Vascular and Endovascular Surgery

 The Department of Vascular and Endovascular Surgery at Amrita Hospital, Kochi, provides comprehensive care for diseases of the vascular system - including arteries, veins, and lymphatic vessels - using medical therapy, minimally invasive catheter procedures, and advanced surgical reconstruction techniques.
We specialize in treating vascular diseases affecting all parts of the body, except the heart and brain, with a patient-centric, multidisciplinary approach. Our team works in close collaboration with interventional radiologists, nephrologists, podiatrists, and plastic surgeons to ensure state-of-the-art diagnosis, treatment, and long-term management for vascular conditions.
The department is among the few dedicated vascular units in the country offering comprehensive treatment options for vascular diseases under a single specialty, empowering patients to make informed choices about their treatment. 

• Multidisciplinary Approach: Collaboration with podiatry, plastic surgery, nephrology, interventional radiology, and stroke medicine units for comprehensive care.
• State-of-the-Art Technology: Advanced imaging techniques, intravascular ultrasound (IVUS), hybrid operating rooms, and high-precision catheter-based interventions.
• Minimally Invasive Procedures: Advanced endovascular treatments ensuring faster recovery, shorter hospital stays, and minimal discomfort.
• Personalized Treatment Plans: Tailored arterial and venous disease management for each patient.
   

 Peripheral Arterial Disease (PAD)

• Peripheral balloon angioplasty with or without stenting
• Advanced endovascular therapies including drug-coated devices, intravascular lithotripsy (IVL), and atherectomy procedures
• Bypass operations (Aorto-femoral, femoro-popliteal, tibial/pedal bypass, femoro-femoral, axillo-femoral)
• Endarterectomy and patch repair
• Sequential combined endovascular and open surgical reconstruction for multilevel disease

Varicose Veins Treatment

• Endovenous thermal ablation - RF ablation / EVLT
• Endovenous non-thermal cyanoacrylate (Glue) closure
• Surgical ligation and stripping
• Ambulatory hook phlebectomy
• Percutaneous ablation of perforators
• Ultrasound-guided foam sclerotherapy
• Comprehensive compression therapy

Deep Vein Interventions

• Catheter-directed thrombolysis (CDT)
• Percutaneous mechanical thrombectomy (PMT)
• Deep vein venoplasty and stenting for chronic venous insufficiency, post-thrombotic syndrome (PTS), and May-Thurner syndrome
• Intravascular ultrasound (IVUS) guided interventions
• IVC filter placements and removal

AV Access Surgery

• AV fistula (AVF) operations
• Complex AV fistula procedures: superficialization, transposition, translocation
• AV graft placement
• Lower limb AV access creations (femoral vein transpositions/thigh AV grafts)

AV Access Salvage Procedures

• Salvage of failing or occluded AVFs via surgical and endovascular techniques, including thrombectomy and AVF angioplasty
• Central vein venoplasty
• Treatment of access-related complications like pseudoaneurysms and steal syndrome

Carotid Artery Disease

• Carotid endarterectomy
• Carotid body tumor removal
• Carotid aneurysm repair

Aneurysm Treatments

• Abdominal Aortic Aneurysm (AAA) and Peripheral Aneurysms
• Open and Endovascular repair (EVAR and TEVAR)
• Hybrid repair procedures
• Peripheral covered stent placement
   

• Consultation and evaluation of vascular disorders
• Peripheral artery disease (PAD) screening
• Doppler ultrasound and vascular imaging
• Non-invasive wound care and diabetic foot assessment
• Endovenous varicose vein treatments on a day-care basis
   

The department delivers wide-ranging treatments in the following arterial and venous pathologies:

Peripheral Arterial Disease (PAD)

Narrowing/blockage of the arteries of the limbs as a consequence of atherosclerosis (plaque deposition) is getting increasingly common in patients who are diabetic, hypertensive, dyslipidemic and in those addicted to tobacco smoking. This can result ischemia (compromise in blood flow) causing pain in the legs while walking (claudication) or critical conditions like Chronic Limb Threatening Ischemia (CLTI) that includes gangrene and non-healing ulcers with an attendant substantial risk of major amputation. The aim of treatment in these patients is to save them from limb loss (amputation) and improve quality of life. The following services are offered on an individualised basis depending on what is best for each patient considering his general health, disease extent and limb status.
The division also works in collaboration with the Advanced wound care services departments (Podiatry/General surgery/Plastic surgery) to provide comprehensive care of patients with diabetic foot disease. Multi-disciplinary approach is the key-stone in achieving foot salvage by appropriate revascularisation combined with local debridement, specialised dressing and off-loading. Patients may also be treated medically depending on his clinical status. Some patients need only proper counselling for life-style modification and medications. Nonetheless, there are infrequent few for whom non-interventional treatment is all that can be offered. This includes ulcer care like dressings and vacuum-assisted closure (VAC) therapy, hyper-baric oxygen therapy, sympathectomy and prostaglandin or immune-modulatory therapy. Intra-muscular stem-cell therapy is also provided in such clinical scenarios.

