Vascular and Endovascular Surgery

At KIMS-Arete Hospital, the Department of Vascular and Endovascular Surgery has distinguished itself by providing cutting-edge diagnostic and treatment facilities for various kinds of problems associated with the vascular system, such as the arteries, the veins, the lymphatics, and wound care, among others.

Our exceptional vascular surgery is powered by superior expertise through cutting-edge innovative endovascular technologies such as Open Surgical Repair, Endovascular Repair (EVAR/TEVAR), Laser Ablation, VenaSeal Glue Therapy, Foam Sclerotherapy, Cosmetic Sclerotherapy, Hook Phlebectomy, Micro-extraction Hooks, Carotid Endarterectomy, Carotid Angioplasty, Stenting, etc, in performing various endovascular surgeries. 

KIMS-Arete Hospital provides much-needed relief to patients of all ages suffering from various vascular disorders such as acute limb ischemia, deep vein thrombosis, peripheral arterial aneurysms, varicose veins, vascular malformations, aortic aneurysm, thoracic outlet syndrome, peripheral arterial disease, stroke, etc through complex vascular and endovascular treatments that include blood clot removal, stenting, angiography, bypass surgery, etc. 

Apart from the management of vascular disorders, the Department of Vascular and Endovascular Surgery also collaborates with other medical departments, including neurology, cardiovascular medicine, orthopaedic, plastic surgery, radiology, and rehabilitation in procedures such as providing vascular access for dialysis, vascular access for chemotherapy, etc.

KIMS-Arete Hospital, had redefined healthcare by creating a hospital that emphasises a welcoming environment, equipped with the best of technology. The team of vascular surgeons is dedicated to the highest levels of patient care, using advanced technology to perform endovascular procedures, such as complex stenting procedures, removal of blood clots, creation of AV fistulas, and the treatment of complex conditions such as peripheral artery diseases and deep vein thrombosis.

Common Symptoms Presented at the Department of Vascular and Endovascular Surgery

• Swelling of the leg or arm: Abrupt swelling of the limbs, especially if it is accompanied with pain when standing or walking, can be a symptom of deep vein thrombosis.
• Non-healing ulcers: Non-healing ulcers usually occur on the leg due to the poor drainage of blood from the legs (venous insufficiency) and/or poor blood supply to the legs (peripheral vascular disease) etc.[BM1.1]
• Gangrene: This clinical condition is caused by stoppage of blood and causing tissue necrosis (death of tissue) and is identified by discoloured or black tissue. It could be many due to many vascular diseases such as thromboembolic diseases, vasculitis, adventitial cystic disease, etc.[BM2.1]
• Raised red, blue, purple, brown or black birthmark: Suggestive of vascular malformations of the skin. They may swell, bleed, or cause pain.[BM3.1]
• Numbness or tingling in the arm or fingers: This is a common symptom seen in thoracic outlet syndrome, especially when it is accompanied by recurring pain in the neck, shoulder, arm or hand, arm fatigue developed with activity and weakening grip.[BM4.1]
• Easy bruising: The body gets easily bruised and bleeds excessively for prolonged amounts of time, even with small cuts. This often indicates that the person is suffering from any thrombotic disorders such as deep vein thrombosis, pulmonary embolism, arterial thrombosis, etc. 

Tests and diagnostic modalities 

Computed tomography (CT) angiography:  One of the preferred diagnostic imaging studies for a variety of disease processes, CT angiography for the entire peripheral vascular system is usually done in seconds.  It is critical for the pre-procedural planning and post-procedural follow-up of several endovascular procedures, including endovascular aneurysm repair, lower extremity revascularization, and renal artery revascularization.[BM5.1]

Aortography: This is an invasive endovascular procedure which involves a contrast agent that is injected into the aorta through a catheter. It is necessary for any additional information regarding the relationship to the renal arteries, in the occurrence of renal artery stenosis, peripheral vascular disease, etc.[BM6.1]

Magnetic resonance angiography: This test combines the principle of radio and magnetic waves to scan the blood vessels in the body.[BM7.1] 

Contrast-enhanced ultrasound (CEUS):  This non-invasive imaging test has a variety of diagnostic and therapeutic applications in the field of vascular medicine, particularly in extracranial carotid arterial disease, aortic disease, peripheral arterial disease, neovascularization, etc.[BM8.1]

Intravascular ultrasound (IVUS): Also called as coronary intravascular ultrasound, endovascular ultrasound, and intravascular echocardiography, this test utilises the sound waves to assess soft tissue and evaluate arteries and veins in the body.[BM9.1]

Angioscopy: Angioscopy is necessary for the diagnosis of luminal irregularities and visual guidance of specific luminal therapy. It enhances the use of endovascular tools for the treatment of specific disorders by providing a real-time panoramic view of the lumen.[BM10.1] 

Stress test:  A stress test, (also called an exercise stress test), involves the monitoring of the determinants of heart health, such as rhythm, blood pressure, and breathing, while the patient is either walking on a treadmill or riding a stationary bike.

