Conditions and Procedures

AAA (Abdominal Aortic Aneurysm)

What is Abdominal Aortic Aneurysm (AAA) Disease?

Triple A or Abdominal Aortic Aneurysm is an enlargement of the lower part of the aorta, the major blood vessel that carries blood from the heart to the rest of the body.
An aneurysm develops in the lower part of the aorta that extends through the abdominal area, when the wall of the artery becomes weakened and bloated like a balloon. 
A ruptured abdominal aortic aneurysm is extremely dangerous and can cause life-threatening bleeding as the aorta is the body’s primary provider of blood.

What are the symptoms of AAA?

Abdominal aortic aneurysms are often difficult to detect as they often grow slowly and usually without symptoms. Most abdominal aneurysms are diagnosed during a routine physical examination when being tested for other health concerns. Anticipating how fast an AAA may develop often difficult. Some aneurysms will never rupture.
Many start small and stay small, while others expand quickly or gradually over time.

When an AAA enlarges, symptoms may include:
● A pulsating feeling between the naval area and the breast bone
● Profound, steady pain in your abdomen or on the side of your abdomen
● Prolonged pain in the back, abdomen or groin area

What are the treatments for AAA Disease?

Doctors will usually recommend surgery if your aneurysm is about 5 to 5.5 centimetres or larger.
For smaller aneurysms, surveillance imaging and examination is recommended at defined intervals in order to measure the size of your aneurysm and to review any other symptoms you may have.
There are two types of surgical treatments for large aneurysms: open surgical repair and endovascular surgery.
Open surgical repair is a well-proven procedure with a long recovery period ranging from 6 weeks to 3 months. This procedure involves replacing the diseased portion of the aorta with a synthetic tube (graft) that acts as a replacement blood vessel.
Endovascular surgery involves the insertion of a reinforced synthetic tube that is inserted through an artery in your leg and threaded into your aorta. It is then placed at the site of the aneurysm and expanded.

The graft is fastened in place with the metal mesh that frequently has small hooks or pins. The graft bypasses the weakened section of the aorta to prevent rupture of the aneurysm.

Your doctor will tell you which procedure is best suited for your particular situation.

Carotid Artery Disease (CAD)

What is carotid artery disease?

Carotid artery disease, also called carotid artery stenosis, occurs as a result of the build-up of cholesterol, fat and other substances travelling through the bloodstream, such as proteins, calcium, inflammatory cells and cellular waste products.
These substances stick to the blood vessel walls, causing fatty stores known as plaque that obstruct the veins that convey blood to your brain and head (carotid arteries).  The plaque may rupture with the plaque contents travelling to the eye or the brain causing visual symptoms or a TIA or stroke.  In certain individuals, severe stenosis may increase the risk of TIA/stroke or visual disturbances.

What are the symptoms of carotid artery disease?

Carotid artery sickness develops gradually. There may not be any symptoms of the disease. However, the primary indication that you have the condition might be a stroke or a transient ischemic assault (also known as TIA or mini stroke).

A TIA (a ministroke) is a temporary shortage of blood flow to your brain caused when a blood clot briefly blocks an artery.

Signs and symptoms of a stroke or TIA include:

  • Sudden unresponsiveness weakness and/or numbness on one side of the face, or in one arm or leg, or one side of the body
  • Sudden loss of vision or blurred vision in one or both eyes
  • Slurred speech, difficulty talking or understanding what others are saying
  • Loss of coordination
  • Extreme headaches, dizziness or confusion
  • Difficulty in swallowing

What are the treatments for carotid artery disease?

