SAVING LIMBS, SAVING LIVES

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1 Advanced Vascular & Endovascular Surgery Narayana Institute of Vascular Sciences Narayana Hrudayalaya Hospital, Hosur Road, Bangalore, India SAVING LIMBS, SAVING LIVES

Vascular Disease As we age, our arteries tend to thicken, get stiff, and narrow because of a build-up of plaque and cholesterol.

2 Your Vascular System All your arteries (red) and veins (blue) make up your vascular system. Arteries carry oxygen-rich blood to your vital organs and to your legs and feet, and veins drain the blood back to the heart. Vascular Disease As we age, our arteries tend to thicken, get stiff, and narrow because of a build-up of plaque and cholesterol. When this occurs in large and medium-sized arteries, it is called atherosclerosis (hardening of the arteries). When the narrowing happens in arteries leading to the heart, it can cause a heart attack. The same situation in other areas of the body can cause peripheral vascular disease. Peripheral Arterial Disease (PAD) Typically with age, the peripheral arteries build up plaque that narrows the passageways causing them to become stiff. PAD results when the peripheral arteries become too narrow or obstructed and limit the blood flow to the legs. One in every 20 Indian over the age of 50 has peripheral arterial disease (PAD). PAD is estimated to affect more than Nine million people in India. Individuals with PAD suffer a five-fold increased Relative risk of a cardiovascular ischemic event and total mortality that is two to three fold greater than those without PAD. What are the risk factors? 1.Aging 2. Diabetes 3. Smoking 4. High cholesterol 5. Obesity 6. Lack of exercise 7. Males are more prone to PAD, but women are at risk as well 8.Family history of vascular problems 9.Jains and Marwaris are at particular risk of PAD What are the symptoms? There may be no symptoms in the early stages of PAD. Developing symptoms may include discomfort or pain in your l Legs when walking with the pain going away when you stop and rest. This could increase to continuous leg pain and tissue loss in the form of Gangrene or non-healing leg ulcer.

cholesterol levels Eat a healthy diet Exercise See a vascular surgeon if PAD is diagnosed, or to

Scan and or Angiography and advise you what treatment is best for you.

recommended depending on your condition.

Endovascular Treatment Healing wounds by Infra-inguinal Bypass Surgery Bypass of Tibial Arteries

that carry blood from your heart, up through your neck, to your brain.

3 What can I do? See your doctor if you are at risk Stop smoking Manage your diabetes Maintain healthy cholesterol levels Eat a healthy diet Exercise See a vascular surgeon if PAD is diagnosed, or to be tested for PAD in its early stages Your Vascular Surgeon will do a Lower Limb Arterial Duplex Scan and or Angiography and advise you what treatment is best for you. Generally speaking a Peripheral Angioplasty (Endovascular Procedure) or a Bypass Surgery is recommended depending on your condition. Healing wounds by Endovascular Therapy Before Angioplasty of Tibial Arteries Healing After Endovascular Treatment Healing wounds by Infra-inguinal Bypass Surgery Bypass of Tibial Arteries with Blood flow into foot Carotid Artery Disease (Stroke) Carotid arteries are two main arteries that carry blood from your heart, up through your neck, to your brain. Carotid artery disease results when the carotid arteries become too narrow or obstructed from plaque and limit the blood flow to the brain. Strokes result either from obstruction of blood flow to the brain by the plaque or when bits of plaque and clots break off from the plaque and flow to the brain.

Extent of Problem Stroke remains the third leading cause of death with nearly 157,000 people dying annually. A large proportion of strokes are caused by plaque in the carotid arteries.

