Vascular Surgery — Town Hospital

Vascular surgery at Town Hospital: an overview

Town Hospital's Vascular Surgery department in the Fifth Settlement, New Cairo, diagnoses, treats and follows disease of the arteries and veins outside the heart: varicose veins and the diabetic foot, narrowed leg arteries and leg clots, aortic aneurysm, and the access points that dialysis and chemotherapy patients depend on. The department's consultants specialise in vascular surgery, peripheral catheter (endovascular) treatment and interventional radiology, and you will find them in the list of doctors below. They combine conventional surgery with catheter and laser treatment that needs no large incision, according to what each case needs.

The tests the department relies on are in the hospital: Doppler ultrasound of the blood vessels, the 128-slice CT scanner and the 3 Tesla MRI; the cath lab is open 24 hours a day, as are the emergency department, the laboratory and radiology. Operations take place in the hospital's operation theatres, with the intensive care unit after major surgery when needed. The outpatient clinics are open every day from 10 am to 10 pm; each surgeon's clinic days and times are in the up-to-date clinic schedule.

Conditions the vascular surgery department looks after

The diagnosis and the choice of treatment remain the vascular surgeon's decision after the consultation and tests. These are the conditions patients most often come to the department with.

Varicose veins

Varicose veins are widened, twisted veins just under the skin, usually in the leg, which develop when the valves inside a vein weaken, so blood pools instead of flowing up to the heart. Some are only a cosmetic nuisance; others cause a heavy, aching leg that worsens with long standing, a swollen ankle, darkening of the skin and, in advanced cases, an ulcer near the ankle that will not heal. Diagnosis rests on the consultation and a painless, radiation-free Doppler ultrasound, which shows which way the blood flows and which valves have failed. Mild cases start with compression stockings, leg elevation and keeping active. Cases that need treatment are dealt with in the hospital by closing the faulty vein from the inside with laser, radiofrequency or medical glue through a small opening in the skin, or by surgical removal when the case calls for it; some of these procedures may not need an overnight stay. The surgeon chooses the method from the size and position of the veins and the Doppler findings, and explains the benefits, risks and alternatives beforehand.

Diabetic foot

Long-standing high blood sugar damages both the nerves and the arteries of the foot, so pain is felt less and the blood supply weakens, and a small cut or a rub from a shoe can turn into an infected ulcer that does not heal without the patient noticing. Assessment starts with an examination of the foot and its pulses and a Doppler ultrasound of the blood supply; the doctor may also request a CT angiogram of the leg arteries and blood tests for infection. Treatment combines wound care and removal of dead tissue, antibiotics for infection, taking the pressure off the ulcer with special footwear or a cast, control of blood sugar with the internist and, where a leg artery is narrowed, restoring the blood supply by catheter or surgery, because an ulcer cannot heal without enough blood. The first aim at every stage is to save the foot, so any wound on a diabetic foot should be shown to a doctor early rather than left to heal on its own.

Narrowed leg arteries (peripheral artery disease)

Atherosclerosis narrows the leg arteries just as it narrows those of the heart. The typical symptom is a cramping pain in the calf or thigh that comes on after walking a certain distance, eases after a few minutes' standing and returns on walking again. In advanced cases the pain appears at rest and at night, the limb is cold and wounds heal slowly. Risk rises with smoking, diabetes, high blood pressure, high cholesterol and age. Diagnosis relies on the examination and the pulses, a Doppler ultrasound and a comparison of the blood pressure at the ankle and the arm, then, when needed, a CT angiogram or a diagnostic catheter angiogram to locate the narrowing before any intervention. Treatment begins with stopping smoking, regular walking and control of blood pressure, sugar and cholesterol, together with antiplatelet and cholesterol-lowering medicines that the doctor chooses to protect the arteries. A significant narrowing that causes disabling symptoms or threatens the limb is treated by widening the artery with a balloon and placing a stent through a catheter, or by bypass surgery that routes blood around the blocked segment; the surgeon decides which suits each patient.

Leg clots (deep vein thrombosis)

A deep vein thrombosis forms when blood clots inside a deep vein, usually in the calf or thigh; it is more likely after an operation or a long period in bed, and with long journeys, pregnancy, some hormonal medicines and cancer. The signs are swelling of one leg with pain or tightness in the calf, sometimes with redness and warmth of the skin. The danger is that part of the clot can travel to the lungs, causing sudden breathlessness and chest pain: an emergency. The diagnosis is made with a Doppler ultrasound and blood tests, and treatment relies on anticoagulants (blood thinners) for a period the doctor sets; they stop the clot growing and let the body dissolve it, and are started or stopped only on prescription and with follow-up because they raise the risk of bleeding. Afterwards the doctor reviews the likely cause to decide how long treatment should last, and compression stockings ease any swelling that remains.