The objective of treating carotid artery disease is to avoid a stroke. Carotid artery disease is treated by taking prescribed medication, making lifestyle changes or having procedures as recommended by your doctor.
 The life changes recommended by doctors in order to moderate the movement of cholesterol, fat and other substances travelling through the bloodstream include: stopping the use of tobacco products, losing weight, regular exercise, eating healthy food, eating foods low in saturated fats, cholesterol and sodium.
Other mainstays include reducing salt intake and excessive alcohol as well as having regular check-ups with your doctor.
Doctors recommend patients with carotid artery disease take anti-platelet medications such as aspirin or other blood-thinning prescriptions to reduce the risk of stroke and other cardiovascular disease complications.
The choices for this treatment include Carotid Endarterectomy –  the most widely recognized treatment for extreme carotid artery disease.
This procedure can be performed under general anaesthesia or local anaesthesia with intravenous sedation.
It involves an incision in the neck and the removal of plaque from the artery.
Once the plaque is removed, the surgeon stitches the vessel closed and blood flow to the brain is restored.
The second option is carotid angioplasty and stenting. This procedure is performed while the patient is still awake but sedated.
Typically this would be considered if the blockage is tricky to reach with Carotid Endarterectomy or there are co-existing health conditions that make medical surgery quite risky.
Doctors will recommend regular follow-ups for a physical exam.
As your treatment progresses, diagnostic tests may be performed to monitor progress.
Your doctor will evaluate your particular situation to ensure you receive the best treatment for your situation.

Deep Vein Thrombosis (DVT)

What is Deep Vein Thrombosis?

Deep vein thrombosis (DVT) also called venous thrombosis, is the formation of a blood clot in one or more of the deep veins in the body. The clot may partially or completely block blood flow through the vein, potentially causing serious health effects.
While DVTs may occur in the arms, brain, intestines, liver or kidney, most DVTs occur in the lower legs, thighs or pelvis area.
Deep vein thrombosis can develop from anything that slows or occludes blood flow through the deep veins. It can also occur after surgery or an accident or when you’re confined to a bed or have limited movement for long time.
Conditions that can increase your risk of a DVT include being overweight, inherited conditions that increase the risk of blood clots, pregnancy and the first six weeks after giving birth.
Cancer and some of its treatments also increase the risk of DVT.
Untreated, DVT can be life-threatening as blood clots can break free and travel through the bloodstream.
They can then become lodged in the blood vessels of the lung, blocking blood flow and resulting in a pulmonary embolism.

What are the symptoms of Deep Vein Thrombosis?

A Deep Vein Thrombosis usually forms in one leg or one arm. There is rarely swelling in both legs or arms and not everyone with a DVT will have symptoms.

Signs and symptoms may include:

  • Swelling of the lower leg or arm (sometimes this happens suddenly)
  • Pain and tenderness in the affected leg that can often be felt in the calf area
  • Red or discolored skin
  • A feeling of warmth in the swollen area
  • Pain on extending the foot
  • The veins near the skin’s surface may be larger than normal

Symptoms of a pulmonary embolism include:

  • Rapid heartbeat
  • Sudden shortness of breath or fast breathing
  • Sharp chest pain and discomfort that often comes with coughing or taking a deep breath
  • Feeling dizzy, light-headed or fainting
  • Pain in the back
  • Coughing up blood
  • Sweating more than normal

What are the treatments for Deep Vein Thrombosis?

The main goal of treatments is to prevent the clot from breaking off in your vein and moving to your lungs and to stop the clot from getting bigger.
Treatment also aims to reduce the risk of another blood clot and prevent long-term complications from the blood clot (chronic venous insufficiency).
Treatments for DVT may include medications such as anticoagulants (“blood thinners”).
Anticoagulants do not destroy clots however, they do stop clots from getting bigger and prevent blood clots from moving.
Compression socks may also be used to reduce swelling in the legs often caused because the valves in the leg veins are damaged or the vein is blocked by the DVT.
In addition, exercising your lower leg muscles if you are sitting still for long periods of time may help. As will standing up and walking for a few minutes every hour while awake. Also avoid activities that may cause serious injuries. This will all help improve circulation and decrease swelling.

Diabetic Foot

What is diabetic foot?

Diabetic foot refers to pathology that results specifically from diabetes. Because of the nerve dysfunction that is related to diabetes (diabetic neuropathy), patients have a decreased ability to feel pain.

What are the symptoms of diabetic foot?

Symptoms vary widely from individual to individual and include the following:

  • Pain or a tingling sensation in the feet at night
  • Skin temperature changes
  • Deadness or shivering sensation
  • Blisters or other wounds without pain
  • Red streaks
  • Wounds with or without seepage
  • Loss of feeling
  • Staining on socks
  • Skin staining
  • Deformed foot appearance

What are the treatments for diabetic foot?

