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Vascular Laboratory (Ultrasound)

Vascular surgeons use ultrasound a lot. Ultrasound is a great way of obtaining good information about flow in blood vessels, without the need to use any radiation such as in a CT scan. Ultrasound scans of arteries can help diagnose conditions such as aneurysms and blockages. We also use ultrasound to keep an eye on your progress after procedures such as stenting.

On site, we have a Vascular Duplex Ultrasound machine, and a visiting Vascular Sonographer. We are happy to take referrals from General Practitioners to perform any type of arterial or venous duplex ultrasound.

We will let you know of any requirements before your ultrasound, but as a general rule, you need to fast before any abdominal ultrasound, as the movement of bowel gas makes the scan very difficult.

Dialysis Access ("fistulas")

The kidneys filter the blood of waste products and regulate our fluid balance. Adequately-functioning kidneys are essential for life. Without them, toxic waste products accumulate, and cause patients in renal (kidney) failure to become sick and die.

If the kidneys can't be saved, the treatment is to filter the blood mechanically, using a dialysis machine.

The dialysis machine requires quite a large volume of blood to pass through it per hour in order to "clean" the blood over a 3 or 4 hour period. One way of getting that blood is to use a large-bore catheter inserted in the neck, with the tip sitting in a large vein near the heart, with a high rate of blood flow. This works very well, but eventually these catheters will block with clot or become infected.

The alternative is to have a conduit of blood with a high flow just under the skin. This is where the "fistula" comes in. An arteriovenous fistula is a connection between an artery and a vein. In patients with renal failure, this can be surgically created, causing arterial (high flow) blood to rush up a vein in the arm, making that vein enlarge and become accessible for frequent (3x/week) cannulation for dialysis.

Dr Ward-Harvey is committed to the concept of "native vein utilisation", ie forming connections using the patient's own artery and vein wherever possible, and also keeping these veins open indefinitely with angioplasty (minimally-invasive stretching with balloons inside the vein). Many centres put in a lot of synthetic grafts for dialysis access (flexible plastic tubes between the artery and vein), which work well in the short term, but invariably run into problems long term with narrowings, blockages, and infection.

Thoracic Outlet Syndrome

Thoracic Outlet Syndrome is a complex syndrome of compression of the nerves, artery, and/or vein at the root of the neck, as those structures pass between the first rib and the collarbone. This condition occurs in otherwise healthy young people, who are generally very physically active.

If the nerves are compressed, patients usually complain of tingling or numbness going down their arm and hand, and may even result in weakness of the hand. If the vein is compressed, the vein may clot, forming a deep vein thrombosis (DVT) of the subclavian vein. If the artery is compressed, then it can degenerate and form an aneurysm, which can then lead to blockage of the artery.

This condition requires a history and physical examination, followed by tailored investigations to determine the best course of action. Most patients will benefit from physiotherapy, but some may need to have a surgical procedure performed. This involves the removal of the first rib, in order to free up space for the nerves and vessels.

Vascular Access (Portacaths, Hickman lines)

Sometimes patients need procedures to get things in or out of the blood repeatedly. This tends to occur in cancer, where patients need a lot of blood tests and need chemotherapy. If the same veins are constantly punctured and injected, this may lead to blockages of the veins. Therefore some patients are referred for the insertion of a plastic catheter system to enable repeated injections without vein problems.

The most common device used for chemotherapy access is called a portacath. This is a small reservoir which sits under the skin of the upper chest, which is needled through the skin. The port is connected to a catheter (hence the name portacath), and the catheter is tunneled under the skin into a vein, so that the tip of the catheter is sitting in the superior vena cava (the large vein draining all the blood from the head and arms). The catheter tip position means that the chemotherapy is instantly diluted as soon as it enters the bloodstream, so that it is not toxic to the veins inthe arm.

The insertion of the portacath is a day-case, and it is usable straight away.