CONDITIONS WE TREAT:
PERIPHERAL ARTERIAL DISEASE (BLOCKED ARTERIES)
Arterial blockages (known as peripheral arterial disease – PAD) can affect a variety of regions in the body. These blockages are usually caused by a process called atherosclerosis, which is a build up of cholesterol plaques on the inside lining of the artery. The arteries supply oxygen to the various muscles and organs in the body, and the signs and symptoms result from a lack of oxygen to the tissues.
Limbs– blocked arteries affecting the legs can cause pain in the calves, thighs or buttocks when walking (called claudication). With severe blockages, there may be pain in the legs when lying down (sometimes relieved by hanging legs down) or skin ulcer development in the foot/leg. Arterial blockages can rarely occur in the arms.
Neck– blocked arteries in the neck (usually the carotid artery) can cause a stroke or mini stroke when a particle of a cholesterol plaque breaks off, travelling upward and blocking a small artery in the brain. Symptoms can include weakness down one side of the body (hemiparesis), slurred speech, visual disturbance, or facial droop on one side. Sometimes it is advisable to treat a blocked carotid artery to reduce your risk of having a stroke. Please see section on stroke/TIA for more information (hyperlink).
Gut– blocked arteries to the gut (small and large bowel) can cause pain after eating a meal and also undue weight loss.
At YVS we treat arterial blockages via a number of techniques, including endovascular, open surgery and/or medical management. We strive to ensure that the any intervention we have performed remains optimised. To this end, we arrange regular follow up ultrasound scans and assess the patient’s response to the treatment.
ARTERIAL ANEURYSM (ENLARGED ARTERIES)
An aneurysm is a ballooning of the wall of an artery, which often develops over time. It often is associated with age and high blood pressure. Sometimes the aneurysm can result from an injury or previous procedure. The risk of having an aneurysm is that it may burst, causing significant internal bleeding which may be life threatening. Aneurysms can occur in almost any artery in the body, and are often managed with regular scans to monitor the size, which may or may not increase, and treatment if it gets to a relatively large size.
At YVS, we treat arterial aneurysms via a number of techniques, including endovascular, open surgery and/or medical management. For smaller aneurysms, we regularly monitor the size of the aneurysm via ultrasound to determine if surgical treatment is required. After an aneurysm is repaired, we ensure the intervention remains optimisedfollow up appointments to monitor the aneurysm routine follow up before and after the aneurysm is repaired to
ARTERIAL DISSECTION (TEAR IN THE ARTERY)
An arterial tear (also called dissection) can occur in the inner lining of the arterial wall, which is made of three layers. It may be caused by a traumatic injury, or be associated with high blood pressure, or related to a prior procedure. It can cause a ‘tearing’ back pain or chest pain in the acute setting, or may not cause any symptoms at all if it is chronic in nature. Arterial tears can occur in any part of the body, and are often monitored over time to assess if the affected vessel degenerates, requiring surgical treatment.
At YVS, we are experienced in the management of arterial tears. An acute tear will often be a clinical emergency requiring inpatient evaluation and management. Chronic tears may require treatment, and if so generally require complex planning to ensure the most durable repair.
ARTERIAL THROMBOSIS (CLOT IN THE ARTERY)
Blood clots more commonly form in veins than arteries, due to the slower flow in veins. There are a number of conditions which can cause blood clot to form in arteries, and these either form directly in the affected artery, or form upstream and get carried by the blood flow, thus blocking an artery downstream.
At YVS, we carefully assess the patient to determine the precise cause for an arterial blood clot. In appropriate cases, we aim to eliminate any fresh blood clot expediently to restore function to the limb or organ that is threatened. It is often crucial to initiate medication in order to prevent the clot from occurring again. Sometimes specialised investigations and physician consultation is required to fully manage the underlying condition.
