vascular surgery

What is vascular surgery?

Our circulatory system consists of blood vessels, which are elastic tubes, some small and some large, whose function is to transport blood from the heart to the various organs and from these organs back to the heart. The blood vessels are divided into arterial vessels, which carry blood from the heart to the various organs, venous vessels, which carry blood from the various organs to the heart, and lymphatic vessels, which carry the fluid in which the cells “swim”, in tubes whose course parallels the course of the veins, back to the heart. In situations where problems arise in the vascular system, treatment by a physician whose field of expertise is vascular surgery is required. Dr. Heldenberg specializes in the diagnosis and treatment of all the vascular diseases: arterial, venous and lymphatic.

What are the problems that may appear in the blood vessels?

Vascular diseases can be divided into diseases of the arteries, diseases of the veins and diseases of the lymphatic system.

Vascular diseases of the arterial system

The arteries are blood vessels that carry from the heart oxygen-rich blood and other substances necessary for the functioning of the cells, in all the organs of the body. Most of the diseases of the arterial blood vessels are obstructive in nature, that is, diseases that cause narrowing of the various blood vessels in the body: the arteries that supply blood to the heart – the coronary arteries, the arteries that supply blood to the brain – the carotid arteries and the arteries that supply blood to the circumference, the rest of the body’s organs.

The disturbance in the blood flow to the various organs is caused by the accumulation of fat deposits (cholesterol) on the wall of the arteries, which narrows the arterial cavity in which the blood flows, and is called “Atherosclerosis”. Arteriosclerosis will manifest itself in pain or the appearance of wounds, especially in cases of impaired flow to the blood vessels in the legs. This disease of the peripheral blood vessels is called “Peripheral Arterial Occlusive Disease” – PAOD. In addition to the obstructive disorder described above, may appear an aneurysmal disease of the arteries; in this situation, the diameter of the artery increases and there is a danger, when the diameter becomes very large, of tearing the artery, that brings about a risk of death.
The common risk factors of the formation of atherosclerosis are: high blood pressure, diabetes, excess blood lipids, smoking and family background. The damages of the disease, in the absence of treatment, may be irreversible and cause a danger to life or the loss of a limb, predominantly the lower limbs.

Vascular disease of the venous system

The veins carry blood, rich in carbon monoxide produced in the cellular respiration processes, from the various organs back to the heart. In the upper and lower limbs (hands and feet) there are two systems of veins, a deep one and a superficial one. In contrast to the arterial system, in the venous system there are valves whose function is to prevent the return of blood back to the organ from which it left, according to its natural tendency to move downwards by the gravity.

When these valves do not function as they should, meaning that the flow is not one-way – towards the heart, some of the blood returns, towards the organ from which it left. This condition is called “venous insufficiency”. It mostly affects the superficial venous system, but in some cases may also affect the deep venous system. Insufficiency of the venous system, superficial or deep, may cause edema, expansion of the superficial veins – the appearance of varicose veins, venous stasis – a color change (hyperpigmentation) of the skin of the calf, leading to heat and even ulcers that form due to increased pressure in the venous system.

Blood clots in the veins

In addition to the flow insufficiency described above, there may be a situation in which blood clots form in the veins, more often in the deep system, or in the superficial system. These blood clots may form after an initiating event that was the reason for the formation of the blood clot – provoked “Deep Vein Thrombosis” (DVT) – such as a state of immobility. Alternatively, a blood clot can form without an initiating event “non provoked DVT”. In situations where there was no initiating event, the attending physician must rule out non mechanical causes, such as an innate tendency to hypercoagulability as the cause of the event, and adjust the treatment accordingly. The initial treatment of thrombosis, apart from seeking to diagnose the cause of its formation, includes treatment with anticoagulants, the duration of which will be determined by cause of forming the thrombosis. The treatment with anticoagulants is intended to prevent the growth of the blood clot – in a local aspect – and reduce the risk of embolism of this blood clot to the lungs (pulmonary embolism)

In contrast to the past when a vein blockage was considered fateful, today it is possible to use substances that dissolve blood clots, if a blockage is diagnosed at an early stage, the physician can try to open the existing blockages in the deep venous system by a catheterization procedure, if and when the mentioned chronic blockage causes a limitation in the patient’s daily routine of the patient.

Disease of the lymphatic system and its context to blood vessels

The lymphatic system is a one-way drainage system (from the intercellular space to the blood circulation), containing tubes and lymph nodes, which conduct plasma-like fluid and cells from the tissues to the blood vessels. This system is an essential part of the body’s immune system. When there is a problem with the function of the lymphatic drainage system, this fluid accumulates in the intercellular tissue and local swelling is created. This process is called due to “Lymphatic Edema”.

Lymphedema may result from two situations:

A. Congenital defect in the structure of the system – the absence or lack of formation of lymphatic ducts. This condition is called “Primary Lymphedema”.

B. Damage to the lymphatic duct system due to surgery, radiation, infections, mostly by exotic pollutants, chronic venous insufficiency, heart failure, etc. This condition is called “Secondary Lymphedema”.

It should be remembered that not every situation in which edema is formed, is an expression of damage to the lymphatic system. The main sign of Primary Lymphedema is its appearance at an early age without apparent risk factors for its formation. In advanced stages of the disease, especially when it has not been adequately treated, chronic skin changes may occur and in extreme cases the legs may grow to large dimensions and become “Elephantiasis”.

Dr. Eitan Heldenberg senior vascular surgeon

Dr. Eitan Heldenberg, Director of the Department of Vascular Surgery at the Hillel Yaffe Medical Center, Hadera, deals in a variety of areas of vascular surgery, classical and endovascular.