Practice No 4208293
Practice No 4208293
Practice No 4208293
Practice No 4208293
Your vascular surgical team
Our vascular team treats the full spectrum of blood-vessel problems. We clear carotid arteries to cut stroke risk, repair aortic aneurysms before they rupture, and restore leg circulation in peripheral arterial disease. On the venous side we relieve varicose veins, manage chronic swelling and heal deep-vein thrombosis. We also prevent diabetic foot infections from turning into limb-threatening wounds and create reliable dialysis access. Whatever your vessel concern, you will find expert diagnosis, minimally invasive options and attentive follow-up here.
Plaque forms from cholesterol and calcium deposits, hardening arteries and reducing blood flow. Smoking and diabetes significantly worsen this process, accelerating artery blockages and complications like chest infections. Intervention becomes necessary when symptoms include severe pain, especially at rest, or non-healing leg ulcers. Additionally, diagnostic scans detecting significant artery blockages or issues like endoleaks in grafts indicate a need for medical treatment.
What is an Aortic Aneurysm?
An aortic aneurysm is a “blowout like a balloon” in the aorta, the large artery carrying blood from the heart to the legs. This condition is dangerous because the aneurysm can leak or burst, leading to fatal internal bleeding. The procedure involves replacing the aneurysm with a new artery.
What does the operation consist of?
The operation utilizes a stent graft, which is a self-expanding metallic device lined with a tough plastic fabric. It comprises two components:
What is an Aortic Aneurysm?
An aortic aneurysm is a balloon-like bulge in the aorta, a major artery carrying blood from the heart to the legs. This bulge occurs deep in the tummy, around the navel. It poses a serious risk because it can leak or burst, causing fatal internal bleeding. The procedure involves replacing the aneurysm with a new artery.
What does the operation consist of?
A cut is made in the skin of the tummy, typically extending from the breastbone to the pubis. A new artery, crafted from a tube of very strong Dacron fabric, is stitched into place inside the aneurysm. The tummy incision is then stitched closed. In cases where the two arteries running to the legs also have aneurysms, a new artery shaped like a pair of trousers is used, with its lower ends stitched to the leg arteries. This specific type of operation requires a cut in each groin. These new arteries are designed to last for 20 years or more.
What is the problem?
The problem is an inadequate blood supply to the leg, foot, and toes, which can lead to severe pain and potentially serious infection. The only course of action is to remove the damaged part of the limb. This amputation must be performed high enough on the leg to ensure proper healing of the remaining stump, specifically just above the knee.
What does the operation consist of?
A cut is made to remove the diseased part of the leg. The goal is to create a rounded stump made of healthy skin. If a serious infection is present, a preliminary amputation might be performed first to clear the infection, followed a few days later by the definitive above knee amputation.
What is the problem?
This procedure is necessary when there is insufficient blood flow to the leg, foot, and toes, which causes severe pain and can lead to serious infection. The only option is to remove the damaged part of the limb, specifically by amputating through the knee, to achieve proper healing of the stump.
What does the operation consist of?
A cut is made to remove the diseased part of the limb. The aim is to create a rounded stump consisting of healthy skin.
What is the problem?
This operation is performed when a toe does not receive enough blood to stay alive, or when there is extensive infection leading to tissue death. This lack of blood flow causes severe pain and allows serious infection to develop. The only choice is to remove the affected toe. In some cases, a toe may have shrivelled and become a nuisance. Sometimes, multiple toes may need removal, or the operation may be performed concurrently with a blood vessel operation.
What does the operation consist of?
Typically, after the toe is removed, the skin can be stitched up over the wound. However, in some instances, it is considered better to allow the wound to heal naturally without stitches, a process that takes about 3 or 4 weeks.
What is an Arteriogram?
An arteriogram is a specialized X-ray procedure designed to diagnose blockages or malfunctions within the arteries of the body.
What does the operation consist of?
A long, fine tube (catheter) is inserted into the artery at the groin. A local anesthetic is injected into the skin at the groin to numb the area, making the procedure painless. A special dye, known as contrast, is then injected down the catheter. X-ray pictures are taken continuously as the dye passes through the blood vessels. Some injections of the dye may cause a hot flushing sensation for a few seconds and an occasional feeling of needing to pass water. Once the test is complete, the catheter is removed, and pressure is applied to the groin for approximately ten minutes to minimize any bruising. The entire procedure typically lasts about one hour.
What is Angioplasty? What is a Stent?
