Open Vascular Surgery

Dr Freeman has extensive experience in performing open vascular surgery in appropriately selected patients. All surgical operations carry some risk however the information provided here is for general educational purposes only. Dr Freeman will discuss on an individual case by case basis whether open vascular surgery is appropriate to treat your specific condition and the risks involved.

What is carotid endarterectomy?

Some patients benefit from surgery to clean out the carotid artery in the neck (carotid endarterectomy) in order to prevent stroke. The decision to perform surgery is based on several factors including the degree of narrowing and whether the patient has had symptoms. Surgery on the carotid arteries does carry with it the risk of causing a stroke. This needs to be balanced against the risk of stroke without surgery which is particularly high in patients who have already suffered damage to the brain. Surgery also carries with it the risk of injury to the nerves that control the tongue, speech and swallowing. These nerves usually recover. There is also the risk of bleeding, especially given that patients need to continue aspirin around the time of surgery. Infection rarely occurs and in some patient’s blood pressure is difficult to control after surgery.

What is open surgical aneurysm repair?

In the past all aneurysms were repaired by open surgery through a large incision in the abdomen. This involves directly sewing a graft into the patient to replace the aneurysm. This carries with it risks. As with any surgery infection and blood clots can rarely occur. Patients receive medication to help prevent these complications. Stress is placed on the heart so heart attack can occur particularly in patients with heart problems. Damage can be done to the kidneys. Very rarely someone might not survive the procedure due to complications.

What is a bypass for peripheral arterial disease?

Surgery for peripheral arterial disease has traditionally involved an open vascular surgical bypass to restore flow beyond blocked arteries in the legs. A bypass is a major procedure. Careful consideration needs to be given in relation to the risks versus the benefits. There can be problems with infection, the wounds, developing blood clots, the heart and lungs and bypasses can themselves block especially in patients who continue to smoke.

What is an arteriovenous fistula?

Patients requiring long term haemodialysis are best served with an arteriovenous fistula. These are surgically created by joining an artery to a vein, usually at the wrist or the elbow. After the operation and over a period of 6 to 12 weeks the blood flow through the fistula increases to the point where there is enough flow to support haemodialysis. Once this is the case the fistula can be accessed with needles through the skin and into the vein. Blood is then taken to and from an artificial kidney.

What is thoracic outlet decompression?

Thoracic outlet syndrome occurs when the nerves or vessels (veins and arteries) to the arm are compressed as they come out of the chest, go over the first rib and pass under the collar bone. Some patients are suitable for surgery to create more room for these structures. This can involve removing extra (cervical) ribs or alternatively the first rib. Damaged arteries and veins may also require surgical repair.

What is varicose vein stripping?

While open surgery has largely been replaced by minimally invasive procedures, it remains appropriate for selected patients with varicose veins. Surgery involves directly removing diseased veins from the thigh and leg through incisions. Often an incision is placed in the groin where the vein is tied off before being stripped from the leg.  Patients can have bleeding, pain related to the incisions and there is a risk of wound infection. Patients normally require a period off work and need to avoid any heavy or strenuous activity.