[vc_row][vc_column icons_position=”left”][vc_custom_heading text=”PAD” font_container=”tag:h3|font_size:30px|text_align:center” el_class=”faq-heading”][cq_vc_accordion accordionstyle=”style2″ contentcolor=”#333333″ contentbg=”#ffffff” accordioncontentsize2=”14px” titlecolor=”#000000″ titlebg=”#ffffff” titlehovercolor=”#ffffff” titlehoverbg=”#dddddd” displayfirst=”on” extra_class=”acordian-faq”][cq_vc_accordion_item accordiontitle=”What is Vascular System?”]The system of arteries and veins in our body is called vascular system. Arteries supply good blood (oxygenated) to various body parts, organs and veins carry bad blood (deoxygenated) from various organs. While heart pumps blood through arteries, lungs purify deoxygenated blood in to oxygenated blood.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”What is Vascular Surgery?”]Vascular surgery deals with diseases of all blood vessels (arteries, veins, lymphatic’s in body except those inside brain which are dealt by neurosurgeon and those around heart by cardiac surgeon). Though the term cardiovascular thoracic surgery was commonly used in past now vascular and thoracic surgery has emerged and recognized as separate super specialties by Ministry of Health and Family Welfare (Government of India). Vascular surgeon exclusively deals with treatment of blood vessels disease, whether it requires medical therapy, surgery or newer minimally invasive percutaneous interventions (endovascular surgery).[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”What are vascular diseases?”]As like other systems vascular system faces two types of problems:
- Obstruction of flow within vessels.
- Arteriosclerosis (Atherosclerosis) :
It is group of disease in which arteries are thickened and lose their elasticity. This can also be called as “hardening of arteries”. The most important type of arteriosclerosis is atherosclerosis. In atherosclerosis, fatty material (bad cholesterol) and fibrous tissue accumulate inside the arterial walls. The diameter of artery decreases, leading to reduced flow of blood supply to the tissue. This is called stenosis.
If this narrowing happens in an artery leading to heart, you experience pain in chest that is one of initial symptom of heart attack. Blood flow then reduces and tissues slowly begin to die due to lack of oxygen. The heart stops beating and person dies.
However if arteries in the upper and lower limbs (arms/legs), narrows person experiences pain after exercise/work (claudication) or even at rest (rest pain). In case of complete blockage of blood flow to limbs the tissues will die to loss of oxygen and is called gangrene. This eventually leads to amputation (cutting of dead tissues/gangrene) of arm/leg to save patients life.
Similarly if vessels supplying to brain is reduced or narrows, small portion of brain tissue dies leading to brain attack/stroke/paralysis.
- b)Thrombosis:
It describes the presence of blood clot (thrombus) attached to inner (intima)wall of vessels (arteries/veins).which leads to complete blockage of blood flow to supplying body tissue and creates similar problems described above.
- Embolism :
Blood flow of vessels is sometimes obstructed by small particles (embolus) of fat, air, blood clot and is called as embolism.
Important- the point of obstruction can be very far from where the embolus originates. For example: thrombus formed in leg veins can travels to lungs creating life threatening situation or clot can travels from heart or major blood vessels (Aorta) to leg, completely blocking artery and leading to gangrene.
- Dilatation of blood vessels
Blood vessels are constructed in layers made up of tissues, strengthening and preserving integrity of vessels.
Certain conditions such as hypertension, atherosclerosis, trauma or infection can disrupt the integrity of vessels. As a result vessels wall gets weak and vessels bulges out this is called as aneurysm. As age advances this aneurysms are enlarged in size and leads to vessels rupture leaking blood out of vessels (hemorrhage).This affect blood flow to important body organs and tissues creating life threatening problems[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”What are risk factors?”]
- Diabetes
- Smoking
- Eating food high in fats
- High blood pressure
- Age
- Hereditary
[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”What are symptoms of leg attack?”]Peripheral artery disease is silent in its early stages but walking even short distance becomes painful for patients as it worsens. This pain is relieved by rest and reappears on walking. This cycle of walk-pain-rest-walk-pain-rest is first warning sign of arterial blockade and is called leg attack.
Other symptoms of disease as it progress in limbs
- Legs and foot become cold and numb
- Blue/black/red discoloration of fingers and toes
- Numbness, tingling or pain in arms, leg, foot or toes.