An angioplasty is a procedure where a balloon on the end of a tube (catheter) is passed into your artery and is inflated to treat a narrowed or blocked artery. It is usually performed under local anaesthetic and the balloon is removed at the end of the procedure. A stent is a small metal cage designed to keep the artery open. It is passed into your artery, much in the same way as a balloon, but the stent remains in the artery and becomes incorporated into the wall. You will be asked to start taking aspirin before you are admitted as this makes the blood less sticky. If you have a stomach ulcer or are allergic to aspirin, please tell your doctor.
What does the operation consist of?
A catheter is introduced into an artery in the groin after a local anesthetic injection. Patients may feel the doctor manipulating catheters in and out of the groin artery, but it should not cause pain. For angioplasty, a balloon is inflated to open the artery. For some patients, or as a primary treatment, a stent may be inserted to keep the artery open. Following the procedure, pressure is applied to the groin, or a special “plug” is used to close the hole in the artery.
What is the problem causing the blocked arteries?
The aorta and its branches, the iliac arteries, can become blocked or narrowed due to the buildup of cholesterol and calcium, leading to reduced blood flow to the legs. This condition causes cramp-like pain during exercise, limiting walking ability, and in severe cases, pain even at rest. The blocked artery requires replacement with a new artificial artery, known as a graft.
What does the operation consist of?
An incision is made in the skin of the tummy, typically extending from the breastbone to the pubis, or sometimes across the tummy. A new artery, usually shaped like a pair of trousers and made of strong Dacron fabric, is stitched into place to bypass the blocked artery. The lower ends of the “trousers” are stitched to the leg arteries, which requires a cut in each groin. The new arteries are expected to last for 20 years or more.
What is the problem?
The main artery that carries blood from your heart down to your legs is blocked near your navel. The legs are starved of blood. This causes pain in the legs, the risk of serious infection and even loss of the limbs.
The arteries below the blockage are in much better shape. They could take more blood and you would then get rid of the pain in your legs and any infection would heal up.
What does the operation consist of?
One cut is made into the skin below the collar-bone, and a cut is made in each groin to locate the arteries. Tunnels are created under the skin to make a path for the new artery. Sometimes, an additional skin cut is needed over the middle of the new artery. A new artery is then threaded through these tunnels from the collar-bone artery to the groin arteries, where watertight joints are created. In some cases, a new artery is placed down each side, or a Y-shaped artery is used to take blood from one collar-bone artery to both groin arteries. The new artery is joined up, and the cuts are stitched closed. Patients should notice warm feet and a reduction in pain within 24 hours.
What is the problem?
The main artery, which carries blood down your leg, is blocked . The calf, foot and toes are starved of blood. This causes pain on walking. If you have pain at rest this can lead to serious infection and may be a sign of danger to the survival of you leg. We hope to open the blocked part of the artery with a balloon so that blood flows properly again.
What does the operation consist of?
A needle is inserted into the main artery of the affected leg in the groin. A guidewire is then passed up or down the artery and through the blocked section. A balloon is introduced over this wire, advanced through the blockage, inflated to open the artery, and then removed. This re-establishes blood flow down the leg towards the toes. Occasionally, a metal stent is introduced to support the artery, and this stent is left in permanently. The operation is typically performed under local anesthesia.
What is the problem?
One of the main arteries which carries blood through your neck to the brain, is partially blocked. This may often cause minor transient strokes, transient episodes of visual disturbance or other neurological symptoms. Occasionally this is a chance finding because of tests carried out for other reasons. There is a very real danger that a major stroke may occur unless the narrowing in your carotid artery is removed.
What does the operation consist of?
A cut is made in the skin down the side of the neck to expose the artery above and below the narrowing. The artery is then opened, and the atheroma (fatty deposits on the artery wall) is carefully removed. After removal, the artery is closed, usually with a patch to widen its diameter. A plastic drain is typically used to remove excessive secretions from the wound for about 24 hours.
What is the problem?
The main artery which carries blood to your leg is blocked in your groin. The leg is starved of blood. This causes pain, infection and even loss of the limb. In order to supply blood to your leg the artery in the groin needs to be ‘cleaned out’ and then widened with a patch. The blood will then run down the leg arteries below the blocked part. The pain and infection then gets better.
What does the operation consist of?
A cut is made into the skin in the groin and thigh. The artery is located, controlled, and opened. The material blocking the artery is cleared out, and then the artery is closed with a patch.
What is the problem?