Treatment for diabetic foot issues changes as the seriousness of the condition progresses.
Prevention is the key to avoiding foot problems in diabetic patients.
Non-surgical treatments are typically the mainstay treatments for diabetic foot issues.
These include avoiding walking barefoot, keeping wounds spotless and dressed, avoiding exposure to temperature extremes, keeping feet warm in winter, self treating corns, calluses or ingrown toenails.
Surgical treatments are only considered when non-surgical treating methods have failed to rectify the diabetic foot issues.
These options include removal of decaying tissue or arterial bypass for peripheral vascular disease or endovascular surgery with placement of stents.
Amputation is also a last resort,  but  a life-saving surgical treatment. Attending to diabetic foot ulcers promptly can reduce the chance of amputation significantly. 
Treating underlying Peripheral Arterial Disease (PAD) can also reduce the risk of amputation.

Peripheral Arterial Disease (PAD)

What is Peripheral Arterial Disease (PAD)?

Peripheral arterial disease, also known as peripheral vascular disease, atherosclerosis or hardening of the arteries, is a common circulatory disorder that occurs when narrowed arteries reduce blood flow to your limbs.
When you develop PAD, the arteries slowly become narrowed or blocked and plaque gradually forms inside the artery walls.
This leads to the extremities not receiving enough blood (mainly the legs). In turn, this may cause intense leg pain whilst walking.
PAD risk factors include age, smoking, obesity, diabetes, history of heart or blood vessel disease, high blood pressure (hypertension) or high cholesterol (hyperlipidemia).

What are the symptoms of Peripheral Arterial Disease (PAD)?

While many people with peripheral artery disease have mild or no symptoms, some people experience leg pain when walking (claudication).
Peripheral arterial disease signs and symptoms include:

  • Leg discomfort, pain or cramping of your hips, thighs or calf muscles. This may develop when walking or climbing stairs.       
  • A burning or aching pain in the feet and toes while resting, especially at night while lying flat
  • Coldness in your lower leg or foot
  • Redness or change in color of the skin
  • Increased occurrence of infection
  • Toe and foot wounds that do not heal
  • Weak or no pulse in your legs and feet
  • Leg numbness or weakness
  • Hair loss or slower hair growth on your feet and legs
  • Slower growth of your toenails
  • Shiny skin on your legs
  • Erectile dysfunction in men

What are the treatments for Peripheral Arterial Disease (PAD)?

Medications, interventional procedures and lifestyle changes are the treatments available for PAD.

Lifestyle changes involve quitting smoking, eating a balanced diet that is high in fibre and low in cholesterol, fat and sodium. Losing weight to help you lower your total cholesterol, regular exercise, and managing health conditions, such as high blood pressure, diabetes or high cholesterol are also important.

Interventional procedures are required to treat more advanced PAD cases including atherectomy (to remove the blockage), angioplasty (to widen or clear the blocked vessel) or angioplasty with stent placement (to support the cleared vessel and keep it open).  Open surgery, endarterectomy (cleaning out artery) or bypass may need to be undertaken if the endovascular option has failed or is not possible.  Today that happens infrequently.

Your doctor may recommend medications to treat conditions such as high blood pressure (anti-hypertensive medications) or high cholesterol (statin medications).

Varicose Veins

What are varicose veins?

Varicose veins are often benign and frequently symptomless.
However larger veins can sometimes indicate underlying circulatory issues.
Rarely, serious complications of varicose veins include blood clots, veins that burst and leg ulcers.
The chance of developing varicose veins increase with age, while genetics, obesity, sitting or standing for long periods of time are other risk factors.
Varicose veins are also significantly more common in women.
Pregnancy also increases the risk of varicose veins. As blood flow increases to the developing uterus, this extra blood volume can also contribute to bulging veins. 

What are the symptoms of varicose veins?

