Coronavirus: vascular surgery update
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We offer a number of specialist vascular services. Please open the tabs below to find out more information.
An aneurysm is a bulge in a blood vessel, caused by a weakness in the blood vessel wall.
Aneurysms may affect the aorta in both the chest and the abdomen. Aneurysms affecting the infrarenal aorta can be treated with open surgery or with a stent graft.
Abdominal aortic aneurysms
We offer endovascular aneurysm repair in the emergency setting for patients with ruptured aneurysms.
Currently the mortality rate from open repair and endovascular aneurysm repair it is 0.5%
Thoracic aortic disease
Our service has one of the largest experience in the UK of treating aneurysms of the thoracic aorta with covered stents.
We started our thoracic stenting programme in 1998 and have an international reputation for the endovascular treatment of aortic dissection, thoracic aneurysms and aortic transection.
Thoracoabdominal aortic disease
We have a large specialist endovascular service for complex aortic disease. This was set up in 2009 and is now one of the leading centres in the UK, with excellent outcomes.
It's possible to treat extensive aneurysms with ‘custom-made’ stent grafts with holes and branches built-in to accommodate the arteries that supply the kidneys and bowel and avoid extensive open surgery.
Aortic dissection is a condition that occurs when there is a tear in the lining of the aorta. It is associated with hypertension (high blood pressure) and is usually diagnosed by CT scan. Patients with this condition usually describe a sudden onset of a ‘tearing’ chest pain. The tear can affect different parts of the aorta and if it affects the ascending aorta patients are treated surgically by the cardiac team.
Uncomplicated dissections of the descending thoracic aorta can be managed medically, but there can be complications such as rupture or occlusion of important blood vessels. These can now be treated endovascularly with covered stents inserted under anaesthetic given as an epidural. This treatment was pioneered at Guy’s and St Thomas’ and is safer than open repair.
We offer a full range of treatment for patients with cerebrovascular disease.
- a stroke unit staffed with stroke physicians, and imaging techniques with duplex ultrasound
- magnetic resonance angiography (MRA) which is a study of the blood vessels using magnetic resonance imaging (MRI)
- computed tomographic angiography (CTA), which is an examination using x-rays to visualise blood flow in arterial and venous vessels throughout the body.
All patients are discussed at regular neurovascular meetings with neurologists, angiologists, surgeons and radiologists to decide the best treatment option.
Treatment for carotid stenosis (narrowing of the carotid arteries) may be performed with endovascular stenting or open surgery.
Peripheral vascular disease
Patients with blockages in their blood vessels are investigated with duplex ultrasound and with either magnetic resonance angiography (MRA) which is a study of the blood vessels using magnetic resonance imaging (MRI) or computed tomographic angiography (CTA), which is an examination using x-rays to visualise blood flow in arterial and venous vessels throughout the body.
Blockages can be treated by endovascular (minimally invasive) or surgical techniques, such as angioplasty, stenting and arterial bypass surgery. We have a team of endovascular surgeons and interventional radiologist who a large range of experience in managing these problems.
We also work with a large team involving diabetes, foot health, infectious diseases, specialist nurses and physiotherapists.
Patients admitted to hospital under the vascular team are also looked after jointly with dedicated physicians such as the Pops Team who provide care and support to manage other medical issues patients may have.
We have a dedicated vascular physiotherapy/rehabilitation team who provide intensive inpatient physiotherapy following surgery. We also have an Amputee Rehabilitation Unit which is on offsite facility for enhanced recover for patients who have lost a limb.
Treatment for simple varicose veins includes injection and foam sclerotherapy, endovenous laser ablation (radiofrequency ablation/ laser ablation)and traditional surgery.
Many complex venous problems are treated in the vascular unit with thrombolysis used for acute ilio-femoral deep vein thrombosis and venous stents used for occlusive venous disease.
Some patients with severe problems need reduction operations. There is now increasing use of tumescent liposuction for the management of lymphodema. Research performed by the academic unit has shown a genetic basis for lymphoedema.
These complex problems can be investigated with magnetic resonance angiography (MRA), which is the a study of the blood vessels using magnetic resonance imaging (MRI), and digital subtraction angiography. Treatment can be by endovascular embolisation and/or open surgery.
Deep venous disease and DVT
Deep vein thrombosis (DVT) is a blockage of the main veins draining the legs or arms (most commonly legs).
Guy's and St Thomas' has one of the largest programs in the country for the treatment of patients with fresh blood clots (acute DVT) and those who have developed a condition called post thrombotic syndrome (PTS) which is the result of damage to the veins after a DVT.
PTS is characterised by chronic leg/arm pain, swelling, cramp and in the leg development of venous ulceration. It is commonly found that in patients with extensive acute DVT or PTS that they have an underlying condition called May Thurners/Cocketts Syndrome.
We are at the forefront of research and development of new treatments for both acute DVT and PTS.
Our patients are treated in close collaboration with a team involving interventional radiology, thrombosis and haematology.