Other

Vascular Laboratory

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 also use this ultrasound to investigate our patients who may need treatment for vascular disease, and for follow-up after treatment.

Palmar Hyperhidrosis

Palmar hyperhidrosis is a condition of excessive sweating of the palms. If it does not respond to topical creams and conservative treatment, it may be permanently cured by an operation called a throacoscopic sympathectomy. This is a minimally invasive ("keyhole") procedure where Dr Ward-Harvey cuts the nerve fibres controlling the sweat glands to the hand. The treatment is nearly 100% effective and permanent, but does usually have the effect of making the rest of the body sweat a little more, called "compensatory sweating". Most people whose lives are affected enough by severe hand sweating to warrant surgery find that this is a small price to pay for having dry hands.

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.

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