Vascular Surgeon
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associate Professor Ramon L. Varcoe

Procedures

There are a large number of surgical procedures performed by a vascular surgeon every day. Included in this section are a few of the more common procedures with an accompanying short description. Professor Varcoe will go through your procedure in detail and spend time answering any questions that you might have.

Pelvic Congestion Syndrome 

Approximately one third of women will experience chronic pelvic pain during their lifetime. A large number of possible diagnoses exist including gynaecological disorders such as fibroids, endometriosis and ovarian tumours which need to be excluded. Dilated pelvic and ovarian veins are often responsible for these symptoms in a condition termed Pelvic Congestion Syndrome.

Pelvic Congestion Syndrome is caused by refluxing veins which result in high pressure blood stretching the vein wall. This is a similar process to lower limb varicose veins however due to their hidden location within the pelvis they often go undiagnosed.

Diagnostic investigations with ultraound and pelvic CT scan are usually followed by a pelvic venogram. This is an outpatient test whereby contrast dye is injected into the ovarian and pelvic veins and then observed with x-rays to confirm the diagnosis.

Definitive treatment for this condition is catheter based and performed under local anaesthetic. The ovarian and pelvic veins which are refluxing are intentionally occluded using a combination of coils and sclerotherapy agents. Patients are kept in hospital overnight as abdominal pain is common for a few days afterward. The treatment successfully relieves the symptoms in 80% of sufferers.

Professor Varcoe has a special interest in this condition and sees many patients with the disorder.


cAROTID sTENTING & eNDARTERECTOMY

We each have left and right side carotid arteries in the neck which divide into two vessels that supply the majority of blood to our brain. At the point of carotid bifurcation it is not uncommon to develop hardening of the arteries, plaque formation and narrowing.

A narrowed artery forces blood through at high velocity causing turbulent flow that may result in the dislodgement of debris and cause a stroke. A minor, reversible stroke may bring this condition to the attention of your doctor and allow treatment with medications such as aspirin, clopidogrel and statins. A number of people have such a narrowing without symptoms and may be unaware of its existence. It is a dangerous condition as the first symptom may be a devastating stroke. Professor Varcoe will examine your risk factors, optimize your medication therapy and advise you on whether surgery may be required to widen the artery.

Usually this decision will be made after an ultrasound and CT scan. If widening of the artery is required it may require surgery to carefully clean out the diseased vessel (endarterectomy) or stenting to dilate the inner channel. Professor Varcoe regularly performs both of these procedures and lectures on how each is best applied to individual patients. He is able to advise you on whether carotid stenting or endarterctomy is best for you based on a complex medical and anatomical risk profile analysis.


rENAL aRTERY sTENTING

Our two kidneys filter the blood of toxic metabolites and excess fluid. They are supplied with this blood by branches of the aorta found in the mid abdomen, called renal arteries. If these renal arteries become narrowed by hardening, plaque or inflammatory diseases problems can occur.

Commonly we see raised blood pressure as the body makes an effort to drive more blood to the under-perfused kidneys, and occasionally we may see deteriorating renal function. Under these circumstances Professor Varcoe may recommend a procedure to overcome the narrowing. Minimally invasive stenting is usually preferred as first line treatment and can be performed under local anaesthetic with an overnight hospital stay.


Venous Disease & Procedures

Veins are blood vessels that allow blood to pass from the periphery back to the heart. They do this against gravity with the aid of one-way valves. If these valves become dysfunctional, blood can pool around the ankles and calves leading to problems.

Venous dysfunction leads to raised pressure in the superficial veins of the leg and may present in a number of ways; including swelling, aching, skin discolouration, varicose veins or even ulcers. The appearance of the veins or any of these symptoms may be significant enough to warrant treatment, a large number of options for which may exist for any one leg.

Compression stockings may control the venous pressures but can be hot and difficult to apply. Traditionally venous stripping has been used to remove the problematic vein however this is now being replaced by less invasive forms of treatment such as Venaseal adhesive, radiofrequency ablation, laser and foam sclerotherapy.

