Vascular & Endovascular Surgery
Introduction
The Apollo Vascular Centre is a premier provider of a complete range of
Vascular and Endovascular Surgical services at Indraprastha Apollo Hospital,
New Delhi.
It provides world class vascular care and promotes collaboration among the
different specialties involved in that process. It is dedicated to providing
comprehensive and interdisciplinary care to patients with atherosclerosis,
the process in which fatty materials, cholesterol and other substances,
collectively known as plaque, accumulate in the lining of an artery. This
process often is referred to as "hardening of the arteries."
Plaques can significantly reduce the blood's flow through an artery. When
plaques become fragile and rupture, they cause blood clots that can block
blood flow or break off and travel to another part of the body, causing a
heart attack, limb loss or stroke.
Promoting collaboration among different specialties allows both established
and emerging diagnostic and therapeutic methods to be applied, increasing
efficiency and reducing risks to patients. The Vascular Center's emphasis on
collaboration will greatly improve the care patients receive. Among the
specialties involved in the care of our vascular patients are cardiology,
endocrinology,nephrology and interventional radiology.
The Vascular Center's clinical services encompass all elements of vascular
care as detailed below:
» Diagnostic evaluations and medical management
» Non-invasive vascular testing
» Diagnostic angiography and endovascular therapeutics
(minimally invasive procedures)
» Surgical care including Inpatient services and critical care
» Meticulous Follow-up and post recovery rehabilitation
Vascular Diseases and Treatments at Apollo Vascular Centre
Arterial disease affects most people with age, especially in those who have
high risk factors that include patients who suffer with Diabetes, high blood
pressure, heart disease, a sedentary lifestyle, a family history of vascular
disease (e.g. Aneurysms), poor nutritional habits or smoke heavily. Patients
with poor circulation usually have diseased arteries all over their body.
The arteries usually affected are in the legs, heart and neck. The severity
of the disease and length of time it goes untreated can make a tremendous
difference in the clinical outcome of vascular disease, characterized by
stroke, limb amputations or death.
Indraprastha Apollo Hospital is a leading center of excellence in
India in the provision of:
- Treatment of Carotid Artery Disease to prevent Stroke:
Hardening of the arteries (Atherosclerosis) affecting the vessels
in the neck can lead to strokes. Patients with carotid artery
disease and stroke are treated by a team of vascular surgeon and
neuro-physician dedicated to stroke prevention. We also have a
certified vascular laboratory for the non-invasive assessment of the
carotid arteries. Depending upon the narrowing of the carotid
artery, intervention may be recommended even in patients who have
not yet had a stroke. The standard proven form of treatment for this
problem is an operation called carotid endarterectomy to remove the
plaque. In patients who are high-risk or unsuitable for surgery a
non-invasive treatment is available called carotid artery stenting
with distal embolic protection.
- Treatment of Diabetic Foot and Peripheral Arterial Disease of
Lower Limb Arteries:
Arterial disease develops when cholesterol or other fatty
inflammatory deposits build up inside the artery walls and cause a
narrowing or blockage. The arteries gradually narrow to the point
where blood flow from the heart to vital organs like brain, kidneys
upper and lower limbs as well as to the bowel becomes insufficient
for survival. The legs and feet are often the first areas of the
body to show the effects of this disease, although other patients
may have strokes from cholesterol formation in the carotid arteries
in the necks.
Lower extremity symptoms may include an aching, tired or heavy
feeling in the calf of the leg, thigh or buttock when walking or
exercising. Patients may also experience discoloration of the toes
or feet, cold or pale feet and toes, numbness or tingling in toes or
feet, decreased hair growth on legs and feet, and/or persistent
ulcers or infections on the feet, toes or legs. If left untreated
this may cause Gangrene of the foot.
On a case by case basis, our vascular team has shown that these
revascularization (endovascular and bypass) procedures save limbs
and ultimately provide a better quality of life for their patients.
With appropriate care, even patients considered high-risk can
undergo these procedures safely and effectively. Our vascular
surgeons have documented thousands of successful patient case
histories that detail how complex revascularizations using distal
bypass operations and angioplasty techniques have achieved a healed
foot and avoided amputation. If even a small portion of the foot can
be saved, it allows the person to walk effectively and to lead a
reasonably normal life.
- Management of Thoracic and Abdominal Aortic Aneurysms:
Weakening of the aortic vessel wall in the chest or abdomen leads
to ballooning of aorta with the blood pressure and eventually leads
to its expansion and rupture. Rupture of aortic aneurysms can cause
rapid exsanguinations of blood in the chest or abdominal cavity
leading invariably to death in majority of patients.
Having performed the first-ever Endovascular Abdominal Aortic
Aneurysm Repair in India in 1997, our Vascular Surgeons tackle all
the routine and complex aneurysm problems, and specialize in hybrid
procedures for difficult and re-do abdominal and thoracic aneurysms.
Our Vascular surgeons are leading opinion makers in this area of
expertise and provides consultancy to biomedical engineering
companies on the clinical aspects of minimally invasive vascular
surgery and design of stent grafts.
Our vascular team advocates endovascular aneurysm repair for
ruptured aortic aneurysms which is known to significantly reduce
mortality in these patients.
- a.) Laser Treatment of Varicose Veins and Management of Venous
Disease:
Varicose veins are a known cause of severe physical and
psychological discomfort. The superficial veins stretch and bulge
under the skin and create pronounced, bumpy "cords" on the
legs. They are more common in women and in people who sit or stand
in the same position for long periods of time. Endovenous Laser
treatment EVLT in conjuction with sclerotherapy can in 90-97%
afflicted patients treat varicose veins quite effectively. This is a
minimally invasive procedure that doesnt require general
anesthesia or cuts, is virtually painless allowing return to normal
active life within 24-48 hours.
b.) Leg Ulcer and Deep Vein Valve Surgeries:
In patients with venous ulcers (ulcers caused by venous disease
only) there is abnormal reverse flow (reflux) in the veins usually
due to damaged or defective deep vein valves. One of our senior
Vascular Surgeons, Dr.Tripathi has devised the technique of Trapdoor
Internal Valvuloplasty and has one of worlds largest
experience in this area.
- Vascular Access surgery for Renal Failure and Cancer
Chemotherapy:
We routinely provide support to our dialysis and Chemotherapy teams
to provide expert advice and treatment of complicated access related
procedures and reconstructive surgeries in the form of
Arterio-venous fistulae formation and correction of complications as
well as maintenance of chemo-ports.
- Sophisticated Diagnostic Imaging Services at the JCI-accredited
Indraprastha Apollo Hospital:
Radiology Department provides excellent support for our specialty
including Duplex Ultrasound, 64 slice state of art CT Scan, MR
Angiography, Radionuclide Scintigraphy and Digital Subtraction
Angiography Lab allow for accurate diagnosis and follow-up of
patient. In addition to Complex Endovascular procedures in the DSA
Lab, we are introducing exciting ultrasound based endovascular
procedures for patients with renal failure which include peripheral
angioplasties and bedside Inferior Vena Cava filters.
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Dept of Vascular & Endovascular
Surgery
Academic Coordinator & Sr Vascular and Endovascular Surgeon
Dr. Prof. Ramesh Tripathi
MBBS, M.Angiology, FICS, FRCS Edin., FRACS Vascular (Australia), FACP
Sr. Vascular and Endovascular Surgeon
Dr. Rakesh Mahajan
MBBS, MS, FRCS, CCST