The main artery which carries blood to your leg is blocked near your navel. The leg is starved of blood. This causes pain, infection and even loss of the limb. The artery carrying blood to your other leg is not blocked. Some of the blood from the good side can be led across to the bad side using a new piece of artery. The blood will then run down the leg arteries below the blocked part. The pain and infection then gets better. Your good leg can easily spare the blood which now goes to the bad side.
What does the operation consist of?
A cut is made into the skin in the groin and thigh on both sides of the body. The left and right arteries are located below any existing blockages. A new artery, made from a special plastic material, is then stitched into place to connect the two arteries under the skin. Finally, the incisions are stitched closed.
What is the problem?
The main artery which carries blood down your leg is blocked just above the knee. The calf, foot and toes are starved of blood. This causes pain and can lead to serious infection and loss of the toes. We can bypass the blocked part of the artery so that blood flows properly again.
What does the operation consist of?
Several cuts are made in the skin along the inside of the thigh to expose the artery both above and below the blockage. A bypass graft is then constructed using either one of the patient’s own veins or a special artificial material. This bypass is stitched into the artery above and below the blocked segment, allowing blood to flow through the bypass towards the toes.
What is Raynaud’s?
Raynaud’s is a condition where the blood supply to the extremities, usually the fingers and toes, but occasionally the nose or ears, is interrupted. During an attack the affected part first becomes white and dead looking, then turns blue as the tissues use up the oxygen and finally bright red as the arteries relax and fresh blood rushes in. Primary Raynaud’s can vary from a very mild form, being little more than a nuisance, to a severe form requiring treatment. Anyone of any age can suffer from Raynaud’s, but teenage women are affected more commonly. This may decline in severity after the menopause. It seems to be a change in temperature, rather than just cold exposure that precipitates an attack, so although worse in winter, it can occur in summer. Stress or anxiety can also provoke a Raynaud’s attack. Secondary Raynaud’s is associated with some other disease or external influence.
What is Scleroderma?
The word scleroderma means hardening of the skin. It is a disease of the connective tissue, which as the name implies holds our bodies together. Therefore not only the skin can be affected, but also internal organs. The majority of sufferers have the mild form where there is limited skin involvement, usually of the hands and feet, becoming stiff and shiny. The gullet often becomes affected making eating and swallowing difficult. Some patients also form tiny deposits of calcium under the skin (calcinosis) which can cause ulceration. In the more severe form, called diffuse scleroderma, wide areas of skin and internal organs such as the lungs, bowel heart and kidneys are affected. Localised scleroderma can be divided into two types: Morphea and linear scleroderma. Morphea is the name given to localised patches of hardening of the skin. Linear scleroderma develops in childhood and may affect the growth of a limb, and is usually limited to one area. Unlike morphea, linear scleroderma tends to involve deeper layers and can affect the mobility of underlying joints.
What about treatment?
Your GP or specialist may prescribe a vasodilator, which is a drug that relaxes the blood vessels. Occasionally, your specialist may feel an operation called a sympathectomy, may be of benefit. This involves either cutting or destroying the nerves that cause the arteries to constrict. This operation is more successful for Raynaud’s of the feet, your specialist will explain this to you.
What is a transient ischaemic attack?
Transient Ischaemic Attacks (TIA’s for short), are a kind of mini-stroke. The symptoms may be very like a stroke but they get better very quickly. Common symptoms include brief attacks of weakness, clumsiness, numbness or pins and needles of the face, arm or leg on one side of the body. Temporary slurring of speech or difficulty in finding words can also occur. The eye can also be affected resulting in loss of vision in one eye. This is called Amaurosis Fugax. These attacks may only last for a few minutes or hours and are usually better within a day.
What causes TIA’s?
TIA’s and strokes are caused by narrowing and blockages of the blood vessels that supply the brain. The trouble is due to hardening of the arteries (atherosclerosis) which may be caused by smoking, high blood pressure, high cholesterol levels and diabetes. In TIA’s the blockage is temporary and quickly clears itself. The symptoms depend on which blood vessel to the brain or eye is blocked and so which is starved of blood.
What is Intermittent Claudication?
The pain you feel in your legs is called ‘intermittent claudication ‘. The reason for the pain is a narrowing or blockage in the main artery taking blood to your legs. Over the years cholesterol and calcium build up inside the arteries, causing hardening of the arteries (atherosclerosis). This occurs much earlier in people who smoke, those who have diabetes, high blood pressure or high levels of cholesterol in the blood. The narrowing or blockage means that the blood flow is reduced. The circulation is sufficient when you are doing nothing, however when you walk the calf muscles cannot obtain enough blood and cramp pain occurs. This is made better by resting for a few minutes. If greater demands are made on the muscles, such as walking up hill, the pain comes on more quickly.
