What is vascular surgery?
Blood is pumped away from the heart in arteries and returns via the veins. This ‘circulatory system’ is essential for providing organs with essential oxygen and other nutrients they require to function. Problems arise when blood cannot flow smoothly through this system. Vascular surgery is a branch of medicine that specialises in the diagnosis and treatment of blood vessel disorders. Vascular surgeons are the experts that specialise in providing a range of treatments, including surgery, to maintain the function of the body’s circulatory system.
Vascular surgery at the Royal Free Hospital Private Patients Unit
Here at the Royal Free Hospital Private Patients Unit (PPU) we offer a wide array of vascular services, provided by our multidisciplinary team of leading specialists. The PPU combines the convenience, comfort and personalised attention of a private hospital with the very best state-of-the-art services, technology and professional experience expected from a top London NHS teaching hospital.
We are unique in that all of the profit that is made each year is reinvested back into the NHS services at the Royal Free Hospital trust, and this contributes to the world-class care that our hospitals provide.
Conditions we treat
Our specialists and their teams are trained to provide a high standard of care for a variety of vascular problems, including:
Peripheral arterial disease (PAD)
This describes a narrowing of the arteries supplying the limbs due to build-up of fatty deposits or ‘atheroma’. It usually develops in the legs, initially causing pain when walking, known as claudication, but can progress to rest pain, ulceration and even gangrene. PAD commonly affects people over the age of 50 years, occurring in up to 1 in 5 men and 1 in 8 women within this age group. Smoking, high blood pressure, high cholesterol and, in particular, diabetes are major risk factors.
These are sections of veins just beneath the skin that lose their elasticity and become dilated with time. In many people, they are often unproblematic but unsightly and uncomfortable. However in some, severe varicose veins cause pain, skin changes, ankle ulceration or bleeding.
Deep vein thrombosis (DVT)
DVT is caused by a clot within a vein, usually in the leg. It occurs when blood is static for too long due to a period of immobility, such as following surgery or on a long-haul flight, or in situations where the blood is prone to coagulation. People over the age of 60 years and some pregnant women are at the greatest risk.
Abdominal aortic aneurysm (AAA)
This is a condition of the aorta (the main artery from the heart that runs through the chest into the abdomen). An aneurysm occurs when a weakness in the wall causes the artery to enlarge due to the constant pulsatile pressure inside. This is often painless and unsuspected, but is at risk of enlargement and rupturing. In the UK, a national screening programme for AAA is offered to men aged over 65 years.
This is caused by a disruption of the blood supply to the brain. It may be temporary and resolve, in what is known as a Transient Ischaemic Attack (TIA). In more serious cases, a stroke can occur, which frequently results in irreversible brain damage if not treated urgently. Strokes can be quickly recognised by using the acronym FAST: Facial weakness, Arm weakness, Speech problems, Time to call 999.
What we offer
Our vascular surgeons are trained to perform a wide array of treatments and procedures, in conjunction with our expert multidisciplinary team of specialists:
Abdominal aortic aneurysm repair
This is performed to prevent an aneurysm rupturing and involves replacement of the diseased aorta by an artificial graft. AAA repair can be performed as an ‘open’ procedure, which involves opening the abdomen. Alternatively a keyhole or ‘endovascular’ procedure replaces the diseased aorta with a stent graft from within the artery through only small cuts in each groin. Endovascular aneurysm repair (EVAR) is less invasive and recovery is faster, but there is a low risk of later complications after placement. Our specialist experts will discuss with each individual patient the most appropriate treatment options for their care and are able to answer any questions on the procedures.
Thoracic endovascular aortic repair (TEVAR)
This is a similar procedure to abdominal aortic aneurysm repair for defects higher up in the aorta, within the chest cavity. Thoraco-abdominal aortic aneurysm repair is necessary when the aneurysm extends from the chest cavity into the abdomen.
This procedure is performed to open up a narrowed artery and is commonly used to treat PAD. It is a minimally-invasive procedure that involves inserting a fine plastic tube (catheter) with a balloon on the end into the artery in the groin. The catheter is directed to the site of the blockage and the balloon inflated to open up the narrowing and restore blood flow.
This is the surgical removal of a fatty plaque that has built up within an artery and has started to restrict blood supply. Endarterectomy can be performed on the carotid arteries that supply the brain, head and neck, to prevent a stroke. It can also be used for diseased femoral arteries, which supply blood to the legs.
An alternative to angioplasty is to bypass the diseased section of artery by sewing an artificial ‘graft’ into the vessels above and below the blockage, creating a new clear route for blood to flow through. Different types of bypass are used depending on the location of the blocked artery:
- Axillo–bifemoral bypass runs from the axillary artery, under the collarbone, to the right and left femoral arteries in the top of the legs
- Fem-distal bypass graft restores blood flow from the femoral artery, which provides the main bloody supply to the leg, to the distal arteries further down in the calf and lower foot
- Fem-fem crossover graft connects both femoral arteries to bypass a blockage on one side. For example, a blocked right femoral artery can be connected to a healthier left femoral artery thereby improving blood flow to the right leg
- Ilio-femoral bypass is used for a blockage in one of the two iliac arteries. These branch from the aorta and become the femoral arteries. The procedure joins the healthier iliac artery to the femoral artery on the opposite, blocked side
- Ilio-profunda bypass runs from the iliac artery to another important artery in the leg, the profunda femoris
- Carotid subclavian bypass is used to restore blood flow to the subclavian artery, which supplies the arm, using the carotid artery in the neck
Our specialist teams will be able to identify the most suitable procedure for each individual patient and can offer information and support throughout.
When a blood clot (thrombus) or other piece of debris in an artery becomes dislodged, it will be swept into the circulation, eventually causing a blockage; this is known as an ‘embolus’. These are extremely dangerous, potentially obstructing blood flow to vital organs or to the limbs. Embolectomy/thrombectomy is a procedure to remove the clot or debris from the artery.
Varicose vein surgery
If varicose veins are problematic or unsightly and not resolving with conservative measures, such as compression stockings, they can be treated with surgery. This can either be done using a heat source to close the vein (laser or radiofrequency ablation) or injecting a medicine that causes the vein to shrink (sclerotherapy). There are many other procedures and techniques available and the specialists will discuss these with each patient.
Arteriovenous malformations (AVMs)
Some people are born with abnormal tangles of vessels that have not formed correctly. These ‘AVMs’ are often disfiguring, painful and can lead to bleeding and other major problems. They can be treated with a variety of techniques including surgery, embolisation to block off the troublesome vessels, or in some cases medication.