- Paleness of foot or leg on elevation
- Dry, fragile or shiny looking skin
- Wounds and ulcers refusing to heal
Symptoms of disease as it progress in Brain
- Sudden temporary weakness or numbness of face, arm and/or leg on one side of body
- Temporary loss of speech or trouble speaking or understanding speech
- Unexplained dizziness, unsteadiness or sudden fall
- Temporary dimness or loss of vision particularly in one eye.
Important: An early diagnosis and treatment can prevent cutting leg of (amputation) and paralysis (brain stroke).[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”How to initiate treatment?”]If you have one of symptoms mention above contact your doctor or vascular surgeon. If vascular problems are suspected, your doctor may order Doppler scan (ultrasound) or angiography. Based on reports further treatment or even bypass surgery may be needed to improve blood flow. Similar like heart attack requires angioplasty or bypass, similar treatment may be needed for vascular disease.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”What is angiography?”]It is imaging of vascular system of body using X-rays. Vessels are not visible normally hence special dye (contrast agent) is injected in to blood.
It is available in different forms like CT angiography, MR angiography and Digital Substraction Angiography (DSA). In this process dye is injected inside body through small injection in groin with help of wire and plastic tube (guidewire and catheter). This dye flows through blood vessels and same time X-rays are taken to delineate blood vessels. DSA is similar to coronary angiography (CAG) performed for knowing obstruction in blood vessels of heart.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”What if no treatment received?”]Any disease if not treated at initial stages becomes increasingly complicated and difficult to manage. When disease becomes incurable doctor might suggest you amputation of arm/leg or you may sustain stroke leaving part of your body paralyzed.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”Can vascular disease be completely cured by medicine?”]No. Medicine can control disease but can’t root it out.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”What are various treatment options available?”]Bypass surgery:
Surgery is time tested and well established treatment of blocked arteries. This is performed by vascular surgeon with help of patients own vein or artificial tubes made up of synthetic materials. Blood will flow through newly established track bypassing obstructed vessels carrying essential nutrients and oxygen and thus preventing stroke or amputation.
Surgery also can be done in forms like endarterectomy which means removal of diseased inner layer of artery. Embolectomy and thrombectomy are terms employed to remove blood clots from arteries or vein to save leg and arm from amputation.
Endovascular surgery:
It is name given to minimally invasive percutaneous surgical intervention. This involves correction of blockage or aneurysms either with small catheters and wires placed through needle puncture in arteries or through small incisions. These procedures require small period of hospitalization and quick return to daily routine. All arterial blockages are not amenable to this strategy and needs careful patient selection. Cost of these procedures is high in comparison to bypass surgery. Balloon angioplasty, Stenting, Endovascular aneurysm repair (EVAR & TEVAR) and Catheter directed thrombolysis (CDT) is some of endovascular procedures vascular surgeon performs routinely.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”What is balloon angioplasty?”]If blood vessels has become very narrowed, vascular surgeon will push balloon catheter ( catheter which has balloon at tip) across obstruction site. This balloon is inflated to rupture/break hard plaque and thus reestablish circulation. This procedure is called as Percutaneous Transluminal Angioplasty (PTA), percutaneous through skin, transluminal across vessel and angioplasty shaping of blood vessels.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”What is stent?”]Stent is tube made up of metallic wires, which lends supports to blood vessels and is placed by endovascular approach with help of catheters and guidewires.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”When stent is needed?”]As blood vessels become narrower, sometimes they lose their elasticity. In such scenarios even after angioplasty, a blood vessel doesn’t remain open and collapses back to previous narrowed size. In these cases stents are deployed to prevent collapse of vessels wall to maintain integrity of blood flow.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”Will these symptoms recur?”]Yes, if instructions are not followed properly with medications. It also can occur in different location like opposite leg or arms.