For many people, there are no symptoms at all and veins are simply a cosmetic nuisance,  especially with the smaller, spider veins.
However, sometimes veins can be troublesome and painful with symptoms including:

  • Heaviness in the legs
  • Itching near the veins
  • Cramping and swelling in the lower legs
  • Pain after long periods of sitting or standing
  • Veins that appear knotted and twisted
  • Burning and throbbing sensation in the legs
  • Hardening of the veins, changes in the colour of the vein, inflammation of the skin or near leg ulcers of the ankle which require prompt medical review

What are the treatments for varicose veins?

There is no absolute prevention for veins, however maintaining a healthy weight, exercising, elevating legs, compression stockings, changing from sitting to standing position regularly and avoiding high heels (women) may help.
Most veins that develop in pregnancy will typically resolve within 12 months without surgical intervention.
Surgical treatments include sclerotherapy, where a small or medium-sized vein is injected with a special solution that closes the veins and generally causes the veins to gradually fade within a few weeks. 
Other surgical interventions are generally done as day procedures in hospital and include vein stripping (tying off a vein before it joins another vein) and then removing the offending vein through tiny incisions.
Other treatments include laser therapy that destroys and seal veins or phlebectomy, a day procedure that is minimally invasive and uses a small scalpel to remove varicose veins that are very close to the skin surface of the leg.
In more advanced cases, vein stenting may be undertaken.

Vascular Ultrasound Clinic

Vascular Ultrasound Clinic

Westmead Specialist Vascular Services is a state-of-the-art Doppler ultrasound clinic located in our suites next to Westmead Private Hospital as well as at in our rooms at Norwest Private Hospital.
Ask your GP for a direct referral to our clinic which is open 8:00am-3.30pm Monday to Fridays.
All appointments can be made by calling 02 8622 1455. All scans can be bulk-billed.
Remember you do not need to see the vascular specialist first to have a vascular scan in our lab, your GP can refer to us directly and a downloadable bulk-bill GP referral to our Westmead and Norwest labs can be found here.

What conditions can I be screened for at the Ultrasound Clinic?

Our arterial studies are performed for carotid disease and peripheral arm and leg disease, aneurysms, fistulas and renal arterial scans.
We also perform a full range of DVT, pelvic vein and other vein studies as well as pressure studies – eg ABI (resting) or ABI (exercise), toe pressure and others.

What are the pros and cons of ultrasound for vascular conditions?

Ultrasound involves no radiation, no needles and no anaesthesia so it is considered to be a very low risk procedure.
It also does not use contrast dye which is known to damage kidneys.
Ultrasound is extremely useful in helping to identify blockages (stenosis), abnormalities like plaque or blood clots (DVT), narrowing of vessels and evaluating varicose veins.
Ultrasound can also be used to detect tumours and malformations and identify specific areas where there is reduced or greater than normal blood flow to specific areas, often caused by infection.
Vascular ultrasound is also a valuable tool in screening high risk patients and for the detection and ongoing monitoring of aneurysms.
It may also assist in monitoring patients who have undergone a bypass graft or stent and in assessing bowel and kidney disease and damage to the arteries of the major organs.
There are very few downsides to having an ultrasound procedure.

What is the difference between a normal ultrasound and vascular ultrasound?

Our clinic uses state-of-the-art Doppler ultrasound, which is a test to estimate the blood flow through the blood vessels using high-frequency sound waves that bounce off your body ’s circulating red blood cells.
A standard ultrasound can produce images of your veins and arteries but can’t show the speed or flow of blood like a Doppler ultrasound can.
This is particularly useful when doctors are trying to detect and monitor blood clots or poorly functioning valves.

What happens in a vascular ultrasound and how long does it take to complete?

In total, a vascular ultrasound takes about 30 minutes.
No special preparation or diet is needed for most ultrasounds, so medications can be taken as required, you may eat and drink as normal and arrive 10-20 minutes before your scan time.
Abdominal scans are the exception. If you are having an abdominal scan you will need to fast for 6 hours and people with diabetes may have a light breakfast at 6:00am with medications. Do not wear jewellery, creams, perfumes or other gels for leg scans.
During the procedure, you will be asked to lie on a special table, and a non-toxic gel will be applied to the skin and a probe placed over the area to be examined.