garters or elastic tops that can cut off your circulation

 

I should check my shoes every time I put them on?

Yes, always look inside the shoes for foreign objects. Make sure the shoes are in good repair and free of loose seams, loose heals and nails. Break in new shoes gradually. Wear them one or two hours at a time before you check your feet in the mirror for reddened areas.

 

What kind of shoes should I wear if I have neuropathy?

The best shoes for neuropathy are in-depth shoes with custom molded insoles with plastic/evazote.

 

How long should I do foot care?

How long should I do foot care?

 

What you can do?
  • Check your feet for cuts and sores, red spots and swelling and infected toe nails, find time to check your feet
  • If you cannot bend over to see your feet take a mirror to help
  • Wash your feet at least twice a day in warm water, do not soak your feet because your skin will get dry after sometime
  • Before bathing test the water with your elbow  to make sure it is not too hot
  • Dry your feet well, be sure to dry between your toes with a thin, clean white cloth. Use talcum powder to keep the skin between your toes dry.
  • Keep the skin soft and smooth by applying cold cream or a moisturizers
  • Apply coconut oil to your feet and leg at least twice a day as this helps the skin to remain intact
  • Do not put lotions or cream in between toes as it might cause an infection forming a wet surface between the toes.
  • Do not walk bare foot even indoors because it is easy to step on something and hurt your feet
  • Always wear a socks or stockings
  • Choose socks made of cotton wool because they keep the feet dry
  • Check the inside of your shoes before you put them on to be sure that lining is smooth and there are no objects in them
  • Wear footwear with eva or platozote insoles.
  • Wear shoes that fit well and protect your feet
  • Wear shoes to protect your feet fro hot and cold surfaces
  • Put sunscreen lotion on the foot to prevent sunburn in extreme of heat
  • Keep the feet away from radiator and open fires
  • Do not put hot water bottles or heating pads on you feet
  • Wear socks at night if your feet get cold lined boots are good in winter too keep your feet warm

What else can I do

  • Keep the blood flowing to your feet. Put your feet up when you are sitting. Do not wear tight socks, elastic and rubber bands.
  • Stop smoking . Iit reduces blood flow to your feet
  • If you have high blood pressure and high cholesterol , work out an a diet plan with your doctor to lower the same.
  • Ask your educator to give and exercise plan.
  • Walking, dancing, cycling are good exercises for your feet
  • Avoid activities that are hard on the feet, such as running and jumping.
  • Wear sports shoes that fit well and provide good support

Be Sure to

  • Check the sensation in your feet
  • Check the pulse in your feet
  • Get feet checked for foot problems
  • Learn how to take care of your feet
  • Talk to your foot care specialist
  • Take advice on special footwear

Get Started

Begin

  • Taking good care of your feet today
  • Set a time everyday to check your feet
  • Note the dates and visits to the podiatrist
  • Stick to your foot care program

Tips for proper foot wear

  • Never wear plastic shoes, because they don't stretch or breathe
  • When buying shoes, make sure they are comfortable from the start and have enough room for your toes with a wide toe
  • Use canvas or leather shoes for daily wear as they support the feet well and also allow the feet to breathe
  • Proper footwear can prevent most of the serious foot problems