The work of the department is the diagnosis, management and treatment of vascular diseases and their complications, both elective and emergency.
Our work is predominantly composed of
- Aneurysms (Abdominal aortic, Thoracic aortic, post-traumatic)
- Peripheral Arterial Disease (atherosclerosis) (Chronic ischaemia, critical limb ischaemia, acute Ischaemia)
- Stroke Prevention
- Superficial venous insufficiency (varicose veins)
For more information on vascular diseases or procedures, go to www.circulationfoundation.org.uk
What is an aneurysm ?
Aneurysms can occur in any artery but are only common in the abdomen (aortic aneurysm) or behind the knee (popliteal aneurysm). Occasionally they can occur in the chest (thoracic aortic aneurysm) and very rarely elsewhere in the body.
Why is it dangerous ?
As the aneurysm grows slowly, it can become lined by clot, and occasionally this may cause problems with the circulation in the leg(s). This may be because pieces break off from the aneurysm and travel into the leg arteries, or because the entire aneurysm clots off suddenly which prevents blood flowing to the legs. This is more a feature of aneurysms behind the knee, and is rare in aortic aneurysms.
What are the symptoms ?
When an aneurysm is near rupture, there may be some back or abdominal discomfort, or tenderness over the aneurysm.
Rupture is accompanied by severe lower back pain, and patients often collapse or faint due to low blood pressure.
If the circulation to the legs is cut off by clot, the leg becomes cold, white and painful, then loses feeling and becomes weak or paralysed. If this is left too long, even successful treatment of the aneurysm may not save the leg.
Will it need an operation ?
When do you operate ?
What sort of operations are there ?
With the advent of keyhole techniques, endovascular repair (EVAR) is now a real option for up to two-thirds of patients. Potentially this can be performed under local or epidural block instead of a general anaesthetic, and there is less stress on the heart and lungs during the operation. However, this involves lifetime followup scans, and quite a lot of patients need secondary interventions to make sure the aneurysm remains sealed off. This can often be accomplished in the Xray department.
If I need an operation, what will happen ?
Will I get a choice ?
What other sorts of aneurysm are there ?
Aneurysms of the popliteal artery occur behind the knee. Here the risk is more about clotting than rupture, and aneurysms over 3cm are considered for repair which may be either a bypass operation or a stent.
A different sort of aneurysm called a pseudo-aneurysm can occur following surgery or treatment on the arteries. This is usually at the site of a bypass graft or where the vessel has been injured or had a needle put in. It is due to a small hole that does not seal and gradually gets larger. These usually require surgery if they enlarge or cause symptoms but we won’t discuss them further here.
Peripheral Vascular Disease: Intermittent Claudication
Your GP or a Specialist may have diagnosed you as having Intermittent Claudication. This page contains information about the condition and answers to frequently asked questions about the diagnosis, treatment and risks of peripheral arterial disease.
What is Intermittent Claudication (IC) ?
How does it usually affect people ?
Can it affect other areas ?
Why have I got it ?
Will my symptoms get worse ?
Am I going to lose my leg ?
What can I do to get better ?
Will I need an operation ?
What should I worry about ?
My pain doesn't follow the pattern
What are varicose veins ?
Why have I got them ?
What should I do about them ?
Who is surgery recommended for ?
Why doesn't everyone with varicose veins get offered surgery ?
From a non-medical point of view, vein surgery is not cost effective either., because patient expectations are so high, there is quite a lot of dissatisfaction with the end result particularly if a routine complication such as a groin wound infection or skin nerve injury occurs. This leads to significant numbers of complaints and claims for compensation which all takes money from the NHS budget, even if few are successful. Because vein surgery is subject to the same waiting time rules as cancer or life-saving surgery, there are financial penalties for not meeting these targets and vein surgery ends up costing Trusts as much as it brings in, there is no incentive to offer it.