Vascular (blood vessel) disorders treated by vascular surgery include varicose veins, blockages and narrowings in the arteries or abnormal swellings of the arteries (aneurysm). The most common of these venous conditions facing the vascular surgeon is varicose veins. This occurs when veins in the legs and thighs become enlarged and twisted. This is often caused by the failure of the one-way valve system in the veins, in which case it can be treated surgically by removing the segments of veins containing the malfunctioning valves as well as those veins which are significantly dilated. Arterial problems can be due to blockages, narrowings or dilatations (swellings). Treatment for each problem, depends on the site of the artery and the underlying pathology. Patients medical condition will be taken into consideration when offering treatment options. New endovascular treatments are also available depending on the suitability of the artery, situation and pathology.

This is the dilatation or ballooning of a section of the aorta which is the main artery coming out of the heart. An aneurysm usually occurs because of an underlying weakness in the wall of the aorta at that point. Very often you will not have any symptoms from the aneurysm and it may only be discovered through a chest x-ray or CT scan. If the aneurysm begins to get larger or leak, you may experience chest or back pain. If there is a risk of the aneurysm bursting, surgery will be required.

You have two carotid arteries, one on either side of your neck, that supply blood to your brain. Carotid artery disease occurs if these arteries become narrowed due to atherosclerosis (a build up of fat and cholesterol deposits on the inner walls of the vessels). If a clot forms in one of the carotid arteries and reduces or stops the flow of blood to part of your brain, it may cause a stroke. You have an increased risk of developing carotid artery disease if you: · have a family history of atherosclerosis · smoke · have high blood pressure (hypertension) · have diabetes · have coronary artery disease. Treatment may involve lifestyle changes e.g. stopping smoking, exercising more, dietary changes and/or medication. If there is severe narrowing of the arteries, treatment may involve surgery.

Peripheral arterial disease refers to the narrowing of arteries outside the heart and brain, usually as the result of atherosclerosis or "hardening of the arteries" (a build up of fatty deposits on the inner wall of arteries). When the arteries become narrowed, the flow of blood to the target organs or tissues is reduced. The arteries commonly affected are those carrying blood to the kidneys, stomach, arms and legs. Peripheral arterial disease often appears first in your legs, with the most common symptom being dull, cramping leg pain that occurs when exercising but stops when you stand still. This is known as "intermittent claudication". Treatment for peripheral arterial disease may involve medication and/or surgery.

These are bulging veins that lie just beneath the skin (superficial veins). They occur when the walls of a vein are weak or damaged or if the valves in the vein that normally stop the blood from flowing backwards are impaired, resulting in pooling of the blood and stretched veins. Besides being unattractive, varicose veins can be painful and cause inflammation or ulceration. The following different types of surgery are available if varicose veins require treatment: Sclerotherapy – a tiny needle is used to inject a chemical solution into the vein that causes the vein to collapse. This approach is recommended for small varicose veins or spider veins that typically appear on the upper legs. You will need to wear elastic bandages or stockings over the treated area for some time after surgery. Vein stripping – the varicose veins are cut out and the veins that branch off them are tied off. The cuts (incisions) made in the skin are closed with sutures or steristrips. You may need to wear elastic bandages or stockings over the treated area for some time after surgery. This procedure requires anaesthesia. Phlebectomy – small cuts (incisions) are made in the leg and the varicose veins are pulled out with a tiny hook-like instrument. The cuts are closed with tape rather than sutures and, once healed, are almost invisible. You may need to wear elastic bandages or stockings over the treated area for some time after surgery. This procedure requires anaesthesia.

Vascular ulcers are open wounds on the skin that do not heal or that keep coming back once they do heal. They occur because there is not enough blood being supplied to the skin to heal injuries that may be caused by minor trauma or pressure. Arterial or ischaemic ulcers are usually the result of atherosclerosis or "hardening of the arteries" (a build up of fatty deposits on the inner wall of arteries). When the arteries become narrowed, the flow of blood to the tissues is reduced. These ulcers are usually found on the toes and edge of the foot and are often very painful. Treatment for arterial ulcers may involve surgery. Venous or stasis ulcers occur when impaired blood flow in the veins causes pooling of blood in the legs. These ulcers are often associated with varicose veins. Venous ulcers are usually found on the lower leg between the knee and the ankle and the leg is often swollen and discoloured. Compression or pressure bandages are the main treatment for venous ulcers although surgery may be required in some patients.

Skin conditions dealt with by general surgery include lumps, tumours and other lesions of the skin and underlying tissues. These are often fairly simple conditions that can be dealt with by performing minor operations under local anaesthetic (the area of skin being treated is numbed). Often these procedures are performed as outpatient or day case procedures.

Carotid surgery is usually done to prevent stroke. This constitutes a "cleaning" out of the main artery in your neck taking blood to the brain. This is done through a 10 - 15cm neck incision which is not a painful operation but a delicate one, as we deal with blood that goes to your brain. I usually use a temporary shunt whilst I work on your artery and then close this with a patch to prevent blockage or narrowing. Patients usually go home in 2 to 3 days. This is a routine operation in specialist hands with minimal complications.

The abdominal aorta is the main artery from the heart to come down to your abdomen. It can get diseased and cause either narrowing, blockage or the wall can get weakened and form an aneurysm which is a common problem in smokers, usually males in the 65 to 80 yr age group. If there is a blockage this could be bypassed with a graft or treated with a stent. If there is an aneurysm (ballooning of the wall), once it reaches a certain size it can burst (rupture) and the patient can die from this. Treatment is preferable before symptoms, either: Open Surgical repair with a graft sewn into the aorta to exclude the blood flow into the sac. This is via an incision in your abdomen and recovery usually takes 5 - 7 days OR Endovascular repair with a stent graft via a cut in the groin, the recovery is faster 2 - 3 days but not all aneurysms are suitable for this type of treatment. The shape and dimensions have to meet certain criteria to be suitable for a stent graft; your specialist will discuss this with you after first ordering a CT scan.

This is usually done for severe limb pain, arterial ulcers, gangrene or necrosis. It is usually done in the legs but very rarely in the arms. The treatment options are either: Endovascular - balloons and or stents to open up the narrowed / blocked areas in the arteries OR Surgical bypass using your own vein as a "pipe" to carry blood from above the blockage to below it. The decision regarding which type of treatment, and how, will be discussed with you after appropriate scans to road map the arteries and in consultation with your specialist. Patients MUST stop smoking and their risk factors must be controlled to get an optimal (best) result which is durable (long lasting). Ideally patients are on an anti clotting substance like aspirin, anti cholesterol medication and have good control of their blood pressure prior to treatment for best results.

Access for dialysis is done by a small incision under anaesthesia, to create a fistula in the upper limbs by connecting a superficial vein to an artery, so that it can be used for dialysis. Access for chemotherapy is by placing a Portacath, under anaesthesia, in your neck vein using an ultrasound and a Port for chemotherapy under your skin on the chest wall for puncture for the drugs to be administered.