These are bulging veins that lie just beneath the skin (superficial veins). They occur when the walls of a vein are weak or damaged or if the valves in the vein that normally stop the blood from flowing backwards are impaired, resulting in pooling of the blood and stretched veins. Besides being unattractive, varicose veins can be painful and cause inflammation or ulceration. The following different types of surgery are available if varicose veins require treatment: Sclerotherapy: a tiny needle is used to inject a chemical solution into the vein that causes the vein to collapse. This approach is recommended for small varicose veins or spider veins that typically appear on the upper legs. You will need to wear elastic bandages or stockings over the treated area for some time after surgery. Vein stripping: the varicose veins are cut out and the veins that branch off them are tied off. The cuts (incisions) made in the skin are closed with sutures. You will need to wear elastic bandages or stockings over the treated area for some time after surgery. This procedure requires anaesthesia. Phlebectomy: small cuts (incisions) are made in the leg and the varicose veins are pulled out with a tiny hook-like instrument. The cuts are closed with tape rather than sutures and, once healed, are almost invisible. You will need to wear elastic bandages or stockings over the treated area for some time after surgery. This procedure requires anaesthesia.

You have two carotid arteries, one on either side of your neck, that supply blood to your brain. Carotid artery disease occurs if these arteries become narrowed due to atherosclerosis (a build up of fat and cholesterol deposits on the inner walls of the vessels). If a clot forms in one of the carotid arteries and reduces or stops the flow of blood to part of your brain, it may cause a stroke. You have an increased risk of developing carotid artery disease if you: have a family history of atherosclerosis smoke have high blood pressure (hypertension) have diabetes have coronary artery disease. Treatment may involve lifestyle changes e.g. stopping smoking, exercising more, dietary changes and/or medication. If there is severe narrowing of the arteries, treatment may involve surgery. Surgical treatment: Surgical treatment Carotid Endarterectomy: an incision (cut) is made along the side of the neck, the carotid artery opened and the fatty material (plaque) removed. The artery is closed with a patch. Minimally invasive: a long thin tube (catheter) is inserted through a small incision made in the groin. The catheter is guided to the carotid artery where a balloon attached to the catheter is inflated to clear the blockage or a small metal tube (stent) is put in place to hold the blood vessel open.

Balloon Angioplasty: a long thin tube (catheter) with a tiny balloon attached to the tip is inserted through a small incision (cut) made over an artery in your arm or groin. The catheter is guided through the arteries to the site of the blockage where the balloon is inflated to clear the blockage and, in some cases, a metal tube (stent) is inserted into the artery to keep it open. Endarterectomy: incisions are made in the affected limb and artery and the fatty material (plaque) in the blood vessel is removed. Bypass Surgery: a piece of a vein from another part of the body or a tube made of synthetic material (graft) is used to join the artery above and below the narrowed or blocked section. This creates a detour and a new path for the blood to flow around the blocked segment.

Balloon Angioplasty: a long thin tube (catheter) with a tiny balloon attached to the tip is inserted through a small incision (cut) made over an artery in your arm or groin. The catheter is guided through the arteries to the site of the blockage where the balloon is inflated to clear the blockage and, in some cases, a metal tube (stent) is inserted into the artery to keep it open. Endarterectomy: incisions are made in the affected limb and artery and the fatty material (plaque) in the blood vessel is removed. Bypass Surgery: a piece of a vein from another part of the body or a tube made of synthetic material (graft) is used to join the artery above and below the narrowed or blocked section. This creates a detour and a new path for the blood to flow around the blocked segment.

Vascular ulcers are open wounds on the skin that do not heal or that keep coming back once they do heal. They occur because there is not enough blood being supplied to the skin to heal injuries that may be caused by minor trauma or pressure. Arterial or ischaemic ulcers: are usually the result of atherosclerosis or "hardening of the arteries" (a build up of fatty deposits on the inner wall of arteries). When the arteries become narrowed, the flow of blood to the tissues is reduced. These ulcers are usually found on the toes and edge of the foot and are often very painful. Treatment for arterial ulcers may involve surgery. Venous or stasis ulcers: occur when impaired blood flow in the veins causes pooling of blood in the legs. These ulcers are often associated with varicose veins. Venous ulcers are usually found on the lower leg between the knee and the ankle and the leg is often swollen and discoloured. Compression or pressure bandages are the main treatment for venous ulcers although surgery may be required in some patients.