Our Key Subspecialties  

Specialized care is catered to patients with complex aortic, arterial, and venous conditions. With a dedicated focus on the treatment of vascular disorders, the Department of Vascular and Endovascular Surgery prioritize delivering the highest quality care to our patients, by engaging our expertise in executing the best medical, minimally invasive endovascular, and surgical treatment options; to craft patient-centred solutions, tailored to each patient’s needs. 

• Aortic aneurysms: An aortic aneurysm is a bulge that occurs in the aorta, the major artery that carries blood away from the heart, and the vascular specialists at KIMS-Arete Hospital are highly trained in swift, life-saving interventions for this very serious condition. Our doctors conduct endovascular aortic aneurysm repair (EVAR) to treat abdominal aortic aneurysms and thoracic endovascular aortic aneurysm repair (TEVAR) to treat aneurysms in the chest, using minimally invasive procedures. The doctors deploy stent grafts through a small groin cut, ensuring a shorter hospital stay and faster recovery. 
• Carotid artery disease: When the carotid arteries that carry oxygen and blood to the brain become narrowed, blood flow to the brain could deplete and potentially cause a stroke. The doctors will surgically remove plaque that builds up inside the carotid artery by making an incision on the side of the neck, over the affected carotid artery, in a procedure called carotid endarterectomy. Carotid angioplasty and stenting may be used when carotid endarterectomy isn’t possible or is too risky. Carotid body tumour excision is another procedure routinely carried out at KIMS-Arete Hospital. Early resection of carotid body tumours should be undertaken while still small to minimize the risk of neural injury, which increases with tumour size. 
• Peripheral Arterial Disease (PAD): At KIMS-Arete Hospital, the vascular surgeons are comprehensively trained for a holistic understanding of various approaches to provide flexible solutions for the wide range of disease and patient-specific factors that are encountered during the treatment of PAD. Advanced PAD leads to a decline in ambulatory function and diminished quality of life. In its most severe form, critical limb ischemia, rest pain, and tissue necrosis are associated with high rates of limb loss, morbidity, and mortality. Revascularization of the limb plays a central role in the management of symptomatic PAD by either angioplasty or limb bypass.  
• AV Fistula: The experts at KIMS-Arete Hospital, including vascular surgeons and nephrologists, conduct AV (arteriovenous) fistula creation, a surgical procedure to create a connection between an artery and a vein, for patients requiring dialysis care. AV Graft surgery, also employing a tube to connect the artery and vein, offers an alternative procedure for such patients. The multi-disciplinary and collaborative approach allow our doctors to assess the optimal timing and select the most suitable method for creating access in such patients. This is a day-care procedure which provides optimal dialysis access in 2-4 weeks with long-term reliability, resulting in patient convenience and an improved quality of life.
• Varicose Vein: KIMS-Arete Hospital, provide various options to treat varicose veins, such as Laser Ablation Therapy, VenaSeal Glue Therapy, Ultrasound-assisted open-vein surgery, Foam Sclerotherapy & Hook Phlebectomy. Most of these surgeries are typically performed as daycare procedures, with only a few cases requiring an overnight hospital stay.  
• Deep Vein Thrombosis: For patients with symptomatic acute DVT and a large clot, a minimally invasive procedure known as DVT thrombolysis is commonly performed to rapidly reduce symptoms and remove the clot from the deep veins. DVT thrombolysis involves inserting a small catheter into the leg using ultrasound and x-ray guidance. Our team of doctors also places an IVC filter, which allows the blood to flow past the filter while catching blood clots, if any, thereby stopping them from moving up to the heart and lungs. This helps prevent a pulmonary embolism. Intravenous ultrasound is used to detect blood clots or blockages in the deep veins.  
• Congenital Vascular Malformations (CVM): CVM refers to abnormally developed blood vessels, present from birth. Due to their rarity and the precision demanded for treatment, our vascular surgeons provide personalized treatment plans. They carefully assess the most suitable procedure for each patient, ensuring the best course of action. Procedures that are used to treat CVMs include intravascular embolization of the malformations with special agents, ultrasound-guided percutaneous embolization, ultrasound-guided percutaneous sclerotherapy, and surgical excision, in necessary cases. 
• Vascular Trauma Management: Management of vascular injuries, especially when they occur in combination with fractures, soft tissue loss, and nerve damage, is extremely challenging.  In most cases, an interdisciplinary approach by a specialized trauma team is necessary, and a vascular surgeon’s job is to restore the blood flow caused by thrombosis or to stop the bleeding and to perform the vascular reconstruction.   
• Diabetic Foot Treatment: The advent of emerging interventions in vascular surgery offers hope in reducing amputations and increasing limb salvage for those with diabetic feet. Left untreated, foot ulcers in patients with diabetes mellitus can progress to limb amputation. Timely intervention by a vascular surgeon can avert major limb loss. Although neuropathy complications cannot be reversed, the greatest benefit a vascular surgeon can give to a patient with diabetes is the ability to reperfuse an ischemic foot.  Our doctors recommend vascular assessment as a routine step in the management of “diabetic foot.”  
• Aortic Dissection: A tear between the innermost and middle layers of the aorta (aorta has 3 layers). There could be no symptoms, but at times it could also result in a decrease in blood flow to various organs and tissues like the kidneys, liver, etc., causing a heart attack or life-threatening internal bleeding.
• Pulmonary embolism: The formation of blood clots in the lungs, damaging them due to restricted blood flow causing decreased oxygen levels in the blood. This is the third most common cardiovascular disease after heart attack and stroke.
• Thoracic outlet syndrome (TOS): A group of various conditions in which either blood vessels or nerves are compressed in the thoracic outlet (area between the neck and shoulder). It causes shoulder, neck pain, numbness in the fingers, etc.
• Vascular graft infection: A potentially life-threatening complication that may occur after the patient underwent vascular reconstructive surgery. If infected grafts are not removed in time, they may break open, causing excessive bleeding.
• Portal hypertension: Increased blood pressure in the portal vein. It is usually due to cirrhosis (liver scarring).

