Vascular Surgery Clinic in Budigere, Bangalore

Treatment and Procedures

1. Varicose Veins

Varicose veins are enlarged, twisted veins that typically appear blue or purple in color and are commonly found in the legs. They occur when the valves within the veins weaken or fail, causing blood to pool and the veins to become swollen and distorted. In many cases, varicose veins are simply a cosmetic concern. A very common, mild form of varicose veins is called spider veins. Varicose veins can sometimes cause aching pain and discomfort and may lead to more serious health problems. Management involves exercising, raising legs when sitting or lying down, or wearing compression stockings. 

A venous Doppler ultrasound is usually performed to confirm varicose veins. It's a painless procedure utilising sound waves to observe the blood flow through the valves in the veins. It can help find a blood clot. If simple management doesn't help, doctors may consider surgeries or other procedures to close or remove veins. 

• In sclerotherapy, a solution is injected into the varicose veins to close and scar them. 

• Laser treatment uses bursts of light to make varicose veins fade without cuts or needles. 

• Catheter-based procedures, which employ radiofrequency or laser energy, are used to treat larger veins by causing them to collapse. 

• High ligation and vein stripping tie off and remove veins through small cuts in an outpatient procedure. 

• Ambulatory phlebectomy removes smaller veins through tiny skin pricks with minimal scarring.

2. Peripheral Vascular Disease

Peripheral Vascular Disease is an arterial condition that affects the blood vessels outside of the heart and brain. PAD occurs when arteries become narrowed or blocked by atherosclerosis, a buildup of plaque made up of fat, cholesterol, calcium, and other substances. Usually, the patients with PAD are asymptomatic. But, in some cases, patients may experience a painful ache in their legs as they walk, which disappears after a few minutes' rest. In medical terminology, this is called intermittent claudication. A consultation is needed if the patient experiences recurring leg pain during exercise.

Your vascular surgery doctor will diagnose this condition using the ankle-brachial pressure index (ABPI) test. It involves measuring blood pressure in your upper arms and ankles using a cuff and a Doppler probe. The doctor will divide the blood pressure results from the ankles by the first results from the arms. If the patient has PAD, the blood pressure in the ankle is lower due to reduced blood supply. Further testing involves ultrasound testing and angiogram.

PAD can be managed with lifestyle changes and medication therapy like thrombolysis; however, in extreme cases, revascularisation procedures may be required, such as angioplasty and artery bypass graft.

3. Vascular Access Salvage

Vascular access salvage is a procedure used to restore the function of blocked or failing vascular access sites, such as an arteriovenous fistula (AVF), arteriovenous graft (AVG), or central venous catheter (CVC). These are crucial for delivering life-saving treatments like hemodialysis in patients with end-stage renal disease (ESRD). When they malfunction, it can significantly impact a patient's quality of life and treatment options.

Types of salvage procedures:

• Endovascular techniques: These minimally invasive procedures use catheters and imaging guidance to remove clots and restore blood flow. Examples include balloon angioplasty, stenting, thrombolysis, and aspiration thrombectomy.

• Surgical techniques: Open surgery is also done to repair or replace the AV fistula or graft to optimize blood flow. 

Why do we need this procedure?

• Preserve native vessels: By repairing existing AVFs or AVGs, the need to create new access sites, which can be more complex and have higher complication rates, is avoided.

• Reduce reliance on central venous catheters (CVCs): CVCs carry a higher risk of infection and complications compared to AVFs and AVGs. Salvage procedures can help patients transition away from CVCs or avoid them altogether.

• Improve treatment outcomes: Ensuring well-functioning vascular access is essential for effective dialysis as well as chemotherapy delivery.

4. Endovenous Laser/Radio Frequency Ablation

Radiofrequency ablation (RFA) is a pain management technique that uses heat to destroy tissue. A precisely placed needle is used to send radio waves to heat the nerve area, which prevents pain signals from being sent back to the brain. RFA is commonly considered for long-term pain conditions, especially those affecting the neck, lower back, or arthritic joints that have not been successfully treated with other methods.

Procedure:

• Your doctor will use a local anaesthetic to numb the area of your skin where a needle will be inserted.

• A thin needle will be inserted into the area where you feel pain.

• The needle placement will be guided by a special real-time continuous X-ray called fluoroscopy.

• Once the needle reaches the intended site, your doctor will do a test to confirm it's in the proper position.

• A local anaesthetic will be injected through the needle to numb the target area.

• A radiofrequency current will be sent through the needle to heat the identified nerve portion.

• The current will destroy that nerve area, stopping it from sending pain signals to your brain.

