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Southern DHB Vascular Surgery

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    Southern DHB Vascular Surgery is a district-wide service delivered from both Dunedin and Southland hospitals.

    What is Vascular Surgery?

    Vascular surgery is the branch of surgery that involves the diagnosis and treatment of disorders of the vessels that carry blood away from (arteries) and back to (veins) your heart.

    Vascular disorders include blockages and narrowings of the vessels, abnormal swellings of the vessels (aneurysm) or vessel malfunctions.

    The disease processes involved in vascular disorders often involve other body systems and your treatment may therefore require the combined efforts of other medical specialists such as radiologists and general physicians.

    Practitioners

    • Dr Jolanta Krysa

      General and Vascular Surgeon - Clinical Director
    • Dr Ian Thomson

      Vascular Surgeon
    • Dr Sarah Lesche

      Vascular Surgeon
    Procedures

    Aortic Aneurysm

    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.

    Carotid Artery Disease

    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

    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.

    Varicose Veins

    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. You will 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 will need to wear elastic bandages or stockings over the treated area for some time after surgery. This procedure requires anaesthesia.

    Hyperhidrosis

    Hyperhidrosis is excessive sweating that may occur over the entire body or only in certain parts, most commonly the face, underarms, palms of the hands and soles of the feet. It may also refer to severe facial blushing.

    This condition is caused by overactivity of the nerves that carry messages to the affected sweat glands. These nerves are part of the 'sympathetic' nervous system, which means that they are 'involuntary' or not under our conscious control.

    Treatment may be with medication or, for facial and palm sweating, may involve a surgical procedure known as Endoscopic Thoracic Sympathectomy (ETS). This is a minimally invasive procedure (it does not require a large incision or cut to be made) and involves interrupting the nerves that supply the sweat glands.

    Ulcers

    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.