Dr Arvind Kohli
Specialists in vascular surgery possess the advanced knowledge and skills to provide comprehensive care to patients with vascular disease, understand the needs of these patients, teach this information to others, provide leadership within their organizations, conduct or participate in research in vascular disorders, and demonstrate self-assessment of their outcomes. Further vascular specialist guides the holistic management of vascular diseases: open surgery, endovascular intervention, and medical therapy.
What is Vascular Disease?
Vascular disease is an abnormal condition of the blood vessels. Blood vessels (arteries and veins) are the tubes that pump blood throughout the body. Arteries carry oxygen- rich blood from the heart to nourish every part of the body, including the brain, kidneys, intestines, arms, legs and heart itself. Veins carry the blood back to the heart. Problems along this vast network of blood vessels, called the vascular system, can cause severe disability and death.
Vascular disease commonly occurs at sites of turbulent blood flow, such as when the direction of blood flow in the arteries changes abruptly. The figure illustrates sites in the arterial system where this change in direction of blood flow occurs.
Arch Branches supply blood to the brain through the carotid arteries, and when diseased, frequently cause life threatening strokes.
Coronary arteries supply blood to the heart and, when diseased, can block the flow of blood and cause a heart attack. This is a cardiovascular disease and is primarily managed by heart specialists – cardiologists.
Renal Arteries supply blood to the kidneys and, when diseased, can cause high blood pressure and eventually, kidney failure.
Iliac Arteries supply blood to the hip and the legs and, when diseased, cause leg pain with walking (claudication), often in both legs.
Femoral Arteries supply blood to the legs. If they become diseased, it may cause claudication, usually in the calf muscles. This lack of circulation can lead to continuous pain in the toes and foot, and may progress to the development of gangrene.
Vascular disease affects the entire body and includes stroke, peripheral artery disease (PAD), abdominal aortic aneurysm (AAA), carotid artery disease (CAD), arteriovenous malformation (AVM), critical limb ischemia (CLI), pulmonary embolism (blood clots), deep vein thrombosis (DVT), chronic venous insufficiency (CVI, and varicose veins.
Everyone is at risk of vascular disease, and nearly 1 out of 2 people will suffer from it in his or her lifetime. With the increase in obesity and Type II diabetes in India and as the population ages, it is estimated that by 2024 vascular disease will take the lives of over two million Indian each year.
Vascular surgery in the Third Millennium
Arterial and venous disease treatment by angiography, stenting, and non-operative varicose vein treatment like sclerotherapy and endovenous laser treatment are rapidly replacing major surgery. These newer procedures provide reasonable outcomes that are comparable to surgery with the advantage of short hospital stay (day or overnight for most cases) with lower morbidity and mortality rates. The durability of endovascular arterial procedures is generally good especially when viewed in the context of their common clinical usage i.e. arterial disease occurring in elderly patients and usually associated with concurrent significant patient comorbidities especially ischaemic heart disease. The cost savings from shorter hospital stays and less morbidity are considerable but are somewhat balanced by the high cost of imaging equipment, construction and staffing of dedicated procedural suites, and of the implant devices themselves. The benefits for younger patients and in venous disease are less persuasive but there are strong trends towards nonoperative treatment options driven by patient preference, health insurance company costs, trial demonstrating comparable efficacy at least in the medium term.
Common professional associations
Associated areas of interest and operative surgical practice for vascular surgeons are access surgery for hemodialysis and peritoneal dialysis, organ harvesting for transplantation, renal transplantation, pancreatic solid organ transplantation Organ transplant.
Vascular supecialist will frequently have close associations with specialist interventional radiologists for a combined treatment of certain conditions. The radiologists contribute to endovascular cases management, sometimes with angioplasty and stenting, but also in specific areas of expertise e.g. sclerotherapy for vascular anomalies and arteriovenous malformations (AVMs), coil embolisation of bleeding visceral arteries in trauma or for occlusion of tumour supplying arteries as a prelude to operation, CT- guided procedures such as lumbar chemical sympathectomy.
Common medical associations are the involvement providing surgical opinions and treatment for a multidisciplinary clinic with vascular surgeons, vascular nurses, wound management nurses, podiatrists, prosthetists, rehabilition physicians, vascular physicians, endocrinologists, etc. to manage high risk foot disease patients.
Less common operative surgical associations are: sympathectomy (ETS, Endoscopic thoracic sympathectomv), lumbar sympathectomy, Hyperhidrosis surgery); vascular access for chemotherapy etc. patients; dialysis/ECM0 (extra-corporeal membrane oxygenation) for patients in Intensive Care Wards; vascular mobilisation for access associated with other specialist operations e.g. extensive orthopaedic spinal and pelvic surgery, retroperitoneal cancer dissections, renal tumour surgery.
How to Prevent Vascular Disease
Vascular disease can strike anyone, at any age, at any time. And it often strikes without warning symptoms may not appear until it is limb or life threatening. Do not smoke or use any tobacco products Adopt healthy eating habits.Exercise regularly.and Reduce high blood pressure. Keep your cholesterol levels under control.lf you are diabetic, control your blood sugar level. Reduce stress and have a holistic approach towards life.
(The author is Vascular Specialist Super Speciality Hospital GMC)
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