Vascular Surgery

Whether it is treating varicose and spider veins, or performing vascular and endovascular procedures, Novomed’s specialists work with our patients to find the most suitable therapy. Our vascular surgeons have the training and experience needed to treat any problem related to blood vessels, no matter how simple or complex. They also offer the minimally invasive endovascular surgery procedures, which have a shorter recovery time and fewer complications.

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What does a Vascular Surgeon do?

A vascular surgeon looks after the health of all the veins and arteries in the body except for those of the heart and the brain, which fall under the expertise of a cardiovascular surgeon and neurosurgeon respectively.

Patients don’t only see a cardiovascular surgeon when they need an operation. Many vascular disorders are treatable with medication, or simply through lifestyle changes, such as exercising regularly. Cardiovascular surgeons are trained in all types of surgery, rather than just specializing in a few.

Varicose Veins: Types and Symptoms

What are varicose veins?

When people think of varicose veins, they normally picture twisted, bulgy colorless veins on the lower leg. However, this is not the only form they take, as varicose veins include the tiny dark purple, red, or bluish-green veins, and sometimes varicose veins aren’t visible at all.

So, what causes varicose veins? To answer this, we first need to look at how our circulatory systems work. Blood circulation starts from the heart and the blood runs throughout the body via the arteries and returns to the heart via the veins. Veins in legs are like a one-way road, controlling the return flow of the blood to the heart through small one-way valves, with the help of the leg muscles pumping to fight gravity and keep the blood moving towards the heart.

If this mechanism is compromised, for example if the valves in the veins don’t close fully or the veins weaken, the venous blood can return to the legs. This leads to increased pressure on the surface veins, which can cause the irregular and unpleasant appearance that we know as varicose veins or venous insufficiency syndrome.

Types of venous insufficiency

  • Spider veins, or telangiectasia, are smaller than 0.5 mm in diameter
  • Reticular veins are 0.5mm – 3mm in diameter
  • Varicose veins are more than 3mm in diameter

Varicose veins: symptoms

While some varicose veins are clearly visible, not all are, and in either case, you may have the following additional symptoms:

  • swelling of the feet and ankles
  • throbbing or burning in your feet or legs
  • uncomfortable, heavy legs after long periods of standing
  • muscle cramps in the legs (particularly at night)
  • thin, itchy and dry skin over the affected vein

These varicose vein symptoms can be exacerbated by warmer weather and long periods of sitting or standing.

Varicose Veins: Risk Factors

While there are some steps you can take to help prevent varicose veins, there are certain risk factors that increase your chances of developing them.

Gender Varicose veins affect women more than men. Research indicates this is because female hormones tend to relax vein walls, causing the valves to become more prone to leakage.

Genetics If a close family member has varicose veins, you are more likely to develop them.

Age As part of the natural aging process, veins begin to lose their elasticity, and the valves within them stop performing as well as they used to.

Being overweight Excess weight places increased pressure on your veins, meaning that they must work harder to send the blood back to the heart. This means greater pressure on your valves, which can make them prone to leakage.

Occupation Some studies indicate that professions that require you to stand a lot, may increase your risk of developing varicose veins.

Pregnancy If you are pregnant, the volume of blood in your body increases to help support the growing fetus, and this puts additional strain on the circulation system. In addition, increases in hormone levels cause the walls of your blood vessels to relax. In addition to these factors, your expanding uterus also exerts pressure on your veins, and all of these combine to put you at risk of developing varicose veins. However,

most women find their condition improves significantly after they give birth.

Heat In warm climates such as the UAE’s, or when immersed in a hot bath, the veins swell and open up to help cool the body down. As the veins are larger, more blood can pool in one place, thus exacerbating varicose veins.

 

Varicose Veins: Should You See a Doctor?

When should you see a doctor about your varicose veins?

Varicose vein pain: If you have pain or discomfort in your legs, or if the skin covering the veins is sore, you should see a specialist.

Aesthetic concerns: If you are bothered by the appearance of the veins, our specialists can help you. Please bear in mind that if you are seeking treatment purely for aesthetic and not medical reasons, your medical insurance is unlikely to cover the cost.

Medical complications for varicose veins

Due to the increased pressure on the veins and poor circulation in the leg, complications can arise in varicose veins:

Edema: The lower legs or ankles can swell.

Thrombosis: A superficial venous thrombosis, or blood clotting, can occur within the affected veins. Unlike deep vein thromboses (DVT) – which, as the term implies, are blood clots that develop in the deep veins of the legs – the superficial clots associated with varicose veins do not normally cause a pulmonary embolism. However, in the case of severe varicose veins, there could be a risk of DVT.

Bleeding varicose veins:As these veins are near the skin’s surface, they can sometimes bleed if you bump or scratch your leg on something.

