An initiative of Chikitsa Plus to provide you a coordinated & comprehensive Vascular and Endovascular care
When would you need visit a vascular surgeon?
There is a long list of conditions, where it is suggested to seek vascular and endovascular consultant. Below are a few conditions where it is essential to consult.
Road traffic accidents often involve various parts of the body that are seen by different specialist doctors - eg bones ( orthopedician) , skin and soft tissue injury (plastic surgeon), head injury ( neurosurgeon ), etc. Bleeding is one of the dreaded complications in trauma and is usually tackled by whichever surgeon is first present in an emergency. There are two specific points when the role of a vascular surgeon becomes of utmost importance. First when bleeding is internal or so severe that simple pressure doesn't work - vascular surgeon can control it in different ways (i.e open surgery or endovascular control of bleeding) More often, after some pressure or primarily stitching by an emergency surgeon blood vessels form a clot and bleeding stops. However, this also stops the blood supply to the injured part eg leg or hand. If the blood supply to hands or legs is not restored within a few hours there is a high risk that the patient may lose his/ her leg or hand. Assessment by a vascular surgeon is a mandatory checkpoint in all best trauma centers across the world.
Wound healing in Diabetics is close to impossible - Its a known fact in almost every household. However, one thing which we don’t know is that a major reason for this is blood vessel blockages that happen in diabetes over time. Patients might have compensated blood flow despite blood vessel blockages. But once a small ulcer form due to poor-fitting shoes, faulty nail cut, or minor trauma- healing doesn’t happen due to poor blood flow. Additionally poor ability to feel pain ( neuropathy) and increased pressure points in feet cause impaired ulcer healing. Also in some diabetic patients clots can form in the heart , then flow down the bloodstream and block a blood vessel in the leg or hand causing the risk of minor or major amputation. Timely assessment of vascular blockage and opening by angioplasty or bypass is a key role of the vascular surgeon in diabetes. A common challange is delayed referral to a vascular surgeon. Often patient already developped huge ulcers and infection in whole foot. In such scenarios despite opening blockages, patient land up loosing legs. Screening for blockages is also recommended for diabetic patients once a year, so that appropriate treatment can be started in time.
On average only 1% of patients with renal failure are able to receive a kidney transplant. For rest 99% although hemodialysis is a bitter reality- but it’s also their lifeline. If managed well -people live for decades despite being on regular dialysis. AV Fistula is the lifeline of patients receiving dialysis. Although many surgeons, nephrologists create AV fistula, a vascular surgeon can provide the best success rate and outcomes in AV fistula care. Apart from creating simple AV fistula - many other aspects of AV fistula care eg managing failing fistula, failed AV fistula, ballooning, basilic vein transposition & AV graft are best done in hands of a vascular surgeon.
Gangrene is the death of an organ or part of the body - finger, toe, or legs. Mostly it occurs after the blood supply to that part has been blocked due to various reasons. Patients with heart blockages, high blood pressure, high cholesterol, diabetes, smoking habit is prone to form blockages of blood vessels. If a blockage occurs slowly over a period of months to years, patients can feel symptoms like pain on walking - “Claudication”. However, in certain conditions like diabetes or sudden occlusion, these warning symptoms may be absent. Sometimes patients can experience “PreGangrene” when the tips of fingers or toes may turn blue or red and cold. If this happens and blood low is no restored soon - these can progress to gangrene. The vascular surgeon’s role is key in changing the outcomes of a patient with gangrene.
Veins carry blood back from legs towards the heart. If due to any reason this return is not sufficient - the excess blood gets accumulated in the legs and therefore results in leg swelling. Basically two types of problems can lead to excessive blood accumulation in leg. First and most common are varicose veins - where the leakage happens from deep to superficial veins causing swollen veins and sometimes progressing to skin changes and even ulcers. Varicose veins are easily treated by laser or Glue on a daycare basis. The more serious disease id deep vein thrombosis - “blood clots in major veins”, therefore, blocking entire legs flow. This not only causes pain and swelling in the legs but can be fatal if part of the clot breaks and moves towards the heart. DVT is an emergency situation and must be assessed by a vascular surgeon to decide between various kinds of treatment required.
Age, smoking, deranged cholesterol, diabetes, obesity, and high blood pressure all are risk factors that cause the development of blockages in blood vessels in the heart as well as all over the body. Nonhealing leg ulcers are common presenting complaints in surgical OPDs and many times the cause is insufficient blood supply due to blood vessel blockage. If not assessed properly for vascularity - people often undergo debridement or even minor amputations in the hope to heal the wound. But In lack of good vascularity, the wounds keep getting worse, many times requiring major amputation. Vascular surgeons work on the principle of “Time is Tissue”. When the clinical symptoms involve either blackening of toes/ fingers or any kind of nonhealing ulcer an immediate assessment of vascularity by angiogram, followed by improving blood flow by angioplasty or bypass should be done. Nowadays with advancement in technology - operating in the elderly has been made much safe and in most cases, blood flow can be improved by angioplasty only. With this approach hospital stay is minimum and risks associated with surgery are almost nil.
Conditions & Treatments
This is an extensive list of conditions that we treat, please click on the buttons below to explore more.
Aortic and Peripheral Arterial blockages eg in Smokers, diabetes leading to Pain and Gangrene
Renal artery stenosis
Mesenteric Ischamia
Carotid Artery Stenosis
Thoracic Outlet syndrome due to cervical Rib
Sudden Arterial Blockage - eg. in Atrial Fibrillation and Road Traffic Accidents
Complex Cancer surgery where cancer is invading involving
Dr Himanshu Verma
Founder, Varenyam Vascular & Chikitsa Plus
Dr. Himanshu Verma has over a decade of experience in the best medical centers of India and USA (Mayo) in treating various complex vascular diseases using both endovascular (minimally invasive) and open surgical techniques. His clinical focus is on treatment of aortic aneurysms, redo i.e. previously failed vascular procedures, peripheral gangrene, varicose vein & diabetic foot etc.
Graduated from Institute of Medical Sciences, BHU, Varanasi, Post-Doctoral Fellowship in Vascular & Endovascular Surgery, Rajiv Gandhi University Of Health Sciences, Bangalore and Ted Rogers clinical research fellowship in Vascular Surgery, Division of Vascular Surgery, Mayo Clinic, Rochester, MN, USA, Dr Verma, is an expert in performing complex vascular surgeries under local anaesthesia and thereby reducing risks associated in the procedure and stay in the hospital.
Dr. Verma has also performed more than 3000 complex AV fistula surgeries for dialysis patients. He has an avid interest in being up to date with recent developments in Vascular surgery and to his credit has over 40 publications including 9 book chapters and more than 25 presentations in prestigious national and International forums.
Mission
To bring awareness, affordability & quality healthcare services in the field of vascular and endovascular medicine & surgery. With a commitment to make it in the reach of everyone and to serve the patients with the ideology of "Seva paramo dharma" for the benifit & wellbeing of all.
Vision
To create a smart, quality and affordable integrated healthcare delivery system in India, inculcating technology and best medical skills.
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