What about treatment?
Most people with intermittent claudication do not require surgery, but if your symptoms are very severe, or if they do not improve, further treatment may be necessary. An ultrasound scan of the arteries is usually performed first to see what can be done. Later an xray of the arteries, an angiogram, may be required short blockages in the artery may be stretched open with a small balloon device (angioplasty). This is usually done under local anaesthetic, and may involve an overnight stay in hospital.
Larger blockages are bypassed preferably using one of your own veins from the leg or a plastic tube (bypass graft). This is a major operation, under a spinal or general anaesthetic, and involves being in hospital for about 4 to 8 days. The decision about surgery is usually one for you to make yourself, after your surgeon has explained the likelihood of success and the risks involved. More detailed information about these procedures is available.
What is Ultrasound Guided Foam Sclerotherapy?
Ultrasound Guided Foam Sclerotherapy involves injecting a chemical (sclerosant) mixed with air into a varicose vein. This causes inflammation of the vein’s inner lining, making it “sticky”. Pressure is then applied to the vein using cotton wool and tape, followed by a thigh-high stocking or bandage, which leads to the obliteration of the lumen and occlusion of the vein.
This procedure offers several advantages over traditional surgery, such as avoiding vein stripping, causing little to no discomfort after treatment, and resulting in less bruising. It does not require a general anaesthetic, incisions in the leg, or hospital admission. Re-treatment for further varicose veins is simple. An advantage is that it is unlikely to disrupt your daily routine and does not require time off work. The final outcome may take a number of weeks/months to evolve, which is longer than surgery, and long-term results are still under evaluation.
What does the operation consist of?
The veins to be treated are marked. A needle is placed into the main affected surface varicose vein, which is the only part of the procedure that might cause discomfort and may be performed with a small amount of local anaesthetic. Ultrasound imaging is used to ensure accurate needle placement and to monitor the foam’s progress during injection. The foam is injected, and injecting it causes no discomfort, although the legs may ache slightly afterwards. Once the foam has filled all the main surface veins, the top end of the vein is compressed to keep the foam within these surface veins. Further injections may be needed to ensure all varicosities are completely injected. The entire treatment typically takes 20-30 minutes. Following the injections, the veins are compressed with cotton wool and tape, followed by a Class II thigh-high stocking or a bandage. The purpose of this compression is to keep the veins compressed so they do not fill with blood when standing. The stocking or bandage is worn day and night for a week, and then an above-knee elastic stocking is worn during the day for a further 10 days. If varicose veins are present in both legs, they are treated on separate occasions. Patients are able to walk immediately after the treatment. Compression of the veins is an important component of keeping the vein closed. A hard lump and some bruising may remain where the vein was after a few weeks, which is normal and indicates successful treatment.
What is a Varicose Vein?
A varicose vein is a skin vein that has swollen because of overspill of blood from veins running deep in the muscles of the legs. Varicose veins cause symptoms, and if left untreated, they can bleed or clot or cause ulcers. The operation involves the main feeder vein to the varicose veins being ‘sealed’ and obliterated using laser energy. The varicose veins themselves are then removed through tiny cuts down the leg.
What does the operation consist of?
Before the operation, the surgeon marks the varicose veins to be removed on the skin using an indelible marker pen. Patients are asked to take nothing by mouth for 6 hours before the operation to prevent vomiting. The operation area will be shaved to remove excess hair. During the procedure, the anaesthetic begins in the operating theatre, and the operation is then performed. After the operation, the leg is bandaged with wool and an elastic bandage, which stays on until the next morning and is then replaced by a thigh-high elastic compression stocking. Patients are encouraged to mobilize fairly soon after the procedure. The avulsion wounds are closed with sterile micropore, and there are no stitches. Some purple or yellow staining of the skin from bruising always occurs and fades in 3 to 4 weeks. Swelling around the ankle may last a week or two, controlled by wearing the elastic stocking. Lumpiness under the skin where the veins were removed is normal and settles down.
What is a Varicose Vein?
A varicose vein is a skin vein that has swollen because of overspill of blood from veins running deep in the muscles of the legs. Varicose veins cause symptoms, and if left untreated, they can bleed or clot or cause ulcers. The operation involves the main feeder vein to the varicose veins being tied off at the groin and sometimes behind the knee, and being removed. The varicose veins themselves are also removed through tiny cuts down the leg.
