Common Vascular Surgeries Performed in India

While diagnostic radiology allows doctors to see the structures inside the body and interpret the images to diagnose the disorder, interventional radiology involves treating the disorders with the help of imaging technology. 

In general, doctors who specialize in vascular surgeries and/or interventional radiology perform some of the same procedures, but their respective training, specializations, and the conditions they treat vary considerably. 

Vascular surgeons receive extensive training in both traditional “open” surgery and minimally invasive endovascular procedures. However, interventional radiologists (IRs) are only trained and certified to perform minimally invasive procedures, which may or may not be vascular disorders. IRs are experts in reading and interpreting imaging results to diagnose various medical conditions. 

• Spider veins- This problem commonly occurs in the legs and appears as bluish-colored veins. Also known as telangiectasia, spider veins may or may not have an underlying condition. But they look bad and often cause worry in people. 
• Varicose veins- It is a serious condition in which the veins in the legs become enlarged, swollen, and also get twisted sometimes due to malfunctioning of the vein valves. Varicose veins are often a sign of chronic venous insufficiency. 
• Deep vein thrombosis (DVT)– It is a condition in which blood clots start to form inside the deeper veins. DVT can cause major health issues and even lead to life-threatening complications, such as pulmonary embolism. 
• Diabetic foot ulcers- In diabetic foot ulcers, a wound appears in the leg in which the tissues start dying, giving rise to an ulcer. This disease is very common among diabetes patients. If left untreated, a diabetic foot ulcer can lead to tissue and bone death, and the patient’s leg may need to be amputated to save his/her life. 
• Varicocele- It is a medical condition in which the veins inside the scrotum become twisted and start causing problems such as swelling, pain, and mobility issues. If a varicocele is not treated for a long time, it can also lead to fertility problems. 

At mild stages, all these conditions can be treated with medications. However, in the advanced stage, the patient will most likely need surgical treatment. 

• Cramping or pain in the thighs, calves, or buttocks that subsides with rest. 
• Pain, numbness, or soreness in the toes when they are elevated 
• Discoloration of the skin in the legs or feet 
• Slow or non-healing wounds of the legs or feet 
• Swelling or inflammation in the legs or feet 
• Achiness or fatigue that increases during the daytime 
• Pelvic pain, heaviness, or pressure that is not related to a gynecologic condition 
• Ulcers may form when you cut or injure your leg 
• Veins that appear enlarged and bulge out from the skin 

Apart from these symptoms, in many cases, vascular problems may not exhibit any symptoms at all. But if you do have any of these symptoms, visit a vascular doctor promptly. 

• Angiogram or Angiography- This test is recommended to look for blockages in the blood vessels. An angiogram involves injecting a contrast dye in the vessel and creating X-ray images to examine the blood circulation in different body parts. 
• Venography or Venogram- This test involves injecting a special dye that allows the diagnostician to check the vein’s health. X-ray images of the veins are taken after injecting the dye. It helps to identify deep vein thrombosis and other abnormalities in the veins. 
• Duplex/Doppler Ultrasound- Also known as vascular ultrasound, a duplex ultrasound combines traditional ultrasound and doppler ultrasound techniques to examine the blood flow through the blood vessels. Traditional ultrasound uses sound waves to create images of the vessels. The doppler ultrasound uses sound waves to measure blood flow. This test helps to diagnose blood clots, varicose veins, and venous insufficiency. 
• CT(Computed Tomography) – This test enables the radiologist to examine the blood vessels and find blood clots closely. 
• MRI (Magnetic Resonance Imaging)- An MRI scan with contrast dye is used to produce high-quality images of the blood vessels. The contrast agent (gadolinium) used for the MRI has the ability to alter the magnetic properties of the water molecules. Thus, it provides enhanced images and helps to determine the best approach to treat the existing disease.

Usually, the tests are suggested for a patient depending on his/her symptoms. If the initial testing doesn’t provide clear results, then other tests are recommended for an accurate diagnosis.

• Vein ligation & stripping
• Thrombectomy 
• Varicocelectomy
• AV fistula

Thanks to modern technology, minimally invasive procedures have been developed that minimize skin trauma during vascular treatments. 

Endovascular Surgery

This type of surgery is called minimally invasive vascular surgery. It involves making smaller incisions to gain access to the veins and arteries. Then the endoscope, a small, thin, flexible tube, is inserted into the blood vessels to address the problem. Some common endovascular surgeries are-

These commonly performed vascular surgeries are further explained in detail below. 

