Vascular surgery in Perth
Diseases and treatment options
Dr Ritter provides top-class vascular surgery across the full spectrum of vascular diseases, with special sub-interest in vascular diabetic complications and complex aortic work.
Arterial disease
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An aneurysm is a ballooning or dilation in a blood vessel. Aneurysms can occur in any vessel in the body, but are often found in the aorta (which is the main blood vessel in our body), the intestinal arteries or the leg arteries. When an aneurysm bursts it is a catastrophic event which, if left untreated, can lead to fatal internal bleeding within minutes. Once an aneurysm reaches a certain size, surgical intervention is usually required.
Treatment options include:
open surgery to replace the diseased blood vessel with an artificial blood vessel (graft).
minimally invasive endovascular aneurysm repair (EVAR) to reline the vessel from the inside with a stent.
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Carotid artery disease occurs when the carotid arteries, responsible for delivering blood to the head and brain, are blocked by fatty deposits known as plaques. These blockages increase your risk of stroke – a medical emergency when the blood supply to the brain is interrupted or seriously reduced. Carotid disease can be symptomatic or asymptomatic, which determines the treatment taken.
The goal in treating carotid artery disease is to prevent stroke. If the blockage is mild or moderate, lifestyle changes and medication to control blood pressure or lower cholesterol may be sufficient. If the blockage is severe or a stroke or mini stroke (TIA) has already occurred, removing the blockage from the artery may be required.
Options for removal include:
carotid endarterectomy – opening the carotid artery via the neck and removing the fatty deposits.
carotid angioplasty and stenting – using a tiny balloon via catheter to widen the artery and insert a stent.
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Claudication is pain caused by insufficient blood flow to the muscles during exercise, usually felt in the arms and legs. It is most often a symptom of Peripheral Artery Disease (PAD), where narrowed arteries reduce blood flow to the extremities.
Treatment is a digital subtraction angiography also referred to as angiogram. This minimally invasive keyhole technique involves a balloon being inflated inside the diseased vessel to squash the plaque and allow blood to flow again unrestricted. Sometimes a stent is also inserted to keep the artery open.
Sometimes bypass surgery is required.
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Mesenteric ischemia is decreased or blocked blood flow to the large or small intestine. It can be chronic with plaque building up slowly over time, or acute due to a blood clot.
Treatment options include:
open surgery to clear the blockage.
minimally invasive keyhole surgery to use a balloon to open the narrowed area of intestine. A stent can also be inserted to keep the vessel open.
Venous disease
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Varicose veins are abnormally enlarged and painful veins, often visible just beneath the skin, caused by incompetent valves that allow blood to travel backwards down the leg. They can vary in size from quite small (2 to 3 mm) to very large (2 to 3 cm across). Varicose veins can cause additional conditions like superficial thrombophlebitis, chronic venous insufficiency, varicose ulceration and bleeding.
Treatment options include:
open or keyhole surgery to safely remove the veins.
RFA (radiofrequency ablation) which uses radio waves sent through a precisely placed needle to heat nerves and prevent pain signals being sent back to the brain.
EVLT (endovenous laser therapy) which is similar to RFA but uses laser.
injection sclerotherapy – usually used in conjunction with surgery to clean up remaining veins.
Learn more about varicose veins and their treatment, CLICK HERE.
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Post thrombotic syndrome is a condition that can occur in people who have had a deep vein thrombosis (DVT) of the leg. It can cause chronic pain, swelling, heat and redness in the leg.
Treatment options include:
elevation at night, compression stockings and pain management.
vascular interventional radiology procedure which involves a balloon opening and stenting of the narrowed vein.
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Pelvic congestion is caused by enlarged veins in the pelvic area and causes chronic pelvic pain. In simple terms, these are varicose veins of the pelvis. Women who have had more than one pregnancy are at highest risk of pelvic congestion.
Treatment options include:
hormonal medications to slow down blood flow.
blocking the ovarian and peri-uterine veins with minimal invasive techniques to stop the blood pooling in the pelvis.
Renal disease
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For those requiring dialysis to treat kidney failure, an arteriovenous fistula (AVF) is created to provide renal access. An AVF is a connection of an artery to a vein, causing extra pressure and blood to flow into the vein, making it grow large and strong. The larger vein can withstand repeated needle insertions needed for dialysis. For as long as dialysis continues, the vein will require careful monitoring and often surgical maintenance procedures to keep it running.
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Renal artery stenosis is the narrowing of one or more arteries that carry blood to the kidneys. This can lead to uncontrolled high blood pressure or may result in the kidney to stop working.
Treatment options include:
renal angioplasty and stenting to widen the artery and place a stent that holds the vessel open, enabling better blood flow.
renal artery bypass surgery to graft a substitute blood vessel to the renal artery, making a new route for blood to reach the kidneys.
Diabetic complications
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Diabetes, especially if poorly treated, can cause nerve damage and poor circulation resulting in foot ulcers, blisters, pain and foot infections. Infections in the feet can spread, damaging other organs and potentially becoming fatal. Sometimes feet must be amputated.
Dr Ritter was part of the expert panel that wrote the Australian guidelines for diabetes-related foot disease.
Treatment options include:
an arterial bypass for peripheral vascular disease, improving blood flow to the extremities.
endovascular surgery to place a stent to keep blood vessels open and restore blood flow.
surgical infection control.
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Diabetic vascular disease is the hardening of the arteries throughout the body, caused by diabetes mellitus. Too much glucose builds up in the blood because of a lack of insulin – or because the body is unable to adequately use insulin. Diabetes usually affects the smaller vessels, requiring special surgical expertise to restore the blood flow effectively.
Untreated, it impacts the lower extremities causing ulcers, pain, infection and can even lead to limb loss.
Thoracic outlet
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Venous thoracic outlet syndrome is a vein compression between the clavicle and first rib which presents most commonly as an abrupt spontaneous swelling, bluish discolouration and heaviness or pain in the upper extremities.
Treatment options to decompress the vein include:
anti-clotting therapies.
catheter-based thrombolytic therapy.
surgical thoracic outlet decompression.
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Arterial thoracic outlet syndrome is a compression of the main artery supplying the arm between the collarbone and the first rib. This can lead to pain when using the arm, clot formation in the artery or even blockage of the vessel.
Treatment usually involves surgery to restore blood flow by:
removing part of the rib to relieve pressure.
repairing the damaged artery with a vein patch.
replacing the damaged artery with an artificial tube.
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Neurogenic thoracic outlet syndrome is caused by abnormalities of bony and soft tissue in the lower neck region that compress and irritate the nerves of the brachial plexus. Responsible for motor and sensory function, this leads to weakness and numbness of the hand, shrinking hand muscles, and pain, tingling and numbness of the neck, chest and arms.
Treatment involves surgery to remove pressure from the nerves by:
removing the first rib.
removing additional bony prominences (cervical ribs).
Popliteal artery entrapment syndrome
Popliteal artery entrapment syndrome (PAES) is an uncommon condition where an abnormally positioned or enlarged calf muscle presses on the main artery behind the knee – the popliteal artery. The artery becomes trapped, making it harder for blood to flow to the lower leg and foot. Symptoms include cold feet, tingling or burning, numbness, heaviness, leg cramps and swelling. Blood clots in the lower leg can also occur.
Surgery is the only way to correct the abnormal muscle and free the artery. An incision is made in the back of the knee or on the inner calf, and the muscle is released to give the artery room and restore blood flow.