Age High blood pressure Diabetes Smoking High cholesterol Obesity Lack of exercise Irregular heartbeat Family history of Atherosclerosis (hardening of the arteries) and/or stroke Ministrokes (or

Some symptoms include: Weakness, numbness, or tingling on one side of the body Inability to control movement of a body part Loss of vision or blurred vision in one or both eyes Inability to speak

4 Extent of Problem Stroke remains the third leading cause of death with nearly 157,000 people dying annually. A large proportion of strokes are caused by plaque in the carotid arteries. In 2006 it was estimated that Indians would pay about Rupees 579 crores for stroke-related medical costs and disability. What are the causes and risk factors? Age High blood pressure Diabetes Smoking High cholesterol Obesity Lack of exercise Irregular heartbeat Family history of Atherosclerosis (hardening of the arteries) and/or stroke Ministrokes (or transient ischemic attacks TIAs ) are usually temporary lasting a few minutes to a few hours, and should be treated as serious medical emergencies requiring immediate treatment. Some symptoms include: Weakness, numbness, or tingling on one side of the body Inability to control movement of a body part Loss of vision or blurred vision in one or both eyes Inability to speak clearly Difficulty talking or comprehending what others are saying Dizziness or confusion What can you do? See your doctor if you are at risk or experience a ministroke Maintain normal blood pressure levels Stop smoking Control cholesterol levels Maintain a healthy weight Exercise See a vascular surgeon if Carotid Artery Disease is diagnosed Your Vascular Surgeon will do a Carotid Arterial Duplex Scan and or Angiography and advise you what treatment is best for you. Generally speaking a Carotid Endarterectomy Surgery or a Carotid Stenting (Endovascular Procedure) is recommended depending on your condition and suitability. Duplex Scan Carotid Angiogram

5 Carotid Endarterectomy Surgery for Stroke prevention Carotid Stent Procedure Before After

Abdominal Aortic Aneurysm (AAA) Your aorta is the largest artery in your body. An AAA occurs when the wall of the aorta progressively weakens and begins to bulge.

6 Abdominal Aortic Aneurysm (AAA) Your aorta is the largest artery in your body. An AAA occurs when the wall of the aorta progressively weakens and begins to bulge. It may continue to enlarge and eventually rupture if left untreated causing severe internal bleeding and death. Extent of Problem More than 15,000 people die each year from rupture of an aortic aneurysm. Nearly 200,000 people are diagnosed with AAA annually. It is estimated that more than one million people are living with undiagnosed AAA and at least 95 percent of these can be successfully treated if detected prior to rupture. Who is at risk? People with a history of atherosclerosis (hardening of the arteries) Those with a family history of AAA Those who smoke Patients with High blood pressure Chronic lung disease What are the symptoms? A pulsing feeling in the abdomen Unexplained, severe pain in your abdomen or lower back Pain, discoloration, or sores on your feet (this is a rare symptom) What can you do? See your doctor if you are at risk Stop smoking Maintain normal blood pressure levels See a vascular surgeon to be tested to see if you have an AAA. See a vascular surgeon if your doctor diagnoses an AAA Your Vascular Surgeon will do an Abdominal Ultrasound Scan and or CT Angiography and advise you what treatment is best for you. Generally speaking a Open Aneurysm Surgery or a Endovascular Aneurysm Repair (Endovascular Procedure) is recommended depending on your condition and suitability. Dr Prof Tripathi performed India s First Successful Endovascular Aneurysm Repair in Since then, he has the largest Experience of Endovascular Repair of Aneurysms in India having performed over 500 such repairs including hybrid and fenestration procedures

7 Current Therapy: Open Surgical Repair AAA Aneurysm opened, graft sewn in, aorta wrapped and closed around graft Established procedure (>40 years) Excludes aneurysm and prevents sac growth Proven, long-term results Considered the gold standard Operative mortality 1% to 5% (elective repair) Endovascular AAA Repair (EVAR) Primary Bifurcated Module Delivery Infrarenal Placement Completed Primary Deployment Contralateral Limb Delivery Cathete Contralateral Limb Deployment Completed Repair

8 Documented Benefits of Endovascular Repair of Aneurysms Shorter hospital stay Less blood loss during operation Fewer postoperative complications involving respiratory system and heart Less patient discomfort and shorter recovery time Before After 1 year post EVAR

