Endovascular and Vascular Surgery, Endovenuous Laser Ablation of Varicose Veins

What is it?

Vascular surgery is the field of medicine that is concerned with the diagnosis, treatment and prevention of diseases of the arteries, veins and lymphatics.

Vascular surgery is carried out for repair of blood vessels in all parts of the body except in the heart and brain. There are two main types of vascular surgery

• Open vascular surgery reconstruction 
  • Direct repair by suturing (stitching)
  • Endarterectomy (removing the plaque that is blocking the vessel)
  • Bypass (using patient's own vein or a tube graft made of artificial material)

• Closed "Endovascular" procedures 
  • Catheters are inserted into the arteries through skin punctures.
  • Angioplasty and stenting: opening up narrowed vessels with balloons, which are inserted inside the narrowed area to enlarge the segment
  • Endoluminal stent grafting of aortic aneurysms and dissections involves putting a tube from within the artery, so that the affected area is covered with a strong layer within
  • Catheter-administered thrombolytic therapy: injection of drugs into the affected part to dissolve the blood clot
  • Vena caval filters: mechanical devices placed in the vein to prevent large blood clots in the leg veins from going to the lung arteries
  • Endovenous Laser Treatment and radiofrequency Ablation.

Why do you need this surgery?

Your Vascular Surgeon would only suggest surgery to you when your aneurysm becomes larger and carries an increased risk of sudden rupture. Your surgeon will then access the chances of aneurysm rupture versus the risks of corrective surgery and advise you accordingly.

How should you prepare for the surgery?

• Alert you doctor should you have any allergies to any medication.
• Talk to your doctor or other people who have had the surgery. Knowing what to expect may help reduce your anxiety before the operation.
• Plan for your care and recovery after the operation. Allow for time to rest, and try to get help for you day-to-day activities.

What happens during the surgery?

• For abdominal aortic aneurysm
• The abdomen is opened to expose the aorta
• Temporal clamping is done above and below the aneurysm
• Aneurysm itself is incised, opened throughout its length and any blood clot and debris is removed
• The graft is inserted so that it lies within what was the inside of the aneurysm.
• When the clamps have been removed, blood flows again through the graft and the wall of the aneurysm is closed over the graft

• For Endovenous Laser Treatment (EVLT) and Radiofrequency Ablation (RFA) are both done under local anesthesia.
  • It works by using Laser or Radiofrequency energy to heat the vein from inside, which causes it to seal shut and disappear.
  
  

What are the potential risks or complications?

• Most surgery which requires the patient to undergo under a general anaesthetic carries the risk of major complications and death
• Respiratory complications can occur as abdominal operation can discourage deep breathing and coughing
• Bleeding is a clear risk as the operation involves major blood vessels.
• For varicose vein surgery, recurrence of varicose vein and damage to the superfical nerves of the skin (causing regional numbness), scarring and darkening of the skin color may occur. In rare incidences, the deep vein system may be blocked off and cause leg swelling.
  

What happens after the surgery?

• You will go to the intensive care unit (ICU) where you will stay for the first 24 to 48 hours after operation.
• You will be fit for discharge in about 7 to 10 days.
• For EVLT and RFA, the leg will be bandaged with crepe and stockings for 2 weeks after the operation. Most often, you may return to work within a few days. After 2 weeks, you can resume normal leisure and recreational activities.

Going home

• Have a relative or friend to pick you up on the day of your discharge
• Follow up with the pre-arranged check up at the hospital with your doctor
• Full recovery should take about 4 weeks

When should you call the doctor?

Call the doctor right away if:

• You develop a fever
• You become short of breath
• You have chest pain that becomes worse despite taking painkillers

Call the doctor during office hours if:

• You have questions about the operation or its result
• You want to make another appointment
  

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