What does the operation consist of?
Before the operation, the surgeon marks the varicose veins that need to be removed on the skin using an indelible marker pen. Patients are asked to take nothing by mouth for 6 hours before the operation to prevent vomiting. The operation area will be shaved to remove excess hair. During the procedure, the anaesthetic begins in the operating theatre, and the operation is then performed. After the operation, the wound has a dressing, and there are stitches in the wound, which will be removed after 7-10 days (sometimes self-absorbing stitches are used). An elastic stocking may replace the crepe bandage applied after the operation. Some purple or yellow staining of the skin from bruising always occurs, often in the upper thigh, and fades in 3 to 4 weeks. Swelling around the ankle may last a week or two, controlled by using the elastic stocking. Patients are expected to get out of bed the day after operation despite discomfort. Lumpiness under the skin where the veins have been removed is normal and settles down.
What is a varicose vein?
A dilated tortuous superficial vein that is cosmetically unsightly and can give symptoms. Small ones are called spider veins or telangiectasia.
What is Sclerotherapy?
It is the use of an irritant solution or foam to destroy a vein. The solution/foam is placed into the vein by injection to irritate the linings of the vein so causing the walls to become adherent, to collapse and to become fibrosed and disappear.
Who can be treated?
Provided there is no problem with the valves in the veins – local sclerotherapy can flatten areas of superficial veins remarkably. The deep veins still return blood from your legs to your heart. Anyone can be treated providing there are no contra indications.
What does the operation consist of?
The procedure is performed in consulting rooms and takes 15-20 minutes. A rubber tourniquet may be used to dilate the veins with the patient standing. Fine needles are used usually without local anaesthetic. Once the solution is injected, compression is maintained with firm but not tight bandages. After the procedure, patients should walk for 15-20 minutes to keep the veins collapsed and allow the sclerosant solution to work well. Patients can walk normally and should avoid keeping the leg dependent for long periods, elevating the leg when sitting. Initially after treatment, the veins may look worse, with bruising, hardening of the skin, and local inflammation (a reaction to the agent). Some hyperpigmentation (increased color where the vein was) may persist for several months. Repeat injection sclerotherapy can be performed at one to two-month intervals.
What is the problem?
Lymph is the fluid that oozes out of the blood vessels into the tissues of the body. If the lymph channels are not working correctly, lymph can build up in the tissues, causing swelling, commonly in the feet, ankles, and legs, along with tightness and discomfort. This also increases the tendency for infection (cellulitis) in the swollen areas. Lymphatics may function poorly due to being too few (either from development or damage) or damage from injury, infection, surgery, or x-ray treatment. Since it is impossible to reverse this, treatment is concentrated upon improving the drainage of the lymph from the limb thus reducing the swelling. Lymphoedema is a chronic condition requiring continuous care over many years.
What does the operation consist of (Treatment Components):
◦ Elevation: The foot of the bed should be slightly raised (about 4 to 6 inches) so that gravity assists in lymph drainage during sleep. Elevation always helps.
◦ Elastic Compression: An elastic stocking gives external support and compression, aiding in the drainage of lymph and controlling swelling, and should be worn at every available opportunity.
◦ Infection Control: Particular attention must be paid to any skin damage or infection, as infection should be avoided at all costs and treated promptly if it occurs.
◦ Massage: Massaging the limb in the direction of lymph flow helps drainage.
◦ Exercise and Weight Control: Regular exercise assists the calf muscles in pumping blood up the veins.
What is a leg ulcer?
A leg ulcer is a wound on the lower part of the leg that takes longer than six weeks to heal, often originating from a minor injury. The usual underlying cause is a problem with the veins, where damaged valves lead to blood flowing backward, stretching veins, causing fluid to leak out into the surrounding tissues, resulting in leg swelling and poor skin nutrition, which can develop into a venous ulcer. It is important that they are properly diagnosed so that the correct treatment can be given. Leg ulcers can be treated successfully.
