Vascular Surgery
At North Toronto Surgical, our skilled vascular surgeons specialize in diagnosing and treating disorders of the circulatory system. They employ advanced surgical techniques to address conditions such as peripheral artery disease, aneurysms, and varicose veins, ensuring comprehensive and personalized care for our patients' vascular health.
Abdominal Aortic Aneurysm (AAA)
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Aortic aneurysms are a medical condition that occurs when the wall of the aorta, the largest artery in the body, weakens and bulges outwards. This bulging can occur anywhere along the aorta, but it is most commonly found in the abdominal area. Aortic aneurysms are often asymptomatic and are typically diagnosed incidentally during imaging tests for other health issues. However, if an aneurysm grows too large, it can rupture and cause life-threatening bleeding.
The exact cause of aortic aneurysms is unknown, but some risk factors have been identified. These risk factors include age, smoking, high blood pressure, atherosclerosis, family history, male gender, and connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome. Certain lifestyle changes, such as quitting smoking and controlling high blood pressure, can help prevent the development or progression of aortic aneurysms. If an aortic aneurysm is detected, treatment options may include monitoring its growth, surgical repair, or endovascular repair using stents.
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Open Aortic Aneurysm Repair
In an open repair procedure for aortic aneurysms, the surgical team will typically make an incision in the abdomen, and sometimes in the groins. They will then administer an anticoagulant to thin the blood and stop blood flow through the affected section of the aorta. The team will then open the affected area and sew a durable fabric tube (graft) into place to connect the healthy ends of the aorta.
Endovascular Aortic Aneurysm Repair
Endovascular aneurysm repair (EVAR) is a minimally invasive procedure performed through the blood vessels in your groin, specifically the femoral arteries. Depending on the access method chosen by your surgeon, small incisions (5 to 7 cm) in both groins, known as open access, or small punctures/hole in both groins, known as percutaneous, may be made. Long wires and catheters (thin plastic tubes) are then inserted through the arteries and up into your aorta to the aneurysm. The surgeon uses X-ray images to guide them in placing the stent graft in the correct location between two healthy portions of the aorta. Once in position, the stent graft is expanded and held in place by small hooks, effectively sealing off the aneurysm.
To confirm the correct placement and ensure there are no leaks around the stent graft, dye is added to the blood at the end of surgery. Over time, the aneurysm "sac" should gradually shrink around the graft.
Peripheral Arterial Disease (PAD)
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Peripheral arterial disease (PAD) is a condition in which the arteries that supply blood to the limbs, typically the legs, become narrowed or blocked. This can lead to a variety of symptoms, including leg pain, cramping, and weakness, particularly during exercise or other physical activity.
The most common cause of PAD is atherosclerosis, which is the buildup of plaque (a combination of fat, cholesterol, and other substances) in the arteries. Over time, this plaque can narrow the arteries and restrict blood flow to the limbs. Other factors that can contribute to the development of PAD include smoking, high blood pressure, high cholesterol, diabetes, and a family history of the condition.
PAD can also be caused by blood clots, which can block blood flow in the arteries and lead to tissue damage and other complications.
PAD can be diagnosed through a variety of tests, including physical examination, ankle-brachial index (ABI) measurement, and imaging tests such as ultrasound, CT scans, or MRIs.
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The treatment for peripheral arterial disease (PAD) depends on the severity of the condition, the location of the blockage, and the patient's overall health. The goal of treatment is to manage symptoms, improve blood flow to the affected area, and reduce the risk of complications.
Lifestyle Changes: Quitting smoking, following a healthy diet, and getting regular exercise can help manage the symptoms of PAD and improve overall cardiovascular health.
Medications: Medications such as antiplatelet agents, cholesterol-lowering medications, and medications to control high blood pressure may be prescribed to help manage symptoms and improve blood flow.
Angioplasty and Stenting: These minimally invasive procedures can be used to open up blocked arteries and improve blood flow. During angioplasty, a small balloon is inserted into the affected artery and inflated to widen the artery. A stent may also be inserted to help keep the artery open.
Atherectomy: This is a procedure that involves removing plaque from the walls of the arteries using a catheter-based device.
Bypass Surgery: In more severe cases, bypass surgery may be necessary to reroute blood around a blocked artery. This involves creating a graft to bypass the blocked section of the artery.
Exercise Therapy: Exercise therapy supervised by a physical therapist can help improve walking distance and reduce symptoms in patients with PAD.
Wound Care: In severe cases, PAD can cause wounds that are slow to heal or may not heal at all. Wound care and specialized treatments may be necessary to promote healing.