Medical Treatment in Vascular and Endovascular Department 

To counter the increasing mortality and disability from vascular diseases, along with surgical revascularization, pharmacotherapy is also used to improve the patient prognosis. Clinical guidelines recommended the simultaneous prescription of several classes of drugs to treat patients who are either unfit or unwilling for the surgery. The common classes of drugs include: 

• Hypolipidemic drugs: Since hyperlipidaemia (increased lipid in blood) is a common causative factor among vascular diseases, hypolipidemic drugs (lipid-lowering drugs) such as statins, fibrates, bile-acid sequestrants, etc, are used.
• Antithrombotic drugs: If the smooth blood flow through the arteries and veins is blocked by a thrombus (clot), it results in thrombosis. Initially, antithrombotic drugs are given to reduce the risk of severe cardiac problem, such as heart attack, stroke, etc. The two classes of antithrombotic drugs include anticoagulants and antiplatelet drugs. 
• Antihypertensive drugs: While high blood pressure (hypertension) is a known factor which affects the structure of the artery wall, antihypertensive drugs are not prescribed at the first instant. Instead, the physician may advise lifestyle modification recommendations such as weight loss, regular physical exercise, and balanced diet.  Beta-blockers, diuretics, angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, calcium channel blockers, renin inhibitors, alpha-adrenergic receptor blockers, centrally acting agents, and direct acting vasodilators are the common antihypertensive drugs.
• Antidiabetic drugs: Diabetes is a potential risk factor for vascular diseases such as peripheral vascular diseases. It also increases cardiovascular risk. Aggressive treatment of diabetes reduces the risk of microvascular complications such as retinopathy and nephropathy. The common antidiabetic agents include alpha-glucosidase inhibitors, amylin analogs, non-sulfonylureas, dipeptidyl peptidase 4 inhibitors, incretin mimetics, insulin, meglitinides, SGLT-2 inhibitors, sulfonylureas, and thiazolidinediones. 

• Open Surgical Repair & Endovascular Repair (EVAR/TEVAR): The objective of EVAR is to avert the rupture of an abdominal aortic aneurysm, a potentially life-threatening occurrence. By inserting a new tube to line the aneurysm, EVAR diminishes the risk of rupture by alleviating pressure on it. Likewise, TEVAR addresses aneurysms in the thoracic or chest region of the patient.
• Treatment of Varicose veins: Our vascular surgeons excel in treating varicose veins through a range of minimally invasive procedures, ensuring rapid relief and smooth patient recovery.
  • Laser Ablation Therapy: Laser Ablation Therapy cauterizes and closes varicose veins and is a safe, less invasive method that leaves virtually no scars. It is an effective procedure that has fewer complications and is associated with much less pain during recovery. This procedure leaves no scars because catheter placement requires very small skin openings that do not need to be sutured. Most patients report immediate symptom relief.
  • VenaSeal Glue therapy: Another beneficial method is the VenaSeal Glue therapy, which uses a medical glue to seal or close the diseased vein, rerouting the blood flow to healthy veins. With time, your body will absorb the inactive veins, and they will disappear.
  • Foam sclerotherapy: In foam sclerotherapy, our doctors will use a needle to inject a special solution into the varicose vein, which will cause it to expand, stick together, and form a scar, thereby closing off the affected vein.
  • oHook phlebectomy: Hook phlebectomy uses micro-extraction hooks to remove varicose veins through a very small incision.