What does the operation consist of (Treatment Components):
The majority of venous ulcers are treated by compression therapy, which involves wearing several layers of bandages, usually changed on a weekly basis. Patients should rest with their legs elevated whenever possible. Regular exercise is crucial to assist calf muscles in pumping blood up the veins; if unable to walk, moving the feet up and down while sitting or lying is recommended. Patients should wash and cream their legs regularly to avoid dry, easily damaged skin. Medical or nursing advice should be sought as soon as skin damage occurs. Patients should never attempt to heal the wound themselves. Once the ulcer has healed, compression stockings are necessary to prevent recurrence and should be worn at all times during the day. Patients should regularly check their legs and feet for any changes in color. Eating a healthy balanced diet is advised, and if overweight, losing weight is recommended as increased weight puts more strain on the veins. If the ulcer is due to varicose veins, these may be treated once the ulcer has healed.
This programme is a structured follow-up plan for patients who have undergone a graft operation to monitor its health. While most grafts last, a small number may develop minor irregularities and narrowings within the first year, some of which can progress to significant narrowings, risking graft failure. The programme uses ultrasound scanning to detect small changes in blood flow within the graft, potentially identifying problems before symptoms appear, thus allowing for timely intervention to prevent graft failure.
What does the operation consist of?
Following the graft operation, patients are advised to walk as much as they are able to encourage blood flow through the graft and body. Elevating the leg while sitting can help reduce swelling. The core of the programme involves scanning the graft with ultrasound to detect small changes in blood flow. The first scan will be one month to six weeks after the operation, followed by further scans based on initial results. If a problem is detected, it may necessitate closer monitoring with more frequent scans or surgical correction. Patients must contact the Vascular Unit immediately if they experience a sudden onset of symptoms similar to those they had before the operation, such as pain or cramp in the muscles when walking, or a painful or cold foot. The single most important factor affecting the life of the graft is smoking, and stopping smoking is highly emphasized to reduce the risk of graft blocking.
What is an Aortic Aneurysm?
An abdominal aortic aneurysm occurs when the aorta, a large artery carrying blood from the heart to the legs, forms a “blowout like a balloon”. This condition is dangerous because the aneurysm can leak or burst, causing fatal internal bleeding, and requires replacement with a new artery. The procedure involves using a stent graft, which is a self-expanding metallic device lined by a tough plastic fabric, to repair the aneurysm. The stent graft occupies the entire channel of the aorta or iliac artery, directing blood through the graft and preventing it from flowing around it into the aneurysm. The blood remaining in the aneurysm around the stent graft clots and stays there permanently, thus preventing the aneurysm from bursting.
What does the operation consist of?
The stent graft comes in two components. One component is introduced through the groin via the iliac artery (the main artery going to the leg), with its top end placed into the aorta above the aneurysm and its bottom end sitting in the iliac artery below the aneurysm. The second component is introduced through the opposite groin and is made to interlock with the first component in the middle of the aneurysm. A single vertical cut is made in each groin, and it is not necessary to open the abdomen. X-rays are continuously used during the procedure to ensure accurate placement of the device. The initial deployment positions the stent just below the renal arteries, wedging it into the neck of the aneurysm. The rest of the right limb is then deployed. Before discharge, a scan is performed to check that the stent graft is working well and that there is no “endoleak,” which means some blood is still flowing through the aneurysm itself. Most endoleaks observed during or soon after the operation tend to seal on their own. If an endoleak does not seal, a further stent may need to be inserted later. Further scans are required every three months for the first year and then annually.
What is an Aortic Aneurysm?
The aorta is a large artery that carries blood from the heart to the legs, and it can form a “blowout like a balloon” (an aneurysm), which is dangerous because it can leak or burst, causing fatal internal bleeding. This condition necessitates the replacement of the aneurysm with a new artery. This procedure is an open operation to surgically replace the damaged artery.
What does the operation consist of?
A cut is made in the skin of the tummy, usually extending from the breastbone down to the pubis. A new artery, made from a tube of very strong Dacron fabric, is then stitched into place inside the aneurysm. The cut in the tummy is subsequently stitched up. If the two arteries that run to the legs also have aneurysms, a new artery shaped like a pair of trousers is used, with the bottoms of the “trousers” being stitched to the leg arteries, which requires an additional cut in each groin. These new artificial arteries are designed to last for 20 years or more. After the anaesthetic, patients are unlikely to remember anything for several hours and will wake up in an Intensive Care Unit. It is quite likely that they will be connected to an anaesthetic ventilator for a day or two to assist recovery, meaning a tube will be passing into the windpipe to help with breathing. Other tubes may include one down the back of the nose to keep the stomach empty and a catheter in the bladder to collect urine. Plastic tubes will also be placed in the veins of the arms and on the side of the neck to administer necessary fluids. The wound will be painful, and this discomfort is controlled by painkillers, potentially including an epidural injection that the anaesthetist will usually insert during or just before the anaesthetic, as well as injections and later tablets.