Your surgeon will work with you to determine the best treatment plan for your individual case. It's important to follow your doctor's instructions carefully and attend all scheduled follow-up appointments to ensure the best possible outcome and minimize the risk of complications.
Carotid Artery Stenosis
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Carotid artery stenosis refers to the narrowing of one or both of the carotid arteries, the major blood vessels located on each side of the neck that supply blood to the brain. This condition is often caused by the buildup of fatty deposits, known as plaque, within the arteries, and it can restrict blood flow to the brain, increasing the risk of stroke.
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Carotid artery stenosis can be treated through various approaches depending on the severity of the condition and the patient's overall health. Common treatment options include:
Lifestyle modifications: Making changes in lifestyle, such as adopting a healthier diet, exercising regularly, and quitting smoking, can help manage and prevent the progression of carotid artery stenosis.
Medications: Antiplatelet medications, such as aspirin or clopidogrel, may be prescribed to reduce the risk of blood clots. Statins can also be used to control cholesterol levels and prevent plaque buildup.
Carotid endarterectomy (CEA): This is a surgical procedure in which the surgeon removes the plaque from the carotid artery to improve blood flow. It is often recommended for individuals with significant narrowing of the carotid artery or those who have had a recent stroke or transient ischemic attack (TIA).
Carotid artery stenting (CAS): In this minimally invasive procedure, a stent (a small mesh tube) is placed in the narrowed section of the carotid artery to keep it open and restore blood flow. CAS is an alternative to carotid endarterectomy, especially for individuals who may not be suitable candidates for surgery.
The choice of treatment depends on factors such as the degree of stenosis, the patient's overall health, and the presence of symptoms or a history of stroke. Individualized assessment by our surgeons will be undertaken at the time of consultation and guide treatment recommendations.
Lower Extremity Edema
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Lower extremity edema refers to the accumulation of excess fluid in the tissues of the legs and feet, leading to swelling. This condition is commonly associated with an imbalance in the fluid dynamics of the body, often caused by factors such as:
Gravity: Fluid tends to pool in the lower extremities due to the effects of gravity.
Venous insufficiency: Weakened or damaged veins may struggle to return blood to the heart efficiently, resulting in fluid leakage into the surrounding tissues.
Heart failure: A weakened heart may not pump blood effectively, causing fluid retention and swelling in the extremities.
Kidney disease: Impaired kidney function can lead to fluid retention and swelling throughout the body.
Lymphedema: Blockage or damage to the lymphatic system can result in the accumulation of lymph fluid in the tissues.
Inflammatory conditions: Conditions such as arthritis or infections can cause inflammation, contributing to fluid buildup.
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The treatment of lower extremity edema depends on the underlying cause. Here are some general approaches that our vascular team may consider:
Lifestyle modifications:
Elevating the legs: Keeping the legs elevated when sitting or lying down helps reduce fluid accumulation.
Regular exercise: Physical activity promotes circulation and helps prevent fluid retention.
Compression therapy:
Compression stockings: These specially designed stockings apply pressure to the legs, aiding in the movement of fluid and reducing swelling. North Toronto Surgical offers customized fittings for compression stockings at our clinic.
Compression wraps: North Toronto Surgical commonly uses three forms of compression wrap therapy, especially in the setting of lower extremity wounds secondary to edema. Coban is a self-adherent elastic bandage that is commonly used for short-term compression. Unna boots, consisting of a gauze bandage impregnated with a zinc oxide and calamine paste, are specifically designed for managing venous leg ulcers and chronic venous insufficiency, providing compression and promoting healing. Tubigrip, a seamless tubular elastic bandage, offers versatile and simple support for limbs affected by edema, strains, or sprains, allowing for easy application without additional fasteners. All three options—Coban, Unna boots, and Tubigrip—serve different purposes in wound care and compression therapy, and their usage in a patient’s therapy plan will be guided by our vascular team.
Medications:
Diuretics: These medications increase urine production, helping the body eliminate excess fluid. However, their use depends on the underlying cause of edema, and they should be prescribed and monitored by a healthcare professional.
Treating the underlying condition:
Addressing the primary cause of edema is crucial. For example, managing heart failure, kidney disease, or venous insufficiency can help alleviate fluid retention.
Lymphedema management:
For edema related to lymphatic system issues, therapies such as manual lymphatic drainage, compression, and specific exercises may be recommended.
Surgical interventions:
In certain cases, surgical procedures may be recommended, especially if the edema is caused by venous insufficiency.