Varicose Veins

Varicose veins are a common condition afflicting many people. It results from reflux (flow in opposite direction) of blood in certain veins of the lower limb as a result of defective valve function within the veins. This may result in cramping pain in the leg, swelling, skin discoloration and even ulcer formation, what is collective known as Chronic venous insuffiency (CVI). Effective treatment generally entails removal of the abnormal vein surgically (ligation and stripping) or catheter based (endovenous) minimally invasive thermal or non-thermal (glue) ablation procedures, Endovenous therapies are now the standard of care in the present era and are performed routinely in the division with good clinical result mostly under local anaesthesia, hence avoiding the need for major anaesthesia and longer hospital stay. Patients can effectively walk home after the procedure the very same day. Recurrent varicose veins following previous procedures are also dealt with. Because of dedicated ultrasound mapping of veins, the best therapeutic strategy is provided to the patient with very low risk of recurrence. Optimal wound care and compression therapy is also simultaneously provided that heals the healing of the venous leg ulcers.

AV Access Surgery

Chronic kidney patients on maintenance hemo-dialysis require a permanent AV access creation in the upper limbs for the same. Ultrasound vein mapping is routinely used for optimal site selection. With close association with the department of Nephrology, all sorts of simple and complex access creations are undertaken with high success rates. Patients who lack native veins for creation of autogenous AV fistula are treated with AV graft placement. Apart from that patients presenting with dysfunctional access problems are also treated with remedial measures like AVF angioplasty, thrombectomy or surgical measures to improve the usability of the fistula or graft for further dialysis access.

Vascular Trauma

Damage to blood vessels can occur as result of trauma most commonly high velocity motor vehicle accidents (MVAs). This may either cause ischemia (compromise of blood supply of the limb) or major bleeding at the injury site. Vascular surgery forms an integral part of the trauma care at Amrita with high level of surgical expertise in the emergency repair of blood vessels. Embolisation therapy is also done for arresting bleeding from internal structures.

Acute Limb Ischemia

Sudden blockage of arteries of upper or lower limb arteries can result in devastating limb loss. Timely emergency treatment must be provided to save the patient from amputation. Multi-modality services are available round-the-clock at the division, either surgical and endovascular as what is best suited for the patient.

Carotid Artery Disease

Atherosclerotic plaque formation (cholesterol build-up) within the carotid artery (artery supplying the brain) is a major cause of cerebro-vascular accidents (stroke). Amrita hospital has a dedicated stroke medicine unit where comprehensive evaluation and treatment including rehabilitation are provided. Carotid endarterectomy is a surgical procedure where in the diseased area of the carotid artery in the neck is surgically cleared and thus preventing major disabling stroke in the future. Expertise for the following procedure are offered at the division.

Abdominal Aortic Aneurysms and Peripheral Aneurysms

An aneurysm is an abnormal dilatation (ballooning) of an artery to more than one and half times its actual size. Aneurysms can affect any part of the aorta (largest blood vessel of the human body) although the abdominal aorta is the commonest site.

Abdominal aortic aneurysms (AAA) eventually grow in size and can lead to rupture with massive fatal internal bleeding. The division is very experienced in both open and endovascular modality of treatment of AAAs and work in sync with Interventional Radiology to provide the best approach to the patient. 

Dedicated round-the-clock service is also offered for life-saving emergency repair of ruptured AAAs.

Peripheral aneurysms involving other arteries of the body are also treated at the division with either open or catheter-based technology (covered stents). Likewise, minimally invasive and surgical treatments of pseudoaneurysms are also provided. Ultra-sound guided thrombin injection is done with a very high technical success rate.

Deep vein interventions

Deep vein thrombosis (DVT) is a condition in which the major deep veins of the limbs (particularly lower limb) can become thrombosed (clotted) to a variable extent and this could result in acute pain and swelling of the leg.
Patients with extensive DVT up to the iliac veins or above are offered endovascular interventions like thrombolysis or thrombectomy to clear the clot and rapidly restore good venous return circulation that not only hence with immediate symptomatic relief but also negates the long term risk of chronic scarring of deep veins (Post-thrombotic syndrome).
Patients who have disabling chronic venous insufficiency due to PTS or are suspected to have deep vein disease urelated to DVT for eg. Non-thrombotic iliac vein lesions (NIVL) like May-Thurner Syndrome are candidates for venous interventions like venoplasty and stenting that can improve the CVI issues and help in successful healing and remission from venous leg ulcers (VLUs). These complex procedures are undertaken with the image guidance of IVUS to improve the technical success and outcomes of these procedures. 

• Peripheral Arterial Disease (PAD) Management
• Diabetic Foot & Limb Salvage
• Varicose Vein Treatment (Laser, RF Ablation, Glue Therapy)
• Deep Vein Thrombosis (DVT) & Chronic Venous Insufficiency (CVI) Treatments
• Aneurysm Repair (EVAR, TEVAR, Hybrid Procedures)
• Stroke Prevention (Carotid Endarterectomy, Stenting)
• AV Access Surgery (Fistula, Graft, Thrombectomy)
• Emergency Vascular Trauma Management 

• One of the most advanced vascular and endovascular surgical units in the country.
• Pioneering minimally invasive endovascular techniques in the region.
• High success rates in complex procedures, including limb salvage surgeries for diabetic foot disease.
• 24/7 emergency care for vascular trauma and acute limb ischemia.
• A leading center for carotid endarterectomy and stroke prevention.
• Recognized for excellence in AV access surgeries and salvage procedures for dialysis patients.

Phone: 0484 - 2851125, 0484 – 6681125 
Email: [email protected]