Vascular and Endovascular Surgery
Vascular surgery is a nascent surgical subspecialty in which diseases of the vascular system, or arteries and veins are managed by medical therapy, minimally-invasive catheter procedures, and surgical reconstruction. The department of Vascular and Endovascular Surgery at Amrita offers comprehensive care to patients ailing from diseases affecting all parts of the vascular system except those of the heart and around the brain, right from their diagnosis to providing state-of-the-art therapeutic strategies.
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 ischemia 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.
- Peripheral balloon angioplasty with or without stenting
- 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
The division also works in unison with the Podiatry services 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.
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. Effective treatment generally entails removal of the abnormal vein surgically (ligation and stripping) or catheter based (endovenous) minimally invasive thermal ablation, the latter being the standard of care in the present era. Endovenous therapies 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.
- Endovenous Laser therapy (EVLT) /RF ablation
- Surgical ligation and stripping
- Ambulatory hook phlebectomy
- Ultrasound guided Foam sclerotherapy
- Compressive therapy
AV Access Surgery
Chronic kidney patients on maintenance hemo-dialysis require a permanent AV access creation in the upper limbs for the same. The division has a busy AV access program with large number of in-house and external referrals. 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.
- AV fistula operations
- Complex AV fistulae (superficialisation, transposition, translocation)
- AV graft placement
- Salvage of failing AVFs via surgical and endovascular modalities including central vein venoplasty/stenting
- Treatment of access problems like pseudoaneurysms, thrombosis or steal
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.
- Bypass surgery
- Catheter-directed thrombolysis (CDT)
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.
- Carotid endarterectomy
- Carotid body tumour removal
- Carotid aneurysm repair
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.
- Open repair
- Endovascular repair (EVAR and TEVAR)
- Hybrid repair
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 treatment of pseudoaneurysms are also provided.
Other Vascular Pathologies Treated
- Deep vein thrombosis
- Chronic venous insufficiency
- Thoracic outlet syndrome
- Vascular Malformations
- Mesenteric and reno-vascular disease