Abdominal aortic aneurysm (AAA)
Commonly referred to as a triple “A” this is a localised dilatation (expansion/ballooning) of the main blood artery in the body called the aorta. This most commonly occurs in the abdomen between the rib cage and the umbilicus “tummy button”. It occurs most frequently in men over 65 years of age which is why there is a national screening programme to detect when the aorta is over 3cm in diameter.
When the AAA reaches 55mm we would then consider the option of repair. The reason we repair these AAA at this size the risk of bursting “rupture” starts to increase which is a life threatening event. A repair is carried out to prevent this bursting occurring. This can be performed either through an open operation with a cut in the abdomen and a new plastic aorta is reconstructed to replace the diseased aorta.
The other repair method is a stent graft (EVAR) which is a type of “key hole” minimally invasive method of repair. Which type of repair is advised would depend on how fit the patient is and the anatomy of the aneurysm procedure when assessed by the vascular pre-assessment team.
This procedure is performed with the aim of reducing the risk of a patient having a stroke in the future. This is normally performed for patients with a tight narrowing of the carotid artery in the neck and a “patch” is then put on the artery. Typically patients are discharged the next day.
Peripheral arterial disease (PAD/PVD/athersclerosis/hardening of the arteries)
This condition is most commonly associated with smoking and diabetes. It can cause symptoms of intermittent claudication which is pain on walking commonly in the calf. In severe cases the effects cause sufficient restriction to blood flow that gangrene/necrosis or rest pain in the foot occurs.
In these severe cases it is necessary to improve the blood supply to allow the gangrene to be removed (debridement) and heal the foot or improve pain. This can be via an angioplasty/stent or a bypass graft surgery. An angioplasty is a procedure involving the placement of a wire across a narrowing (stenosis) or blockage (occlusion) followed by a tube with a balloon within it which can then be inflated.
This opens up a channel (lumen) down the artery sometimes a stent (metal mesh tube) is placed across this area. A bypass joins two arteries or parts of an artery using either a patient’s own vein from leg or arm. If no vein is suitable, a plastic (prosthetic) graft can be used.
Renal access surgery
This procedure involves creating a join between an artery and a vein often in the arm or occasionally in the leg. This causes the vein to distend over six weeks making it easier to place needles into to allow dialysis and avoids having a permanent plastic line for this.