Reducing risk factors:
- Quit smoking
- Regular exercise
- Proper foot care
- Regular medications
- Healthy diet
Peripheral arterial disease doesn’t go away. Although angioplasty and stenting may improve blood flow from diseases arteries, they cannot cure disease. Only patient has power to slow disease progression and is done with things mention above.[/cq_vc_accordion_item][/cq_vc_accordion][/vc_column][/vc_row][vc_row][vc_column icons_position=”left”][vc_custom_heading text=”VARICOSE VEINS & DVT” font_container=”tag:h3|font_size:30px|text_align:center” el_class=”faq-heading vein”][cq_vc_accordion accordionstyle=”style2″ contentcolor=”#333333″ contentbg=”#ffffff” accordioncontentsize2=”14px” titlecolor=”#0a0a0a” titlebg=”#ffffff” titlehovercolor=”#ffffff” titlehoverbg=”#dddddd” extra_class=”acordian-faq”][cq_vc_accordion_item accordiontitle=”What are Varicose Veins?”]Veins carry impure blood to heart. They have valves to move the blood against gravity to heart. When these valves are destroyed or absent for any reason, the one way flow of blood becomes two way flows on standing, working, walking. This causes veins under skin (superficial) and certain bridging veins to become distended and tortuous are called varicose veins. Sometimes valves in veins inside muscles in leg (deep veins) do not function properly resulting in varicose veins.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”Can these varicose veins cause problems?”]Initially they may not cause any 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 ankle, thickening of skin then leading to skin breakdown and to ulceration. This is called as chronic vein insufficiency (CVI).[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”What is treatment for varicose veins?”]The main stay of treatment for varicose veins is customized compression stockings which can apply prescribed pressure to legs as advised by vascular surgeon. This does not cure varicose veins but prevents its progression to advanced disease.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”Is surgery necessary for varicose veins?”]Surgery is generally required for advanced varicose veins and requires small hospital stay. This involve removal of diseased vein or sometimes repair or transplantation of vein valves.
Varicose veins also can be treated by endovascular approach using laser and radiofrequency ablation (RFA) or sclerotherapy and require small stay than surgery.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”What is deep vein thrombosis (DVT)?”]DVT means dot formation in deep veins in leg and extremely dangerous since these clots can get dislodged and travels to lungs (pulmonary embolism). The only symptom is rapid onset of swelling in leg and pain.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”What causes DVT?”]Commonest cause of DVT is prolonged bedrest from any reasons. Certain surgeries (joint replacement, cancer surgery) are associated with higher incidence of DVT.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”Is DVT preventable?”]Yes, by early ambulation (walking) after any illness or operation. 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.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”How is it diagnosed?”]The best way in suspected case of DVT is Duplex scan. Another test venogram-which involves injecting dye into leg veins and then obtaining X-rays, is rarely used today.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”How do you treat DVT?”]Same medicines mentioned above in a higher dose and hospitalization. These injections forms and these should be switched to blood thinners in tablet form (oral anticoagulation). These need to be continued for minimum of six months some cases lifelong[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”What happens if DVT not treated?”]It may results in travelling of clots to lungs which is fatal. Long term complications can be destruction of vein valves and resulting in chronic vein insufficiency and varicose veins.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”Can these clots be dissolved?”]In few selected patients, if seen early certain drugs (thrombolytic agents) can dissolve clots. Most of the time human body dissolves these to varying degrees.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”What is IVC Filter?”]It is metallic mesh of cone shaped, placed through percutaneous approach either through neck or groin, into large vein (inferior vena cava), inside abdomen. It traps the blood clot and prevents them from going to lungs. It is used in very selective cases.[/cq_vc_accordion_item][cq_vc_accordion_item accordiontitle=”What are procedures performed by Vascular Surgeon?”]
- Endovascular and open repair of abdominal aortic aneurysms (AAA),
- Endovascular thoracic aortic aneurysms (TAA), and thoraco-abdominal aneurysms (TAAA), including fenestrated and branched stent grafts
- Open surgical reconstructions and balloon angioplasty and stenting in all vascular areas including visceral (Renal, Mesentric, IIA) vessels (except heart and brain)
- Aortic debranching procedures
- Carotid endarterectomyand carotid artery stenting
- Bypass surgery and endovascular therapy for peripheral artery disease and gangrene of the limbs
- Endovascular and open surgical treatment for peripheral artery aneurysms
- Endovascular surgical intervention, such asangioplasty and stenting, in all vascular areas
- Endovenous laser therapy treatment, radiofrequency ablation or subfascial endoscopic perforator surgery, sclerotherapy and ambulatory phlebectomy for varicose veins and venous ulcers
- Endovascular and open surgical reconstruction for deep vein occlusions (catheter directed thrombolysis, IVC filter and stenting)
- Hemodialysis access(AV Fistula creation, failing AV access- angioplasty and stenting)
- Treatment of vascular malformations (AVM) (Angioembolisation and excision), median arcuate ligament and nutcracker syndromes, lymph edema, and chylous efusions
- Multiple vascular hybrid procedures (open combined with endovascular approach)
- Complete diabetic foot care including rehabilitation for amputees
- Competent to perform vascular ultrasound and non invasive vascular procedures
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