9 THORACIC AORTIC ANEURYSMS Open Repair Endo Venous Ablation Treatment of Varicose Veins Endovascular Thoracic Aneurysm Repair Venous Surgery Varicose veins are a known cause of severe physical and psychological discomfort. The superficial veins stretch and bulge under the skin and create pronounced, bumpy "cords" on the legs. They are more common in women and in people who sit or stand in the same position for long periods of time. Endovenous Ablation Treatment EVAT in conjuction with sclerotherapy can in upto 97% afflicted patients treat varicose veins quite effectively. This is a minimally invasive procedure under Local Anesthesia, doesn t involve any cut and is virtually painless allowing return to normal active life immediately after this procedure.

10 Faculty Director Consultants Dr Ramesh Tripathi MBBS (JIPMER), FACP, FICS, FRCS Edin., FRACS Vascular (Australia) Dr Prof Tripathi is an internationally renowned leading opinion maker in Vascular and Endovascular Surgery. He is the first and only Distinguished Fellow of Society for Vascular Surgery from Inida. He has significant pioneering contributions to innovative, minimally invasive and new advances in Endovascular Surgery especially in the areas of in-situ fenestration of stent-grafts in the Endovascular treatment of Thoracic and Abdominal Aortic Aneurysms and Deep Venous Valve Incompetence. He is credited for performing India s first Endovascular repair of Abdominal Aortic Aneurysm in 1997 followed by India s first Thoracic Aortic Aneurysm repair in He also performed the first Implant of Medtronic Xcelerant AAA stent graft in Australia and New Zealand at Wellington Hospital, New Zealand on June He has since then performed over 300 Endovascular repair of Aortic Aneurysms. His areas of expertise include bypass surgery and endovascular procedures for peripheral arterial and venous diseases, thoracic and abdominal aortic aneurysms, stroke prevention by carotid interventions and RF / Laser treatment of varicose veins. He is a Faculty Speaker at many prestigious International Vascular Conferences including VEITH Symposium (Vascular and Endovascular Issues Techniques and Horizons), VIVApvd, MEET Rome, Aorta Italy, ISET International Symposium on Endovascular Therapies, European Society of Vascular Surgery, Asian Vascular Society,ANZSVS, CICE and International Congress of Endovascular Interventions. He is on the Board of Governors of Innovasc Endovascular Research Group, New Zealand and continues research initiatives with Thrombosis Research Institute at Narayana Hrudayalaya in developing Endovascular Vein Valves, Aortic Stent grafts and Bioabsorbable Polymer stents. He reviews publications for 9 Journals and is on the Editorial board of Journal of Phlebology. Dr Robbie George MBBS, MS, FRCS, CCST Vascular Surgery (UK) Dr Robbie George is an alumnus of Maulana Azad Medical College, New Delhi where he did his MBBS and MS in General Surgery. He trained in Vascular and Endovascular Surgery at University of Leeds UK. His main interests lie in Open and Endovascular Surgeries, Vascular Reasearch and teaching. Dr Rajesh S MBBS, MS, MRCS (UK), FEVS (Germany) Dr Rajesh trained in Vascular and Endovascular Surgery at MS Ramaiah Medical College and Kiel University Medical School in Germany. He worked as a Specialist Vascular and Endovascular Surgeon at M.S Ramaiah Medical College and King Fahd Specialist Hospital before joining Narayana Hrudayalaya. His interests lie in Open and Endovascular Surgery and Clinical Trials Contact Us Narayana Hrudayalaya Hospitals 258 A, Bommasandra Industrial Area, Anekal Taluk, Bangalore , India Phone Fax Website Ramesh.tripathi@nhhospitasls.org

Lower Extremity Arterial Disease

Lower Extremity Arterial Disease Circulating the Facts About Peripheral Disease Brought to you by the Education Committee of the Society for 1 www.svnnet.org Peripheral Artery Disease (PAD) Many people