Varicose eczema: Your skin can become scaly, flaky and red, and some sufferers develop blisters and crusting of the skin.

Lipodermatosclerosis: In this case, your skin, usually on your calf, hardens and tightens, and might turn brown or reddish.

Venous ulcers: Increased pressure on the veins can cause fluid to seep out of the vein and collect under the skin in the lower leg. This fluid can cause the skin to thicken and swell up, eventually breaking down to form an ulcer.  These ulcers are most often found above the ankles.

 

Varicose Veins: Diagnosis

A specialist will review your medical history and examine your legs for signs of bulging veins and swelling while you are in a standing position. To confirm or determine the extent of the problem, vascular surgeons have several tools to help them.

The most accurate diagnostic tool is the Doppler/Duplex Ultrasound Scan, which is standard procedure for diagnosing venous insufficiency. It is pain-free and radiation-free, using high frequency sound waves to produce an image and collect information about the direction of the blood flow in your veins, to ascertain how well your valves are working. The Doppler test can also be used to check whether there are any obstructions or blood clots in your veins.

Varicose Veins: Treatments

Not everyone with varicose veins will require treatment for their condition, although there are some instances when treatment may be necessary:

  • To ease symptoms: If your varicose veins are causing you pain or discomfort
  • To avoid complications: You require treatment if your varicose veins cause you to develop complications, such as leg ulcers, swelling or skin discoloration
  • For aesthetic reasons: Despite having no symptoms, some people want their varicose veins removed for aesthetic reasons

If your varicose veins do require treatment, the type of treatment you will receive will depend on the position, size and severity of your varicose veins as well as your general health. There are various treatment options and our vascular surgeon will be able to advise you of all your options.

  1. Non-invasive treatments

Compression stockings: Also known as support stockings are a conservative remedy for varicose veins. They come in an assortment of colors and sizes and are specially designed to squeeze your legs to improve circulation. They could also help relieve discomfort, pain and swollen legs

Supporting stockings come in different sizes and colors. Compression stockings are specially designed stockings, which steadily squeeze your legs to help improve your circulation. They may help to relieve the associated pain, discomfort or swelling in your legs. It is essential that the supporting stocking fits you correctly, so your doctor will need to measure your legs in several areas to find the correct size.

Medication: You could be given medicine for varicose veins that will work to minimize the symptoms and improve the general venous condition.

Endo-Venous Laser Treatment (EVLT):

EVLT is a type of laser treatment for varicose veins performed on an outpatient basis under local anesthetic, with the following advantages:

  • Maximum patient comfort
  • Minimal disruption; patients can resume normal activities soon after
  • Minimal pain, bruising and swelling compared to varicose vein surgery
  • Proven medical and aesthetic results
  • Short treatment period

The process is that the problem vein is punctured and laser fiber is inserted into it. The laser energy is used to ablate (destroy) the vein, and blood is redirected to healthier deep veins instead. The old vein fades away and is reabsorbed into the body.

Liquid Injection Sclerotherapy This treatment is effective for removing small-sized varicose veins, usually for purely aesthetic purposes. A special chemical is injected into the veins, using a small needle to scar and seal the veins

Foam Injection Sclerotherapy This technique can treat larger veins than liquid sclerotherapy can

Skin-type Laser Treatment Very strong bursts of light penetrate the skin to target the problem vein. This will cause the vein to gradually fade and disappear.

  1. Varicose vein surgery:

 

Miniphlebectomy This option, also known as an ambulatory phlebectomy is less invasive than vein litigation. It is an outpatient procedure done under local anesthetic and which removes superficial veins, segment by segment, through incisions in the skin so small that they do not need stitches. This technique can be done on its own or alongside EVLT.

Vein ligation and stripping Sometimes varicose vein removal is necessary, which is done surgically under general or spinal anesthesia, usually with an overnight hospital stay. As the name of the procedure implies, the problematic veins are tied off and removed.

If you’re have any questions about varicose veins treatment or you are wondering how to remove varicose veins for medical reasons, or how to get rid of varicose veins for aesthetic reasons, varicose veins prevention, how to treat varicosevein pain, or any other vein-related complaint, our excellent vascular surgeon will be able to help you.

What is an Aortic Aneurysm?

As the name implies, an aortic aneurysm is a dilation or bulge in the body’s main artery, the aorta. This bulge develops in a weakened area, which slowly stretches and bulges with the normal pressure of blood pumping though it. An aneurysm that forms in the chest cavity is called a thoracic aneurysm, while in the abdomen, it is called an abdominal aneurysm.

It is vital to identify and treat an aneurysm as early as possible, or it could prove fatal. If the aortic aneurysm is left untreated, the aortic wall will continue to weaken, and the aneurysm will grow, and could rupture. This would lead to massive internal bleeding.

