Vascular Disease
Peripheral Vascular Disease
Peripheral vascular disease refers to narrowing of the peripheral arteries, usually in the legs, due to a build up of fatty deposits or plaques. It develops slowly over years and many sufferers do not recognise the symptoms. The commonest symptoms are heaviness or pain in the legs on walking which may be relieved by resting for a while. This is what is known as intermittent claudication. More serious peripheral arterial disease may result in pain at rest or even leg ulcers. People most at risk are smokers or ex-smokers, diabetics, those with high blood pressure or raised cholesterol and those with a family history or peripheral vascular disease, heart disease or stroke.
Radiology has much to offer in the detection of peripheral vascular disease and interventional radiology offers many minimally invasive treatments that may avoid the need for by-pass surgery. The leg arteries can be scanned quickly and easily in an out-patient setting using doppler ultrasound scanning. In certain cases a CT scan or MRI scan may be necessary, particularly if intervention is planned.
Arterial narrowings detected on scanning can be widened up by a procedure called angioplasty when a balloon is passed over a guidewire under x-ray guidance and local anaesthetic through the narrowing. The balloon is then inflated and blood flow to the limb restored. Even complete blockages or occlusions can be re-opened. In certain cases the artery may recoil or narrow down again following angioplasty and in these cases the interventional radiologist can place a stent, a small metallic tube that is deployed under x-ray guidance and stays in place permanently to hold the artery open. All of these procedures are performed via a tiny needle puncture in the groin or the arm under local anaesthetic. and most are day-case procedures.
Abdominal Aortic aneurysm
An aneurysm is an abnormal dilation of an artery. It can affect the aorta, the main artery in the body that runs from the thorax down to the abdomen. There may be underlying disease conditions or increased risk due to family history but many aortic aneurysms go undetected and are at risk of rupture which is life-threatening. The NHS offers ultrasound screening for abdominal aortic aneurysm to men between the ages of 60 and 75 but it is possible that others outside these age groups may also benefit from scanning to detect the early stages of an aneurysm.
Dr Crowe offers the full range of non-invasive scanning techniques for abdominal aortic aneurysm ranging from Doppler ultrasound examination, a quick and easy screening test to more detailed CT and MRI angiography for planning treatment and following up patients who have already had an aneurysm treated. Aortic and other vascular scanning is available at all of Dr Crowe’s treatment locations.
The conventional treatment of abdominal aortic aneurysm was open surgery with replacement of the diseased segment of the artery. This is considered when the aneurysm reached a certain critical size (5 cm diameter for men and 4.5 cm in diameter for women). If the aneurysm has not been picked up early and ruptures emergency surgery carries a very high mortality and many of those suffering a ruptured abdominal aortic aneurysm not even make it hospital. Hence the importance of early detection and a planned approach to treatment.
More recently less invasive techniques have been developed to treat abdominal aortic aneurysms using stents (so-called EVAR or endovascular aneurysm repair). Dr Crowe works closely with two of the leading specialist in the country, Mr Donald Adam and Mr Martin Claridge of Premier Vascular who offer the full range of advanced EVAR treatments.
Carotid Artery Disease
The carotid arteries are the main arteries in the neck that supply the brain. Narrowing of these arteries due to build up of fatty deposits, cholesterol or plaque can cause a stroke either due to showering of cholesterol or clot up to the brain or in severe cases due to complete obstruction of the artery. Many patients will suffer mini-strokes or transient ischaemic attacks (TIAs) with full recovery within 24 hours. These TIAs are however a warning that the individual is at risk of a major stroke.
Initial imaging investigation of carotid artery disease is usually by a doppler ultrasound examination which may be supplemented if necessary by MRI scanning, CT scanning or angiography. In less severe cases of carotid artery disease modification of risk factors may be all that is necessary, e.g. stopping smoking and reducing high blood pressure and cholesterol by dietary modification and medication.
In more severe cases of narrowing surgery or stent insertion may be considered. Surgery in the form of carotid endarterectomy is performed by vascular surgeons and carotid artery stenting is usually performed by interventional radiologists. Patients are usually under the care of both a vascular surgeon and the radiologist and there is very much a team approach to treatment. There are ongoing studies comparing the risks and benefits of open surgery and stenting and there are relative advantages of both. The aim in either case however is to reduce the risk of life-threatening stroke.
Diagnostic Scanning for Vascular disease
Dr Crowe offers the full range of diagnostic scanning options for vascular disease, i.e. diseases of blood vessels. This includes ultrasound examination, specialist vascular doppler or duplex ultrasound, CT scanning with CT angiography (CTA), MRI scanning with MR angiography (MRA) and MR venography (MRV). More information can be found under this section Radiology and Scanning.
In addition to these specialist interventions included in the relevant sections Dr Crowe works with a number of different medical and surgical specialities to offer a full range of interventional radiology procedures including:
- Iliac artery angioplasty and stenting
- Femoral artery angioplasty and stenting
- Renal artery angioplasty and stenting
- Ultrasound and CT guided biopsy
- Ultrasound and CT guided aspiration and drainage
- Nephrostomy and ureteric spent insertion
- Superior vena cava (SVC) stent insertion
- Inferior vena cava (IVC) filter insertion
- Bronchial angiography and embolisation for haemoptysis
- Mesenteric angiography and embolisation for gastrointestinal bleeds
- Embolisation of obstetric haemorrhage postpartum
- Emergency embolisation for bleeding post trauma
- Dialysis line insertions.
Vascular Access Lines
Dr Crowe works with a number of cancer specialists, or oncologists, to facilitate chemotherapy treatment and offers a range of vascular access lines, tunnelled central lines and ports that I used to deliver chemotherapy and to allow blood sampling during cancer treatment. The type of line or port device used will depend on what exactly the line will be used for and how long it is intended to stay in place. Options include:
- PICC line (peripherally inserted central catheter)
- Hickman line (single or double lumen)
- Groschong line
- Leonard line
- Portacath or Vascuport
- Powerports
These lines can also be used in other situations where access to a vein is required for a longer duration, e.g. in patients requiring intravenous nutrition or prolonged courses of antibiotics.