• This helps to alleviate the pain of people who suffer from chronic pain conditions.

5. Thrombolysis

Thrombolysis is a medical therapy that is utilised to remove blood clots that can lodge inside the blood vessels of the body. The treatment focuses on breaking down blood clots to restore normal blood flow. Tissue damage owing to the lack of circulation can also be prevented with thrombolysis. 

In Vascular surgery, our vascular surgeons at Manipal Clinics Budigere perform thrombolysis for the treatment of Deep Vein Thrombosis (DVT) or Peripheral Artery Disease (PAD), apart from strokes and heart attacks. Deep Vein Thrombosis is a serious condition characterized by the formation of blood clots within the deep veins of the body, typically in the legs. PAD is a circulatory condition that occurs when arteries become narrowed or blocked by atherosclerosis, a buildup of plaque consisting of cholesterol, fatty deposits, and other substances on the artery walls. 

Procedure:

The technical procedure of the thrombolysis treatment is based on the application of thrombolytics. These drugs use plasminogen, a natural substance present in the blood, to break down the clots or the macroarrangements of fibrin. Activated plasminogen causes the breakdown of the clot or fibrin, and then blood flow is restored to normal. This therapy shall be done in a limited time for optimal results. It depends on the situation and individual factors such as the timing of clot formation and symptom onset.

6. Vascular Medicine

Vascular medicine is a diverse field that specialises in diagnosing and treating conditions affecting the blood vessels throughout the body. It largely deals with problems with the heart, blood vessels, and lymphatic system. Vascular medicine also addresses venous issues, such as blood clots. In addition, vascular medicine manages high blood pressure – which is the cause of various vascular problems. 

Vascular Medicine involves a wide array of treatments ranging from lifestyle modifications, and medication management to surgeries and preventive care strategies, tailored to each patient's specific needs. Treatments are prescribed on a case-to-case basis, depending on the nature and severity of the condition. Our vascular surgeons in Budigere specialize in the medical management of vascular disorders, including conditions such as peripheral arterial disease (PAD), deep vein thrombosis (DVT), chronic venous insufficiency (CVI), vasculitis, and aneurysms. 

Some of the interventions performed by our vascular surgery doctors at Manipal Clinics Budigere, Bangalore include:

• Angioplasty, Angiography, & Stenting

• Bypass surgery

• Aneurysm repair

• Carotid endarterectomy

• Endarterectomy

• Sclerotherapy

• Dialysis access

• Lower limb revascularisation

• Thoracic outlet surgery

• Thrombolytic therapy

• Aortocaval fistula repair

• Arterial bypass grafts

• Laser surgery

• Atherectomy

• Thrombectomy

• Ablation

7. Arteriovenous Malformation (AVM) Treatment

An Arteriovenous Malformation (AVM) is a condition with abnormal entanglement of blood vessels, leading to problems with the connections between arteries and veins. AVMs are commonly found in the spinal cord and brain, but they can also develop in other body parts.

AVMs pose a potential risk of haemorrhage, which can be fatal in some cases. Although most bleeding episodes are not severe enough to cause significant damage and go unnoticed, some may result in massive bleeding. 

• AVMs that have bled once are more likely to bleed again, especially within the first year, and smaller AVMs have a higher chance of bleeding. 

• AVMs with narrow or deeply located veins are more prone to serious haemorrhage. Haemorrhage in deeply located AVMs usually causes more severe damage than the ones on the surface of the brain or spinal cord. 

• Pregnancy increases the likelihood of clinically significant haemorrhage due to the increase in blood pressure and blood volume.

Diagnosis and Treatment:

The following techniques are used in diagnosing this condition:

• Cerebral angiography 

• Computed tomography (CT)  

• Magnetic resonance imaging (MRI)  

• Magnetic resonance angiography (MRA) 

• Transcranial Doppler (TCD) 

Arteriovenous Malformations can be treated in multiple ways, as follows:

• Surgery: Surgical removal of the AVM is a possible treatment option. However, this approach is often considered for smaller and more accessible AVMs. The surgeon removes the abnormal vessels to restore normal blood flow. 

• Endovascular Embolisation: This is a minimally invasive procedure performed by Vascular Surgeons and Interventional Radiologists at our Budigere clinic where a catheter is threaded through the blood vessels to the site of the AVM. A substance, such as glue or tiny coils, is then injected to block off the abnormal vessels and reduce blood flow. This procedure is often used in conjunction with other treatments.

• Radiosurgery: High doses of focused radiation are directed at the AVM to damage and close off the abnormal vessels over time. This is a non-invasive option that can be suitable for some AVMs, particularly those in challenging locations.