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August 2010
10 Vascular Treatments
Vascular disease is not just about ‘poor circulation’. They come in various forms: peripheral arterial disease affects the arteries taking blood to the arms and the legs, carotid artery disease affects the arteries taking blood to the brain, and renal artery disease limits the blood flow to the kidneys, causing high blood pressure(hypertension) or renal insufficiency (renal failure).
Arterial disease is most often caused by atherosclerosis (hardening of the arteries). Here is demystifying the set of options your surgeon would consider.

10 Treatments and Surgeries:

Angioplasty and Stenting:
During an angioplasty, a small balloon is inflated inside a narrowed blood vessel. The balloon helps to widen the blood vessel and improve blood flow. After widening the vessel with angioplasty, sometimes a stent is inserted, depending upon the circumstances. Stents are tiny mesh tubes which support the artery walls to keep vessels wide open.

Endarterectomy:The general term for the surgical removal of plaque from an artery that has become narrowed or blocked.

Carotid Endarterectomy: This is an operation during which the inner lining of the carotid artery is removed if it has become thickened or damaged. This procedure eliminates a substance called plaque from your artery and can restore blood flow.

Carotid Stenting: A slender, metal-mesh tube, called a stent, is inserted which expands inside the carotid artery to increase blood flow in areas blocked by plaque.

Dialysis Access: This is about creating an entrance into the bloodstream that lies completely beneath the skin, and is easy to use. The access is usually in the arm, but sometimes in the leg, and allows blood to be removed and returned quickly, efficiently, and safely during dialysis or, less commonly, for other procedures requiring frequent access to circulation.

Endovascular Stent Graft: This is a tube composed of fabric supported by a stent. It can be used for a variety of conditions involving the blood vessels, but is most commonly used to reinforce a weak spot in an artery called an aneurysm.

Surgical Aneurysm Repair: In surgical aneurysm repair, an aneurysm is repaired or removed through an incision in the skin.

Surgical Bypass: Treats the narrowed arteries by directly creating a detour, or bypass, around a section of the artery that is blocked. During a bypass procedure, a new pathway for blood flow is created using a graft.

Thrombolytic Therapy: This is a treatment used to break up dangerous clots inside the blood vessels. To perform this treatment, clot-dissolving medication is injected into a blood vessel. In some cases, the medications flow through your bloodstream to the clot. In other cases, a long, thin tube, called a catheter, is guided through the blood vessels to the area of the clot. Depending on the circumstances, the tip of the catheter may carry special attachments that break up clots. The catheter then delivers medications or mechanically breaks up the clot.

Venous Access: A process that allows the doctor to deliver medicine directly into the bloodstream without repeatedly puncturing the blood vessels. Here a long, thin catheter acts as a kind of entry into the vein. One end of the catheter is placed in a vein, usually in the arm, neck, or chest. The other end exits the body so that the doctor can deliver the medicine into the vein by means of the catheter. Sometimes, this delivery end may be connected to a circular device, called a port, under the surface of the skin.

Dr.V.Balaji is Consultant Vascular Surgeon at Apollo Hospitals, Chennai

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