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Vascular Diseases & Vascular Surgery

What is vascular surgery all about?

 
Peripheral Vascular Surgery is an evolving surgical superspeciality in India unlike in western countries where it it an independent  full fledged superspeciality. This field has rapidly evolved over the last hundred years with major advances occurring during the II World war. 

Vascular bypass operations in the leg preceded “heart bypass” operations much before. Vascular Surgery is a highly specialized field that deals with all the blood vessels in the body other than the ones in your heart or your brain. Arteries carry pure( oxygenated) blood from the heart to various organs and veins return impure( deoxygenated) blood back to the heart. The diseases related to these arteries and  veins are addressed by vascular surgeon.. Vascular manifestations in different parts of the body are variable and this makes the specialty a complex, challenging one. A vascular surgeon truly speaking is a “vascular specialist” since his expertise encompasses not only surgical procedures but also  vascular medicine. Vascular medicine is infact an upcoming independent subspeciality in western setups as people realize that the vascular surgeons are burdened with the surgical aspect of it. Hence vascular surgery remains one of the few  medical fields today which delivers complete seamless care to patients under one roof.

How big is the problem?

What would be the magnitude of peripheral arterial disease of the legs in India alone? Since we are catching up with our western colleagues in the field of  patient auditing  , the available data of  Indian population suffering from vascular disorders is as below:
 

India alone has a population of more than 40 millions as diabetics About 1000 per million will develop Advcanced ischaemia, which generally means an impending amputation if no vascular surgical procedure is Contemplated. It suffices to say that vascular disordrers not only end up  damaging your limb but they may also cause a heart attack or paralysis because on an average two third of the patients having peripheral vascular disease do  have coronary artery disease meaning the vessels of the heart are also diseased. These chances of a diabetic losing a limb due to compromised blood flow is quite high.On an average a diabetic who has already lost one of his legs the chances of losing the other leg is 50% in the next 5 years.

Among rest of the population about 40,00,000 will develop peripheral vascular disease. These patients need proper vascular care so as to halt the progression of the disease. Venous diseases are very  common may be due to the reason that they are being diagnosed by general physicians easily due to their visibility  at first instance  especially  varicose veins and venous ulcers. Deep vein thrombosis though a very common problem ,still goes undiagnosed for the simple reason that many consider these patients to be patients of lymphaedema which is incorrect and therefore the right treatment is not instituted timely.In fact the treatment of DVT(deep vein thrombosis) a vascular condition  wherein blood clots form in your legs has changed dramatically over the years and surgeries are now performed for this disorder increasingly worldwide to remove the blood clots from the affected leg within 7 days of its presentation with satisfactory results.This not only relieves the patient of pain and swelling in the long run but also the fear of  blood clot breaking and going to the lungs is negated effectively.

What are the reasons that cause vascular problems ?

1. Smoking

2. Diabetes mellitus(Type 1&2)

3. High levels of fats (cholesterol,triglycerides)

4. Obesity,especially truncal obesity

5. Thrombophilic disorders,generally hereditary.

6. Sedentry lifestyle

7.Trauma

8.Old age

How do  vascular diseases present?

Vascular patients generally  have the following  symptoms:

1. Unbearable pain in the legs or arms

2. Discolored extremity  especially bluish black suggesting pregangrenous/gangrenous changes

3.Non healing ulcer which generally is very painful

4. TIA’s(which means an impending paralysis attack)

5.Uncontrolled blood pressure especially in young people

6.last but not the least swelling in the arms or legs .

Other diseases that fall under the domain of a vascular surgeon are mesenteric ischaemias wherein the blood supply to the organs of digestion like intestines is compromised leading to death if untreated,renal hypertension(where kidneys are the cause of uncontrolled blood pressure because of blockage of the kidney blood supply),carotid artery disease wherein the blood supply to the brain is impaired which can cause paralysis and can be fatal. Arterial aneurysms (ballooned arteries) have a tendency to rupture beyond a given size and is almost always fatal if it ruptures esp. the main blood vessel i.e aorta. All these can be corrected  with the timely intervention of a qualified dedicated vascular surgeon. ”A STITCH IN TIME SAVES NINE” holds true.

Vascular disorders  are on the rise around the world especially in developing nations like India due to a large population of diabetics which usually is uncontrolled due to the casual approach of the patient, smoking (cigarette and bidi smokers alike). Peripheral vascular disease initially affects the lower limbs and present with pain on walking initially which if ignored can lead to increase in pain on walking which may virtually end up as gangrene of the limbDoing a surgical intervention is far more successful in a  non gangrenous leg than the one which is gangrenous.This is something a patient needs to know .. Unfortunately, these patients rarely reach a qualified vascular surgeon at this stage. One of the main reasons being lack of awareness among the public and also among many of the doctors about the vascular diseases. Unfortunately many people and doctors alike perceive vascular surgeons to be cardio-vascular surgeons which is not true. A  cardiac surgeon is someone who primarily deals with bypasses of the heart and probably does bits of vascular surgery.DOING BYPASSES TILL THE DORSALIS PEDIS ARTERY IS NOT THEIR DOMAIN  as they  are too busy with their cardiac work.It is because of this reason that this speciality suffered especially in India as most of the cardiac surgeons were not interested in doing distal bypasses till the small arteries of the foot to save the leg.For this very reason this speciality was born and by now has grown by leaps and bounds... There are 60 odd  vascular surgeons in India, who are extensively trained in peripheral vascular surgery and practice only vascular surgery.Getting trained exclusively in vascular surgery not only gives you an edge over cardiac surgeons in surgeries pertaining  to peripheral  vascular surgeries like renal bypasses, mesenteric artery bypasses,bypasses till the dorsalis pedis artery to save the leg from amputation,it also gives this speciality a unique identity which is there to stay.

 
”A BLOCK HERE CAN MIRROR A BLOCK ELSEWHERE” should always be remembered. Since poorly diagnosed and untreated vascular disease can lead to limb and life loss, it is of paramount importance that public and the doctors alike should be aware of early symptoms.. Timely  therapy will not only control the disease, but will markedly decrease the complications resulting  in improved quality of life. What makes vascular surgery unique is its wide application that keeps even the assisting staff interested all the time.If on a given day you are operating on the blood vessels of the leg, The next day you are seen operating on the blood vessels of the stomach, the other day on the blood vessels of the brain, so on and so forth.Having said that I would like to highlight the most common vascular surgery performed in the world i.e carotid endartrectomy.Its a very common vascular surgical procedure done with utmost safety and remarkable results.The chances of getting a stroke are significantly reduced over the years post procedure. Its very useful especially in an Indian scenario as the cost of the procedure is half than what you end up spending in a carotid stenting procedure with equally good results if not better. Further all cases  of carotid disease do not qualify for endovascular stenting. This surgery lasts for almost an hour and the patient is generally discharged from the hospital in a day or two at the most.

AT THE END OF IT ALL I WOULD JUST LIKE TO REINFORCE WHAT I SAID EARLIER    “APPROACH THE RIGHT DOC.  AT THE RIGHT TIME FOR A STITCH IN TIME CERTAINLY SAVES NINE”

Dr Gaurav Singal

Sr. Consultant Vascular Surgeon & Chief

Institute of Vascular Sciences

IVY HOSPITAL, MOHALI