Walk farther without pain
Calf cramp relief often within days.
Heal stubborn foot ulcers
New blood flow speeds wound closure.
Short hospital stay
Many stent patients home within 24h.
Avoid major amputation
Early intervention saves limbs in >90 % of cases.
When every step is a struggle, let us do the walking—here’s how we’ll make your visit easy from car to rooms.
There are wheelchair bays at Kingsbury Hospital, at the main entrance, with helpful porters available to assist with a wheelchair service to our rooms in Harfield House. There is also a lift directly into our rooms from the ground floor.
Before surgery (stent or bypass)
Keep taking medications unless told otherwise, including aspirin & statins; please let us know if you are on any anti-coagulation as this may need to be stopped prior to a procedure
Drink 2L water the day before; no food 6 hours pre-op.
Bring loose shoes; legs may swell slightly after procedure.
After surgery
Walk in the ward 6 hours after theatre; discharge next morning.
Call us: foot cold, new calf pain, groin bleed.
Wound check day 7
Drive after 2 wks.
Call us: wound redness, fever, new leg swelling
Philip Matley has been a vascular surgeon in the practice that now bears his name since 1990. He is past-President of the Vascular Surgery Society of South Africa and a past moderator and chief examiner for the vascular surgery specialist examinations in South Africa. He has served on various national and international regulatory bodies and educational foundations.
During his training in Cape Town, he was the recipient of numerous awards including the Douglas Medal for the best candidate in the examination for the Fellowship of the College of Surgeons of South Africa as well as the Phyllis Knocker-Bradlow Award.
He has a special interest in the minimally invasive treatment of varicose veins, improving the circulation in the legs and brain through stents or surgery and the treatment of aneurysms.
In addition to his surgical practice, he is the chairman of Surgicom, the management body for private surgery practice in South Africa and serves on the board of South African Private Practitioners Forum (SAPPF).
Philip Matley grew up in KZN and is a keen golfer, mountain biker, walker and traveller
Neil grew up in Worcester and matriculated from Esselen Park High School in 1985. He completed his medical training at the University of Cape Town in 1991 and did his internship at Livingstone Hospital in Port Elizabeth. Following internship Neil worked at Red Cross Children’s Hospital as a medical officer in paediatrics before joining Mitchells Plain community health centre, where he gained extensive experience in general medical practice. His surgical experience started in 1996 at Worcester Regional Hospital where he worked as a medical officer in General Surgery for 3 years, prior to starting his specialist surgical training at Groote Schuur hospital in 1999.
On completion of his training in general surgery he was appointed as a consultant general surgeon at New Somerset hospital in 2005, where he was responsible for all clinical services until 2007 when he started his sub-specialist training in vascular surgery at St James’s hospital, the academic hospital of Trinity College Dublin in the Republic of Ireland. During his 3 year training period in vascular surgery, Neil received expert training in all aspects of open, endovascular and venous surgery at this prestigious high case volume unit. Neil returned to Cape Town in 2010 and was appointed as a consultant vascular surgeon at Groote Schuur hospital. In 2014 he was appointed as head of the vascular unit at University of South Africa (Medunsa) in Pretoria.
During the past 7 years, he was responsible for undergraduate, postgraduate and fellowship vascular teaching and training at the university as well as doing private practice at Netcare Unitas hospital in Centurion. Neil has served on the EXCO of the Vascular Society of South Africa since 2014.
Neil is an accomplished and experienced vascular surgeon, with special interests in endovascular surgery, dialysis access and venous surgery. He believes that good clinical practice is built on the foundation of empathetic bedside manner and teamwork.
Neil is married to Tracy, and they have 3 children. Neil enjoys an active outdoor lifestyle with hobbies including running, cycling, and golf. He also has a keen interest in history and philosophy.
Dr. Henri Pickard is a specialist Vascular Surgeon who proudly continues a rich family tradition of surgical practice, following in the footsteps of both his grandfather and father. He studied Medicine at the University of Cape Town (UCT), beginning a journey deeply rooted in heritage and excellence.
After completing his internship in Pietermaritzburg and community service in East London, Henri developed a strong interest in surgery. In 2012, he returned to Cape Town to work at the Trauma Centre at Groote Schuur Hospital, followed by a period at Victoria Hospital where he gained a wide range of surgical experience.