Performed by a vascular surgeon and/or an interventional radiologist, the procedure involves inserting the catheter into the affected vein and using ultrasound to get clear images of the vein. Once the catheter reaches the targeted vein, the laser (present at the end of the catheter) is activated. The catheter is extracted gradually, and the laser tip ablates the vein and stops the blood flow.

The endovenous laser ablation therapy takes around 1 hour, and the patient is discharged on the same day. The recovery after this treatment is also quick. The patient can resume normal activities the next day and recover completely within 2-3 weeks.

Vein ligation and stripping surgery is performed on an outpatient basis and takes around 1 to 2 hours. The procedure involves making small incisions in the groin and lower leg. Then, an ultrasound is used to locate the vein. Once the malfunctioning vein is identified, its ends are tied up, and the vein is stripped out carefully without damaging the healthy veins.

This surgery is slightly more invasive than endovenous laser therapy. Thus, the patients require 2-4 weeks to recover completely. 

The surgery is performed by a vascular surgeon. It involves injecting a contrast dye into the affected veins to highlight the blood flow and find the blockage (blood clot). A catheter is then inserted through a small incision into the targeted vein. A deflated balloon is present at the end of the catheter. Once the catheter reaches the targeted vein, the balloon is inflated. The balloon pushes through the blood clot and breaks it to allow the blood to flow properly.

Once the vein is open, the balloon is deflated and removed with the catheter. If the blood clot is considerably large to be removed through angioplasty, stenting is also done. A venous stent is a small metal mesh tube that expands the blocked or narrowed vein walls and acts as a scaffold to keep it open. Angioplasty and stenting are performed on an outpatient basis and take around 1-2 hours to complete. 

• Systemic thrombolysis in which the blood clot dissolving medicine is administered through the IV line. 
• Catheter-directed thrombolysis in which a catheter is used to bring medication directly to the clot. 
• Mechanical thrombectomy in which a catheter with a rotating suction cup or fluid jet is used to either suction or break up the clot.

The most commonly used technique for DVT treatment is the catheter-based technique. The procedure involves making a small incision in the skin and inserting a catheter into the blood vessel. A contrast dye is also injected into the veins to locate the clot. Once the clot is located, the medication is injected directly into the clot to dissolve it.

Thrombolysis usually requires the patient to be hospitalized for 2-3 days, and the patient’s health is monitored closely. 

The procedure involves making an incision in the skin to access the blood clot. A catheter is then injected into the vessel carefully with the help of imaging. In open thrombectomy, the clot is pulled out using a balloon catheter. In the case of mechanical thrombectomy, the surgeon uses special devices to either break up the clot, dissolve it, or suction out the clot.

In some cases, thrombectomy is performed on an outpatient basis. However, in serious cases, the patient is hospitalized for several days, and his/her health is monitored continuously. 

It involves making a small incision in the groin or neck to access the inferior vena cava. A catheter is inserted into the vein leading to IVC (inferior vena cava), and a contrast dye is injected through it. Once the IVC is identified, the filter is injected. It expands and attaches itself to the vein walls, and then the catheter is removed.

This procedure takes around 30-45 minutes to complete, and the filter is left inside for about 6 months at least. The exact duration for IVC placement is determined by the vascular surgeon. 

If the foot ulcer is severely advanced, the doctor may have to reconstruct the veins and arteries in the affected area to restore the blood flow and promote healing. There are various types of vascular reconstruction techniques, such as arthroplasty, osteotomies, resection, tendon transfer, tendon lengthening, etc., that will be used to treat diabetic foot ulcers. If the ulcer has spread to the bones and the infection can spread, the limb might need to be amputated.

• Open surgery in which a large incision is made to access the twisted and swollen vein. 
• Laparoscopic surgery, in which a keyhole-sized incision is made in the lower abdomen to access the swollen veins and remove them. 
• Microscopic surgery, in which a tiny incision is made in the groin (even smaller than a keyhole) to access the varicocele and operate on it.

Besides the above-mentioned techniques, varicocele embolization is another technique that involves inserting a catheter into the leg vein or neck vein. The swollen vein is then accessed, and tiny coils of stainless steel or platinum are inserted into the vein to block the blood flow.