STROKE / MINI STROKE / TIA
Carotid artery narrowing is a condition that can have serious implications. The carotid arteries are located in the neck, and supply blood to parts of the brain, in conjunction with other arteries. If there is a significant amount of cholesterol plaques in the carotid artery, there is a risk of a piece of that plaque breaking off, traveling up the artery, and causing a blockage in one of the small arteries of the brain. This can cause a stroke or a mini stroke (also called a TIA). Symptoms of stroke or mini stroke include loss of power on one side of the body (hemiparesis), slurred speech, facial droop, or visual disturbance.
At YVS we take this condition very seriously. For patients who have had a stroke or TIA, we will consider surgical intervention if there is significant carotid artery narrowing. In some cases, there is an indication to intervene on carotid artery narrowing even where there has been no previous stroke. We generally follow up patients with carotid artery disease (or those who have had surgical treatment on their carotid arteries) on a regular basis.
DIABETIC FOOT ULCER
Diabetes is a condition with wide ranging implications. Diabetic foot ulcers have the potential to cause significant impact on quality of life, and should be treated promptly and effectively. Ulcers often result from a number of different consequences of diabetes. These include blocked arteries of the leg and foot, changes to sensation causing inadvertent bruises and scratches, impaired wound healing, and retinopathy causing falls which can result in lower limb wounds.
At YVS, we specialise in treating all aspects of diabetic foot ulcers. We prioritise management of the condition as well as prevention of further ulcers. A multidisciplinary approach is critical in this condition. Please refer to our page on ulcers (hyperlink)for more information
CHRONIC KIDNEY DISEASE
Chronic kidney disease (CKD) is a condition that requires multidisciplinary management. In the early stages, there may be no symptoms. In later stages of the disease symptoms may include nausea, vomiting, loss of appetite, and fatigue. Patients can also experience swelling of feet, shortness of breath and can suffer from high blood pressure.
At YVS, we have a strong emphasis on maintaining a sound relationship with the specialist (nephrologist) involved in managing the patients kidney disease. We offer a number of solutions for management of the late stages of CKD, including dialysis access (Vas-cath, Perm-cath, arterivenous fistula, and arteriovenous grafts) and renal transplantation.
Varicose veins are common and present in many forms and varying degrees of severity. These can range from spider veins to large ropy veins, minor eczema to venous ulcers. Given the wide range of disease presentation one treatment does not fit all.
At Yarra Vascular Surgeons you will receive a comprehensive evaluation which includes, in most locations, an on site venous ultrasound scan. After a thorough assessment of your condition and investigations, our vascular surgeons will advise you on the optimal treatment option for you. In some cases, all that the patient requires is reassurance that the veins are not of any clinical concern whilst in others treatment is required in order to prevent further deterioration.
Our surgeons are highly skilled in the performing both minimal invasive varicose vein treatments (endovenous ablation and sclerotherapy) and open varicose veins surgery which in some individuals is still the best option.
DEEP VEIN THROMBOSIS
Deep vein thrombosis or DVT is clot formation within the deep veins. Thousands of Australians suffer from DVT every year. The vast majority are successfully treated with only blood thinning medication with good outcome. Sadly some patients suffer with very extensive clot formation involving the veins in the chest and abdomen. Most of these patients develop longterm problems with obstructed veins. Leg swelling, pain on walking, skin changes and even ulcers are some of these long term complications.
Thanks to the latest technology, we can help some of the patients with acute (usually less than 3 weeks) extensive DVTs (iliofemoral) by removing the clot using minimally invasive techniques. This shortens the recovery period and reduces the severity of their symptoms.
Patients who have had extensive DVT in the past may have persistent obstruction of the central veins and now suffer from 'post thrombotic syndrome' or PTS. PTS symptoms include leg swelling, pain in the legs, skin pigmentation and even ulcers. In the last decade significant advances have been made in both how we investigate these patients and how we can potentially treat these 'blocked veins'. We can now 'look' inside these veins using intravascular ultrasound (IVUS) and gain valuable information about the content and caliber of these veins. We also have access to the latest in stents designed specifically for veins. With these advances and the skills that we have developed in treating these obstructed veins - we are now able to help many patients with post thrombotic syndrome.