In 2014, Henri began his MMed degree and specialist training in General Surgery at Groote Schuur Hospital through UCT. In 2020, driven by a passion for the precision and complexity of the field, he pursued sub-specialist training in Vascular Surgery.
Henri is known for his collaborative work in multidisciplinary teams, his commitment to achieving the best outcomes for his patients, and his compassionate, patient-centred approach.
He grew up in Pietermaritzburg, George, and Cape Town, and matriculated from Rondebosch Boys’ High School. A proud South African, Henri is an enthusiastic Two Oceans runner, avid cricket follower, passionate Springbok supporter, and a devoted follower of Jesus. He is also a committed family man, deeply devoted to his wife Tricia and their three young children.
Dr. Mark grew up in Durban and matriculated in the top 30 in Natal. He completed his medical undergraduate training at UCT in 1998, where he was the elected class rep. for five years. He won the Family Medicine class medal, and Frank Foreman prize for the greatest contribution to student affairs. Internship at Edendale Hospital in Pietermaritzburg was followed by a year at various secondary hospitals in Cape Town for his community service, and then a year getting some GP experience in Manitoba, Canada. In 2002 Mark returned to Cape Town to specialise in general surgery at UCT. He completed this training in 2006, being awarded the ASSA prize for surgical research, and the Swann-Morton prize for the best surgical registrar.
Super-specialist training in HPB (Hepato-Pancreatico-Biliary) surgery started with the 2-year Certificate in Surgical Gastroenterology at Groote Schuur Hospital, with the CMSA exams completed at the end of 2008. In 2009 Mark further expanded his HPB experience and training with a Fellowship in HPB surgery at the HPB/Transplant unit in Newcastle-upon-Tyne, UK.
Super-specialist training in HPB (Hepato-Pancreatico-Biliary) surgery started with the 2-year Certificate in Surgical Gastroenterology at Groote Schuur Hospital, with the CMSA exams completed at the end of 2008. In 2009 Mark further expanded his HPB experience and training with a Fellowship in HPB surgery at the HPB/Transplant unit in Newcastle-upon-Tyne, UK.
Mark joined the Matley and Partners team in 2010. His primary interest is in HPB surgery, and he is accomplished in all aspects of this discipline, ranging from the management of gallstone disease, to complex liver and pancreatic resections. He is a keen endoscopist, including gastroscopy, colonoscopy and ERCP. Mark was the first surgeon in South Africa to perform the ALPPS liver resection procedure. In addition to the HPB surgery, Mark enjoys all aspects of general and laparoscopic surgery, including laparoscopic hernia repairs. He is a believer in team work, and tries to blend the best of modern techniques and technology with some old-fashioned “good bed-side manner”, in addition to careful decision-making and surgical technical expertise.
Mark is married to Tanya and they have two children. Mark’s hobbies include golf, fly-fishing, and scuba diving. Despite more than 25 years in the Cape, he remains a Sharks fan.
Ebrahim joined the Matley Partnership as a specialist colorectal surgeon with international training in laparoscopy from both Amsterdam and Nottingham. He is a Capetonian who matriculated from Livingstone High School, and completed his MBChB at UCT in 2002.
He completed his internship in Durban, where he met his wife Khatija, and completed his community service in Khayelitsha, including an additional year there with Medicin Sans Frontier, rolling out their antiretroviral program.
After two years of surgery in the UK, he completed his specialist training in Cape Town, obtaining his FCS in 2013. During this time he was awarded the MMed degree from UCT for his dissertation “Systems delays in Breast Cancer”. He gained a broad experience in general surgery before two years of sub-speciality training in the colorectal unit at Groote Schuur. In 2016 he was awarded the Specialist Certificate in Surgical Gastroenterology.
In 2017, he was awarded the SASES travelling fellowship to work with internationally renowned colorectal and laparoscopic surgeon, Professor Willem Bemelman, at the Amsterdam Medical Centre. Thereafter he completed his year abroad as a colorectal fellow, in Nottingham, UK. This is a busy unit with 10 colorectal surgeons providing the full range of colorectal specialist services. During this time he gained invaluable experience in advanced laparoscopy for inflammatory bowel disease and cancer surgery, which are his specific interests, and he is currently accruing UK robotic credentialing. Ebrahim is one of a handful of accredited specialist colorectal surgeons in the Western Cape, adding this expertise to the GIT team at Matley and Partners.
He is married to Khatija, a full time Obstetrician & Gynaecologist consultant at Groote Schuur Hospital, and they have two children. He is a golfer, family man and enjoys travelling at home and abroad.