If your doctor suspects you have an aneurysm, or he uncovers evidence of one during a routine test or examination, he will send you for a more specialized test to confirm it. These tests can include an ultrasound, echocardiogram, magnetic resonance imaging (MRI), computerized tomography (CT) scan, etc, depending on where the aneurysm has formed. In addition, if you are in a high-risk group, for example males over the age of 65 who smoke or used to smoke, your doctor may recommend regular ultrasound screenings to detect any aneurysms.

Treatment aims to stop the aneurysm from growing, and could include monitoring it medically (through regular check-ups and lifestyle changes), medication, or surgery.

What is Atherosclerosis?

Atherosclerosis is a narrowing and hardening of the arteries that can restrict the blood flow to your heart and the rest of your body. It occurs when a waxy substance called plaque develops in your blood vessels. Plaque consists of substances that circulate in your blood including cholesterol, fat, calcium, fibrin and so on. Eventually the plaque hardens and narrows your arteries, making it difficult for your blood to flow freely. As a result, your cells are deprived of oxygen. The artery blockage can be partial or total, and it can lead to conditions such as carotid artery disease and coronary heart disease. Once plaque has formed, there are two potential issues that could stop your blood flow completely. First, a piece of plaque could break off and get stuck in a blood vessel, or, secondly, a blood clot could start to form on the plaque’s surface.

Risk factors for developing atherosclerosis are mostly lifestyle-related, such as smoking, high blood pressure, diabetes and high cholesterol. There are numerous specialized tests to diagnose atherosclerosis, including blood tests, a stress test, electrocardiogram (EKG), echocardiography and a computed tomography (CT) scan.

Treatments aim to slow or stop the growth of plaque. A significant factor is lifestyle changes, such as quitting smoking, eating healthily and exercising regularly. Other treatments include medication and surgery.

What is a Carotid Artery Disease?

Carotid arteries are the two vessels, one on either side of your neck, that carry blood to the part of your brain that controls speech, thinking, personality, and motor and sensory functions. In carotid artery disease these blood vessels are narrowed, usually due to atherosclerosis, putting you at risk of having a stroke.

Risk factors for carotid artery disease include lifestyle issues, such as smoking, diabetes, high blood pressure and obesity, as well as advancing age and your family history.

While carotid artery disease can be present with no symptoms, there are warning signs that someone could have a stroke. The most significant is a transient ischemic attack, commonly known as a ‘mini stroke’, where a blood clot temporarily blocks a blood vessel supplying oxygen to the brain.

If doctors suspect you have carotid artery disease, they will send you for diagnostic tests that could include an ultrasound, computerized tomography (CT) scan, magnetic resonance angiogram (MRA) and others.

The treatment our specialists prescribe could include lifestyle changes, such as quitting smoking, exercising regularly and improving your diet; medication; or surgery.

What is Deep Vein Thrombosis?

Deep vein thrombosis (DVT) describes the condition where a blood clot, or thrombus, forms in one of your body’s deep veins, normallyin your legs. The affected leg could swell up, feel warm and/or appear red, although DVT can also appear without any symptoms. It can happen if you are confined to one position for a long time, or it may be the result of a medical condition that affects the way your blood clots.

DVT should be taken very seriously as a clot could break loose and travel via your blood to your lungs where it could lodge itself, a complication referred to as a pulmonary embolism.

There are many risk factors in DVT, including an inherited blood-clotting disorder, birth control pills, pregnancy, being confined in one position for long periods, and smoking. If your doctors suspect you have a clot, they will send you for tests that can include ultrasound, blood tests, venography or imaging scans. The treatment will be aimed, firstly, at ensuring the clot doesn’t grow or break off. After that, the goal will be to prevent clots forming in the future. Our vascular surgeons will work with you to determine the best course of treatment, whether it’s adopting a healthier lifestyle, or blood thinners and other medications.

What is Peripheral Arterial Disease?

Peripheral Arterial Disease (or PAD) arises when the peripheral arteries that supply blood to your head, organs and, particularly, to your limbs, become narrowed. It is often caused by atherosclerosis and can show up as pain when you walk as your legs are not getting enough blood. There are varied symptoms that include coldness in your lower leg or foot, especially, long-lasting sores on your toes, feet or legs, shiny legs and, in men, erectile dysfunction.

If you have symptoms such as leg pain or numbness, your doctor will give you a physical exam and might recommend further tests. These could include an ankle-brachial index, which compares the blood pressure readings between your ankle and your arm, as well as blood tests, ultrasound, an angiography, and the like. Doctors may also recommend routine screening if you are in a high-risk group, for example, if you are over 50 with a history of smoking.