Vascular
Introduction
A vascular surgery is a life-saving surgical procedure that is performed in any part of the vascular or circulatory system to treat certain diseases including stroke and aneurysm. To understand why it is sometimes performed, one must know how the vascular system works.
The blood is one of the most important components of the body since it transports the nutrients to different cells. Serving as “highways” are the different parts of the circulatory system namely the arteries, veins, and capillaries (or collectively known as blood vessels).
The arteries are the ones that bring blood from the heart to various parts of the body. The blood then goes back to the heart through the veins. In between them are capillaries that deliver blood to other parts.
The system also includes the heart, which is its "central" component, a hollow muscular organ found in between the lungs, and it pumps blood in between chambers. The lymphatic system works alongside the vascular system since the lymphs are composed of blood and water. Its job is to keep the lymphatic fluid in the right amount by constantly draining it.
Types of Vascular Surgery
Vascular disease is an abnormal condition of the blood vessels. Blood vessels (arteries and veins) are the tubes through which blood is pumped throughout the body. Arteries carry oxygen-rich blood from the heart to nourish every part of the body, including the brain, kidneys, intestines, arms, legs, and the heart itself. Veins carry the blood back to the heart. Problems along this vast network of blood vessels, called the vascular system, can cause severe disability and death.
Vascular disease commonly occurs at sites of turbulent blood flow, such as when the direction of blood flow in the arteries changes abruptly. The figure illustrates sites in the arterial system where this change in direction of blood flow occurs
Arch Branches supply blood to the brain through the carotid arteries, and when diseased, frequently cause life threatening strokes.
Coronary arteries supply blood to the heart and, when diseased, can block the flow of blood and cause a heart attack. This is a cardiovascular disease and is primarily managed by heart specialists – cardiologists.
Iliac Arteries supply blood to the hip and the legs and, when diseased, cause leg pain with walking (claudication), often in both legs.
Renal Arteries supply blood to the kidneys and, when diseased, can cause high blood pressure and eventually, kidney failure.
Femoral Arteries supply blood to the legs. If they become diseased, it may cause claudication, usually in the calf muscles. This lack of circulation can lead to continuous pain in the toes and foot, and may progress to critical limb ischemia (CLI).
Vascular disease affects the entire body and includes stroke, peripheral artery disease (PAD), abdominal aortic aneurysm (AAA), carotid artery disease (CAD), arteriovenous malformation (AVM), critical limb ischemia (CLI), pulmonary embolism (blood clots), deep vein thrombosis (DVT), chronic venous insufficiency (CVI), and varicose veins.
Risk Factors
Risk factors include:
- Compared to other surgeries, operations performed on the vascular system possess a higher risk. These procedures can touch on major or vital organs such as the abdomen, brain, and heart. Due to the small size of certain blood vessels, it certainly is possible to cause damage to the healthy ones, further complicating the health issue.
- Also, recovery time usually takes longer, especially if the procedure is complex or open surgery. Bruising and swelling are expected within the next 24 hours or a few days (depending on the extent of the surgery). The one thing the patient should watch out for is bleeding. Not all types of bleeding can be seen (a condition called internal bleeding), so it’s essential that patients follow after-care instructions and for doctors to continuously monitor the patient's progress.
- Some operations such as carotid endarterectomy can cause either brain damage or stroke, or sometimes it mimics the latter. Meanwhile, nerve injuries can affect not only the central area but also other parts of the body since the vascular system operates like a vast network. For instance, if a nerve in the spine is damaged, the patient may not be able to use his or her limbs.
- Depending on the findings, the doctor may recommend a minimally invasive or an open surgical procedure. An open surgery uses a huge incision usually in between the chest while a minimally invasive operation utilizes a few small incisions and a probe such as endoscope or laparoscope. These instruments allow doctors to see in real time the exact condition of the blood vessels or the organs. Then, they operate using very small surgical tools.
- People with complex and serious conditions of the blood vessels and lymph system (vascular diseases) often find the help they need vascular and endovascular surgeons. The clinic's experts provide coordinated and comprehensive treatment to people of all ages. Conditions treated include peripheral artery disease, aortic disease, mesenteric disease and carotid artery disease
Procedure
Procedure include:
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Vascular surgery encompasses the diagnosis and comprehensive, longitudinal management of disorders of the arterial, venous, and lymphatic systems, exclusive of the intracranial and coronary arteries. Diplomates in vascular surgery should have significant experience with all aspects of treating patients with all types of vascular disease, including diagnosis, medical treatment, and reconstructive vascular surgical and endovascular techniques. In addition, diplomates in vascular surgery should possess the advanced knowledge and skills to provide comprehensive care to patients with vascular disease; understand the needs of these patients; teach this information to others; provide leadership within their organizations; conduct or participate in research in vascular disorders; and demonstrate self-assessment of their outcomes.
The vascular surgeon must have advanced knowledge and experience with the management of vascular problems including: - All elements of clinical evaluation, including non-invasive testing such as plethysmography, duplex ultrasonography, magnetic resonance imaging, CT scans, angiography, and other diagnostic tests utilized in the diagnosis of vascular disease.
- Comprehensive management of vascular disease to include screening and surveillance, medical management, drug therapy, risk factor management, and wound management including amputations, as well as other adjunctive procedures.
- Indications and techniques relating to the open and endovascular treatment of vascular disorders, to include the entire spectrum of interventions used to treat vascular disorders, including such disorders as occlusive, aneurysmal, and inflammatory disease, trauma, and neurovascular compressive syndromes involving the arteries and veins of the body (excluding the intracranial and coronary arteries). These include the aorta and its branches, as well as the arteries of the neck, pelvis and upper and lower extremities, and the venous system.
Range of Treatment Cost
| Procedure | Min Cost ₹(INR) | Max Cost ₹(INR) |
|---|---|---|
| Peripheral Vascular Surgery | 491546 | 529358 |
| Pulmonary Endarterectomy | 300000 | 500000 |
| Peripheral Bypass Surgery | 478113 | 678113 |
| Aortic Aneurysm Repair | 1500000 | 2000000 |
| Aneurysmectomy | 1500000 | 2000000 |
| Arteriovenous Fistulas | 6000 | 10000 |
| Cholesterol Embolism | 200000 | 250000 |
| Internal Jugular Vein Thrombosis | 100000 | 200000 |
| Osler-Weber-Rendu Disease | 50000 | 100000 |
| Balloon Angioplasty | 100000 | 300000 |
| Renal Artery Aneurysm | 70000 | 120000 |
| Renal Vein Thrombosis | 20000 | 175000 |
| Stent Surgery | 200000 | 600000 |
| Arterial Bypass Surgery | 300000 | 500000 |
| Pulmonary Embolism | 203189 | 403189 |
| Carotid Artery Disease | 178381 | 378381 |
| Carotid Endarterectomy | 136034 | 436034 |
| Renovascular Conditions | 136034 | 200000 |
| Stent Placement Surgery | 200000 | 400000 |
| Carotid Artery Stenosis | 200000 | 300000 |
| Stroke | 604980 | 900000 |
| Varicose Vein Surgery | 500000 | 700000 |