Scheduling a consultation with our vascular specialist will determine whether you’re eligible for these less invasive vascular surgery options or whether there is a need for traditional open vein surgery

• Carotid Endarterectomy: This vascular surgery procedure is used in the treatment of carotid artery disease, wherein the surgeon will make an incision along the side of your neck, to remove plaque that is clogging your carotid artery and then repair it with a stitch or a patch graft.
• Carotid Angioplasty and Stenting: This vascular surgery procedure involves temporarily inserting and inflating a tiny balloon into the clogged artery to widen the area so that blood can flow freely to your brain, while the stent helps prop the artery open and decreases the chance of its narrowing again. Our doctors' significant expertise in various vascular procedures allows them to adeptly address the most complex cases.
• Cosmetic Sclerotherapy: Our surgeons also treat asymptomatic varicose and spider veins near the skin's surface using foam sclerotherapy. This is often considered the treatment of choice for small varicose veins on the legs because it is fast, minimally invasive, and requires no sedation or anaesthesia.
• Peripheral vascular surgery: Peripheral vascular surgeries are few of the latest advances in vascular surgery that involve various vascular and endovascular procedures in the treatment of various conditions which effect blood vessel circulation outside the heart and brain. Over the past two decades, there has been a significant increase in peripheral interventions, with endovascular techniques potentially replacing up to 50% of traditional vascular operations. This demonstrates the benefits of vascular surgery. Wound infection, bleeding, pneumonia, peripheral nerve damage etc are few of the common vascular surgery complications.[BM13.1]
• Peripheral Angioplasty for Upper and Lower Limbs: Peripheral arterial disease (PAD) is usually caused by atherosclerosis blocking the major vessels supplying the lower extremities. Percutaneous transluminal angioplasty (PTA) is used to treat the disease. In the femoral artery, a guidewire is inserted under x-ray control; followed by a deflated balloon catheter, which is pushed forward along the guidewire to the site of obstruction. Then, inflation of the balloon releases the stenosis or occlusion.
• Aortic dissection repair: An aortic dissection is a tear (dissection) in the wall of the aorta (body’s main artery), which could be due to high blood pressure, structural heart problems, etc. There are two methods to treat aortic dissection - open-heart surgery method and endovascular method.[BM14.1] The endovascular surgery risks could include infection, pain over the vein, bleeding, bruising, nerve damage, etc
• Renal artery stenting: Renal artery stenting is a procedure that involves the careful placement of stents in either one or both the arteries (with respect to the damage) that send blood to kidneys. The stent placement is necessary to open up the arteries in case of blockages or renal artery stenosis (narrowing), thus restoring normal blood flow.[BM15.1]
• Creation of AV Fistula for Chronic Kidney Disease (CKD) Patients: Dialysis is a common treatment for kidney failure. To undergo dialysis, a surgical procedure creates an access point by connecting an artery and a vein, in the arm or in the wrist. This is called AV Fistula.[BM16.1]
• Peripheral Bypass Surgeries: These procedures restore blood flow to disturbed arteries. This is done in any part of the body except in the heart and brain.[BM17.1]
• Vasculitis Management: In vasculitis, the immune system attacks the blood vessels, swelling them, disrupting blood flow and resulting in organ damage. In advanced vasculitis, vascular bypass surgery can redirect blood flow around the damaged vessel.[BM18.1]
• Thrombectomy (removal of the clot):  This procedure entails the insertion of a catheter-based clot removal device either to extract or to suction out the clot in order to reestablish blood flow. Thrombectomy can reduce the severity of disability caused by a stroke when used in conjunction with other medical treatments on a specialist unit. 
• Atherectomy: A surgical procedure to remove plaque from a blood vessel (artery). Plaque is the build-up of fat in blocking blood flow, and in extreme cases, rupture causing blood clots. Plaque removal enlarges the artery, thereby facilitating the passage of blood to the heart muscles. This vascular surgery risks could include arrhythmias (irregular heart rhythms), bleeding, blood vessel damage, heart attack, infection, etc.[BM19.1]
• Stent grafting: Usually done in patients suffering from abdominal aortic aneurysm, this endovascular repair involves the insertion of a catheter up through the artery and to the site of the aortic aneurysm. A stent graft (made of a thin metal mesh tube) is opened inside the aorta and fastened in place, preventing any bursting.