Professor Varcoe performs all forms of treatment, with the exception of micro-sclerotherapy for spider veins, and can decide on the best practice venous surgery for you. Furthermore, he has the largest experience in medical adhesive venous ablation (Venaseal therapy) in Australia with outstanding results comparable to highest international standards.


AORTIC ANEURYSM AND AORTIC DISEASE

The aorta is the main blood vessel of the body. It leaves the heart heading towards the head before arching a full 180 degrees to traverse the chest and abdomen close to the body’s midline. Several branch arteries are given off to supply the brain, heart, kidneys, bowel and every other organ of the body.

Aneurysm is a disease whereby the wall of the aorta becomes weak and dilates, forming a shape more like a football rather than its normal tubular configuration. As the aortic wall dilates it becomes weak and may burst or rupture at a point that is predicted by its diameter. The larger the aneurysm the higher the risk. Aortic aneurysm is more common when family members are affected however smoking and high blood pressure are independent risk factors for the disease.

Aortic dissection is a different entity from aneurysm. It occurs when the inner lining of the aorta tears, usually as a result of high blood pressure or an inherent weakness. Blood rushes in under pressure and “dissects” for a distance causing severe pain in the chest or back. This may occlude artery branches or over time develop into an aneurysm. Both of these scenarios are life threatening.

Historically both of these syndromes were treated with open surgery where long incisions were made and patients spent considerable time in the intensive care unit and hospital ward afterwards. Now they are mostly treated with minimally invasive “stent-grafts” which not only reduce the stay in hospital but also significantly reduce the risk of surgery.

These “stent-grafts” are metal stents covered by impermeable fabric that come in a variety of sizes and shapes. Some are even custom made by hand for individual patients. They work by re-lining the aorta and stay in place permanently. As an aortic aneurysm surgeon, Professor Varcoe performs these procedures “percutaneously” through tiny cuts in the skin of the groin that don’t even require a stitch.


Lower Limb Angioplasty, sTENTING & bYPASS

Arteries supply oxygen and nutrient rich blood to the periphery under high pressure. This blood is required to feed muscles at rest and more so during exercise. It is also required to heal cuts, scratches and ulcers.

Blockages in the arteries of the leg are common and usually due to atherosclerosis, or hardening of the arteries. Atherosclerosis is common as we age and is accelerated by smoking, diabetes, high cholesterol and high blood pressure. Many blockages are not symptomatic however symptoms when they do occur range from calf pain and cramping during exercise through to pain at rest, ulceration and even gangrene.

Any blockages need assessment by a vascular surgeon. Treatments when required aim to overcome these blockages either with the use of balloons and stents to re-open the artery or bypass to go around it. Professor Varcoe is an expert on the treatment of this condition and recognised globally for his contributions in this field. He favours less invasive methods where possible for primary treatment and reserves bypass for when there is no other alternative.


sUBCLAVIAN aRTERY DISEASE

We each have two subclavian arteries. They are branches of the aorta that arise in the chest and supply blood to the arms and also the rear portion of the brain.

Narrowing of these blood vessels occur mostly at their origin and is usually the result of arterial hardening and plaque formation. Symptoms may occur as a result of these narrowings and include pain in the corresponding arm upon exercise or even blackout and falls. These serious symptoms must be addressed and treated when they occur.

Professor Varcoe prefers stents to treat these narrowed arteries but uses surgery under certain circumstances. The treatment is individualized to you and your particular symptoms.


AV FISTULA CREATION, ANGIOPLASTY & STENTING

The arteriovenous or AV fistula is a surgically created join between an artery and vein, usually in the arm or leg. It is performed for people who have kidney failure to provide a place to access the blood stream to facilitate haemodialysis.

Once created it takes at least six weeks to mature for use and in some people may take a lot longer. Because of this maturation time it is often performed pre-emptivley for patients who are approaching haemodialysis or in those who choose an alternative form of dialysis as a back-up in case that form fails.

Occasionally the AV fistula may not mature after formation or may mature but then develop problems. These problems include narrowing in a segment that threatens to block the fistula or extends the time taken to dialyse effectively. Angioplasty and stenting of the AV fistula may be required under such circumstances and are preferred over more invasive surgical fistula revision under most circumstances.