The Vein and Artery Clinic is a specialist clinic aimed at providing the best up to date treatment for patients with vascular problems and more procedures can now be done either through minimally invasive or keyhole surgery.

I would briefly like to highlight some of the procedures and treatments now avialable through this clinic:

Varicose Veins

Although traditional surgery is still offered, more and more varicose vein treatment has become minimally invasive. The two newest techniques are endovenous laser ablation (EVLT®) and foam sclerotherapy.

EVLT®

EVLT® is the treatment of an incompetent long or short saphenous vein using a laser catheter. The procedure involves passing a laser catheter via a small skin puncture up the long or short saphenous vein under ultrasound guidance. As the catheter is withdrawn down the vein it delivers laser energy in short pulses damaging the vein wall and causing it to shrink. This closes the faulty vein so that the blood can no longer pass through it.

Compared to traditional surgery EVLT® is less painful, causes less bruising and gives a better result. It can be done under local or general anaesthetic and requires only a skin puncture to access the vein rather than an incision either in the groin or the popliteal fossa. In most cases patients can return to work after about 48 hours as opposed to 7 to 10 days with traditional surgery. There is also significantly lower incidents of infection.

Foam Sclerotherapy

This is the injection of sclerosant foam into the vein. The foam is made of traditional sclerosant that is mixed with air to constitute to a foam. The foam displaces the blood form the vein. Irritation of the inside of the vein wall by the foam allows the vein wall to stick together, hence obliterating the lumen.

Foam Sclerotherapy is useful in two contexts: It is useful for recurrent or residual varicose veins and in this context it can be given in the clinic environment under ultrasound guidance. It is painless and does not require any anaesthetic whatsoever. Patients are required to wear a compression stocking for a week afterwards.

Its other use is in conjunction with endovenous laser ablation. If one has an incompetent long saphenous vein from the groin down to the ankle then the ideal treatment is to laser the long saphenous vein from the groin down to the knee and then obliterate the below-knee long saphenous vein using foam sclerotherapy. This is all done as a single procedure and effectively seals off the whole long saphenous vein from groin to ankle.

Aortic and Thoracic Aneurysms

		Traditionally the repair of thoracic and abdominal aortic aneurysms has required a general anaesthetic, a large abdominal or chest incision, immediate post-operative care in an intensive care unit and a prolonged recovery time. Open repair of more complex aneurysms also carries a significant mortality rate. Repair of these aneurysms has now been revolutionised by the minimally invasive technique of endovascular aneurysm repair (EVAR). Not everyone is suitable for an EVAR but as the technology is evolving, more and more people are becoming suitable for this procedure. The procedure itself is generally performed under epidural anaesthetic so the patient remains completely awake for the duration of his procedure. The femoral arteries are exposed in the groins and the procedure involves passing a stent graft over a guide wire up the femoral artery into the abdominal or thoracic aorta. The stent graft is then deployed under radiological control across the aneurysm sac therefore excluding it from the circulation. Post-operatively the patient can be nursed either in a high care unit for 24 hours or even on the Ward. Eating and drinking can be resumed almost immediately after the procedure. In many cases patients are able to return home on the 3rd or 4th post-operative day. EVAR has the great advantage of being a significantly smaller procedure than traditional open repair. It has a much faster recovery time and a significantly lower mortality rate.

Claudication

Claudication due to occlusions or stenosis of arteries of the lower limbs are now dealt with by two methods. Traditional bypass surgery from the groin down to the knee using the patient's own vein or a synthetic graft is still in use, particularly for a long occlusion of the superficial femoral artery. For shorter occlusions or stenoses, angioplasty with or without stenting is becoming a more popular method of treatment with the obvious advantage of being minimally invasive.

Carotid Disease

Patients with carotid stenosis can present classically either with strokes or transient ischaemic attacks. The patients most suitable for intervention in these cases are those patients who have had a TIA or patients who have had a stroke with a good recovery. Current guidelines suggest that patients presenting with a TIA should be worked up and treated within two weeks of the event. Surgical intervention is advised for all patients with a 70% or greater stenosis of the carotid artery. This is both for symptomatic and asymptomatic cases. The best current procedure is still the carotid endarerectomy, which is a relatively small procedure that can be done under local anaesthetic. The newest procedure coming to the fore now is carotid stenting but this is still not recommended for routine treatment.

Hyperhidrosis
Hyperhidrosis can be a fairly disabling problem leaving patients unable to write or function at work or socially due to the embarrassment of wet clothing. Hyperhidrosis can occur anywhere on the body but the area which are particularly amenable to treatment is where it involves the face, the axilla and the hands. Where hyperhidrosis is confined purely to the axilla it can be easily dealt with through Botox injections. This essentially blocks the neurotransmitter in the sweat gland, therefore preventing it from producing any secretions. The Botox injections work for about 6 to 8 months and then need to be repeated. Where hyperhidrosis involves the face and hands as well the best procedure is a transthoracic laparoscopic sympathectomy. This involves passing a laprascope between the 3rd and 4th ribs in the mid axillary line. The sympathetic chain running on the necks of the ribs on the inside of the chest can easily be visualised and these can then be obliterated using a laser fibre. Both sides are normally done at the same operation and patients can usually go home on the first post-operative day. This procedure is very effective in controlling hyperhidrosis in these areas. Patients with hyperhidrosis usually prefer to try some of the more conservative methods first such as antiperspirants and anticoalergics. These do work in the less serious cases but many patients complain of side effects, particularly of the anticholinergic group of medications. All the procedures mentioned above are available through the Windsor Vein & Artery Clinic.