1. Aneurysm surgery (Aortic, iliac, femoral, popliteal)

An aneurysm is a dilatation or widening of an artery. Tragically, they can rupture with a high mortality rate. Though often palpable, most are usually detected incidentally on US or CT. Aneurysms should be monitored by a Vascular Surgeon until such time as intervention is necessary.

Risk factors are similar to those associated with other cardiovascular conditions: namely high blood pressure and cholesterol, smoking, obesity, diabetes, a history of heart disease and a family history of the same.

2. Endarterectomy (carotid, iliac, femoral) or Bypass surgery

Cardiovascular risk factors, especially smoking, can predispose patients to arterial narrowing by plaque, which reduces the amount of blood flow to the tissues down stream, with consequences ranging from stroke/TIA (carotids), to non healing ulcers, claudication (painful legs when walking), rest pain (painful legs, especially at night), or even an acutely ischaemic limb.

If endovascular methods are not appropriate, then operative intervention may be necessary to restore blood flow, either by removing the plaque (endarterectomy) or by bypassing the blockage (usually using a vein from the leg).

3. Amputation

As a last resort, amputation may be a necessary option for patients with poor blood flow in their lower limbs.

4. Dialysis Access

An arteriovenous (AV) fistula is a communication between the arterial and venous system usually in the forearm or arm and, is created surgically specifically to provide access for haemodialysis for patients with end stage kidney failure.

5. Varicose Vein Treatment
Varicose veins are enlarged, tortuous, unsightly veins, more commonly occurring in the legs, which appear when the valves in leg and thigh veins become incompetent either through trauma, the hormonal changes associated with pregnancy, or advanced age. The valves in veins aid blood to flow back to the heart, and when they become damaged, or incompetent, the blood isn’t returned to the heart as effectively and blood can pool, causing the veins to stretch and enlarge, visible as varicose veins.

Apart from aesthetics, varicose veins may cause aching in the legs, throbbing or itching and an eczema like rash; when left untreated, in some cases varicose veins can also lead to skin ulcers (wounds that occur due to poor blood circulation).

Treatments include injection with sclerosant for less troublesome veins which can be performed in Mr North’s practice, or ligation and stripping done under a general anaesthetic in hospital, which usually requires an overnight stay.