Incidence of vascular diseases has been found to be on the rise in India over the past decade. Atherosclerosis and allied causes like arteriopathies lead to the involvement of Aorta and arteries resulting in aneurismal or occlusive diseases with potential risk to limb, organ and or life.

Advanced age, smoking habit, consumption of alcohol, over eating, obesity, physical inactivity coupled with diabetes and hypertension are found to enhance the disease process. Enlargement or excessive dilation (aneurysm) and blockade of vessels with excessive fat and cholesterol are the two major types of vascular diseases involving pure blood vessels. Aneurysm eventually ruptures threatening life and arterial blockade leads to malfunction of organs leading to stroke, heart attack, kidney failure and leg cramps. In addition, varicose veins and deep vein thrombosis with serious potential complications involving veins are also on the rise, related to blood vessels (veins) nurturing blood back to the heart.

Some of the common vascular illnesses are stroke, Peripheral arterial occlusive disease and others affecting kidneys and intestines. When aorta / arteries start dilating like balloon, it results in a life-threatening illness called Aneurysm for which prompt treatment is required as a life-saving measure. Likewise, when high and uncontrolled blood pressure leads to a crack in Aorta called 'Dissection', urgent measures along with medical, surgical or interventional measures have to be expeditiously employed to save life.

Venous diseases, Varicose veins and Venous Thromboembolic disorders require treatment appropriately. The latter generally occurs in hospitalised patients and migration of clots into heart and lungs could be life-threatening. Arterio-venous malformation constitutes a third variety of vascular illness most of them occurring by birth but presenting much later in life.

###### Investigations

Detailed history with thorough clinical examination provides valuable clues to the organ involved and requires relevant investigations. They include blood tests, duplex scan and CT/MR scanning to delineate extent of arterial disease, nature of organ disfunction and thus necessary treatment modality. Also other systems functioning especially cardiac needs have to be assessed when open procedure is contemplated. Since contrast CT / MRI imaging mandates normal Kidney Function, pre procedural renal parameters should be checked.

###### Treatment Strategies

Dietary control, moderate physical activities and stopping smoking habit should be pursued by patients. Medications for control of diabetes, hypertension and hyperlipidaemia are vital to modify and control deleterious effects on afflicted blood vessels.

If the patient presents with critical symptoms with threatening organ dysfunction, further measures are necessary in the form of endovascular intervention and even open surgical treatment. Endovascular surgery is less stressful for patients than operation but open surgery is durable and lasts a lifetime for patients in most cases.

###### Common vascular illnesses

1. Peripheral arterial disease

Basically these are related to inadequate pure blood circulation to the legs and less commonly to arms. This illness has a wide variety of presentation namely claudication meaning cramps in legs or tiredness or inability to walk up a slope, leg pain occurring at rest, ulceration or even bluish or blackish discoloration meaning extreme blood stoppage which if not treated urgently may end up with the patient losing his or her limb.

For initial difficulty, medications, stopping smoking and graded walking exercises are sufficient. However, worse status of leg calls for Angioplasty [keyhole surgery] or even bypass procedures to save limbs.

2. Carotid artery disease

Carotid [or Brain] artery may be afflicted with fat deposition due to atherosclerosis resulting in prestroke namely temporary weakness of upper and or lower limbs, inability to speak, visual disturbance which again if not treated may lead to permanent stroke with its devastating sequelae. Along with medications, carotid endarterectomy or stenting will help prevent stroke if performed timely.

3. Aortic aneurysm

When abdominal aorta [Mahadhamani] starts ballooning and gets enlarged due to atherosclerosis, this condition threatens life due to rupture upon reaching a size of >5.5 cms or more. Open operation using large diameter dacron graft or endovascular prosthesis could be deployed for treatment. Minimally invasive or keyhole surgery is available at SUT to save patients life. Conventional open surgery and endovascular aortic aneurysm repair are regularly performed at our institution with excellent results. For complicated diseases like Thoracic aortic and arch aneurysms and aortic dissection, hybrid procedure is also performed with high success rate. Arteriovenous access procedures required for long duration haemodialysis are performed with more than 95% patency in patients with chronic renal failure.

Apart from these, there are several diseases that involve blood circulation to various organs of our body for which appropriate treatment strategies are available at SUT Pattom to save life or organ and provide quality of life to those affected.

Symptomatic varicose vein needs to be ablated and venous thromboembolism needs optimal medications for varying time frames to prevent life-threatening pulmonary embolism. Vascular and endovascular procedures are regularly performed for patients. Standard thoracic operations (related to chest and lungs) are performed with high success rate at SUT Pattom, Trivandrum.

###### Vascular Procedures

- Carotid Artery Disease-- Carotid Endarterectomy (CEA)

- Aortic Aneurysm -Thoracic and Abdominal Open Surgical and Endovascular [EVAR, TEVAR]

- Aorto Bifemoral Grafting and surgery for Peripheral Artery Disease.

- Open Repair for Thoracoabdominal aortic aneurysm

- Mesenteric and Renal revascularisation

- Coarctation of Aorta repair

- Hybrid aortic arch aneurysm repair.

- Surgery (open and Endovascular) for Stanford B Aortic dissection

- Thoracic outlet obstruction

- AV Access creation

###### Thoracic Procedures

- Lobectomy

- Pneumonectomy

- Mediastinal tumours and cysts.

- Chest wall reconstruction