Vascular Surgery is a surgical subspecialty that deals with all diseases that can affect the arteries and veins. The exceptions are the coronary arteries (heart) that the Cardiothoracic Surgeons operate on and the cerebral brain arteries (brain arteries) that the Neurosurgeons are responsible for. There are five main areas in which we work: Aortic Surgery Carotid Surgery Peripheral Vascular Disease Renal Access Surgery Venous Surgery Other areas that we are involved in include: Hyperhidrosis Visceral Artery Thoracic Outlet Syndrome Diabetic Foot Vascular Trauma Click on the specific surgery/ disease link above to view more information. Alternatively, under 'Document Downloads' below, click the Vascular Surgery link to view and/or print a document with the surgery/disease information listed above. Vascular Surgery (PDF, 21.2 KB)

The aorta, which is the main artery of the body can change over time (aneurysm) to the point where it can rupture. This is usually a fatal event. This process often occurs to the part of the aorta inside the abdomen below where the kidney arteries have branched off and an aneurysm of this part of the aorta is called an Abdominal Aortic Aneurysm (AAA). Patients who have an incidental finding of an aortic aneurysm should be referred to a vascular surgeon, from there depending on size the patient will be kept under surveillance with a scan at regular intervals. The risk of rupture depends on the diameter of the aorta and once the threshold is reached (about 5cm) elective repair is usually offered. There are now 2 main methods of repair of an AAA: Open Repair The first is what is called 'open repair' whereby an incision is made in the abdomen and the aneurysmal aorta is replaced by a prosthetic graft. Endovascular Aortic Repair The second technique is called Endovascular Aortic Repair (EVAR). In this procedure access to the arteries is gained via the main groin artery (common femoral artery) and with the guidance of a radiology machine, a specially packaged graft is passed up over a wire and deployed inside the aorta to act as a new pathway for the blood to flow through. The aneurysm is depressurised and won’t rupture. Long term follow up with radiological imaging is required if this technique is used. At Middlemore Hospital this is a combined procedure performed with the Interventional Radiologists.

The formation of plaque at the origin of internal carotid artery, which is the main blood supply to the brain, can lead to small fragments of blood and plaques (emboli) moving into the brain and causing a stroke. In the operation of Carotid Endarterectomy, the plaque is removed and the artery repaired to greatly reduce the risk of a stroke occurring.

When atherosclerotic plaque causes narrowing (stenosis) or blockage (occlusion) of the arteries that supply the legs, this can lead to problems with walking (claudication) or the development of ulcers and gangrene. There are various options to improve the blood supply (revascularisation). Often an artery can be opened up (angioplastied) using wires, catheters and balloons using x-ray guidance. At Middlemore Hospital this work is undertaken by the Vascular Radiologists who have special training in these techniques. When surgery is necessary there are a number of techniques available. If a bypass graft around the blockage is required, often a vein from your own leg is used to act as the connection (conduit) between the artery above and below the blockage.

Patients who have kidney failure need to dialyse to clear their blood of products that would normally be cleared by functioning kidneys. There are two main ways to do this: Continuous Ambulatory Peritoneal Dialysis Continuous Ambulatory Peritoneal Dialysis (CAPD) which involves exchanging fluid through a special catheter (Tenkhoff catheter) that goes into the peritoneal cavity (abdomen). This must be done everyday. Haemodialysis The other major form of dialysis is haemodialysis via a needle in a fistula vein or graft. Blood is sucked out from the body and spun through a dialysis machine and then returned to the body via another needle into the fistula. The fistula vein or graft is created by taking a vein and joining it to an artery. This means that the strong pulsatile flow of an artery is directed straight into a vein which dilates and can be easily ‘needled’ by the dialysis nurses. The flow in the so called fistula vein is now much greater so that the blood can be drained off to the dialysis machine and returned without clotting (thrombosing). The increased flow in the fistula vein causes vibrations to develop in the blood which can be heard by listening to the vein with a stethoscope (bruit) or palpated by gently placing fingers on the vein (twill). The increased blood supply and constant needling puts a strain on the veins and fistulas are often maintained by performing angioplasties and corrective surgery.

Varicose veins (dilated and tortuous veins that can easily be seen in patient’s legs) is a very common condition. Largely they don’t cause major problems and can be managed by General Practitioners with simple measures such as wearing special stockings. However, occasionally they cause significant symptoms or disfigurement (cosmesis) which may threaten a patient’s employment or cause significant loss of quality of life. Also on occasions they can lead to damage to the skin on the legs and this may predispose patients to the development of ulcers. In these situations, Vascular Surgeons are often asked to see and manage these patients. Surgery is offered to those patients who meet certain criteria and when other treatments such as compression stockings have failed. Unfortunately, because this condition is so common it is only those patients with more severe disease who can be offered surgery.

The Vascular Laboratory Service is located within the Vascular outpatients Module 9 at Manukau SuperClinic. There are three Vascular Sonographers and they provide a service with surgeons and the Vascular Nurse Specialist. If for any reason you are unable to attend your appointment please inform us so another patient may benefit from your appointment. Your appointment may take anywhere between thirty minutes and one and a half hours, depending on the type of scan you require.

If you are a patient with the Vascular team, you may be seen by a Vascular Nurse Specialist who undertakes case management of all vascular patients and has responsibility for ongoing education of nursing staff and patients. The Vascular Nurse Specialist operates a nurse-run clinic seeing follow-up vascular patients and assessing vascular disease states.

Interventional Radiologists are Specialist Radiologists who specialise in minimally invasive, targeted treatments. Interventional Radiologists offer in-depth knowledge of the minimally invasive treatments coupled with diagnostic and clinical expertise. They use x-rays, MRI and other imaging to advance a catheter in the body, usually in an artery, to treat an abnormality within the artery. Angioplasty (ballooning) and stenting of arteries can be used in the legs to treat peripheral arterial disease. Interventional Radiologists pioneered many techniques which have been adapted to be used in many branches of healthcare. Today many conditions that once required surgery can be treated nonsurgically using those techniques often with less risk and faster recovery time when compared with open surgery. At Middlemore Hospital, all of these endovascular techniques are available to be used to advance the care of patients with vascular disease. The Vascular Surgeons and Interventional Radiologists work in close collaboration to determine the best management plan for each individual patient.

The Interventional Radiologists at Counties Manukau DHB are able to offer patients many minimally invasive treatment options. Please click on the links below to find out more information about common interventional radiology procedures: Angiography Arteriovenous Malformations (AVM) Balloon Angioplasty Bleeding Internally Central Venous Access Embolisation Haemodialysis Access Maintenance High Blood Pressure Stent Stent Graft Thrombloysis TIPS (Transjugular Intrahepatic Portosystemic Shunt) Varicose Vein Treatment Vena Cava Filter