Aortic aneurysm and other aortic disease

The aorta is the main artery that leaves the heart and runs through the chest and abdomen to supply the whole body. With the years a segment can widen into a thin-walled bulge, an aneurysm, usually silent and found by chance on an ultrasound or CT scan requested for another reason; the danger is that the wall can burst if it grows unwatched. Aortic disease also includes narrowing and a tear in the wall (dissection), which begins with sudden severe chest or back pain and is an emergency. The department measures an aneurysm and follows it regularly with ultrasound or CT, with blood-pressure control and stopping smoking; when it reaches a size that calls for treatment or grows quickly, it is usually repaired either by open surgery, replacing the widened segment with an artificial graft, or through a catheter, by placing a covered stent inside the artery. The surgeon chooses the method from the site and shape of the aneurysm and the patient's general health. The department repairs both the thoracic and the abdominal aorta, with intensive care after major operations.

Carotid artery narrowing

The two carotid arteries on either side of the neck supply the brain. One of them can narrow through atherosclerosis without any symptoms, or the narrowing can be found after a brief stroke-like episode, such as temporary weakness of an arm or leg, slurred speech or a short loss of vision in one eye. It is diagnosed with a Doppler ultrasound of the neck arteries, and its degree may be measured, when needed, with a CT or MR angiogram. Treatment relies on antiplatelet and cholesterol-lowering medicines and blood-pressure control; a severe narrowing in someone who has had symptoms may call for an intervention to clear the deposits surgically or to place a stent, and the surgeon discusses the choice with the patient and the neurologist. Sudden weakness on one side of the body or a sudden change in speech or vision needs an ambulance straight away, because stroke treatment depends on time.

Dialysis access, central lines and the port-a-cath

A patient on dialysis needs a permanent way into the bloodstream. The usual choice is an arteriovenous fistula, created in the arm by joining an artery to a vein so that the vein widens and can take repeated needles. The department creates these fistulas, treats their narrowing or blockage through a catheter to prolong their life, treats narrowing of the central veins that causes a swollen arm or poor dialysis, and places a permanent dialysis catheter for patients who cannot have a fistula or while one matures. It also places the port-a-cath, a small reservoir implanted under the skin through which chemotherapy is given, sparing the patient repeated needle pricks. The team explains how to look after the fistula or catheter and when to come back: if the buzzing over the fistula stops, the catheter site turns red, or a fever develops.

Vascular tests in the hospital

• Doppler ultrasound: sound waves that show blood flowing through the arteries and veins, revealing narrowed arteries, failed vein valves and clots; painless and radiation-free.
• CT scan: on the 128-slice scanner; when needed, the doctor may request a contrast scan of the arteries (a CT angiogram) of the leg, abdomen or chest to locate a narrowing or aneurysm before any intervention.
• MRI: on the 3 Tesla scanner, which may be used in selected cases to image the vessels and the tissues around them.
• Diagnostic catheter angiography: direct imaging of the arteries through a thin tube inserted at the groin or the arm in the cath lab; it may continue as treatment in the same session, with a balloon and a stent, if the doctor judges it right and you agreed beforehand.
• Blood tests: such as blood sugar, blood fats, kidney function and clotting tests, in a laboratory open 24 hours a day.

You will find these tests, with imaging and laboratory services, on the Diagnostics page.

When you need emergency care straight away

Call an ambulance or go to the nearest emergency department straight away for:

• A leg or foot that has suddenly turned cold, pale and painful, or lost feeling or movement: an artery may have blocked, and time decides whether the limb can be saved.
• A swollen, painful leg together with sudden breathlessness, chest pain or fainting: a clot may have travelled to the lungs.
• Heavy bleeding that does not stop with pressure, from a varicose vein, a wound, a catheter site or a dialysis fistula.
• A diabetic foot with a swollen, red wound that is discharging or smells, with a fever or chills, or toes turning black.
• Sudden severe chest, back or abdominal pain in someone known to have an aortic aneurysm.
• Sudden weakness on one side of the body, or a sudden change in speech or vision.

Do not wait for the symptoms to pass, and do not put these off until a clinic appointment.

Your care, step by step

• Consultation: the surgeon asks about your symptoms and when they appear, about smoking, diabetes, blood pressure and previous operations, examines your legs, pulses, skin and wounds, and reviews earlier tests.
• Tests: a Doppler ultrasound first in most cases, then, when needed, a CT angiogram or a diagnostic catheter angiogram and blood tests as your case needs.
• Decision: the surgeon explains the diagnosis and the options, from compression stockings, medicines and lifestyle changes to catheter treatment, laser or surgery, with the benefits and risks of each; the decision is made together with you.
• Treatment: catheter procedures take place in the cath lab and operations in the operation theatres; some minor procedures may be done without an overnight stay in the day-care unit, and patients are monitored in intensive care after major surgery when needed.
• Follow-up: regular visits to check the wound, fistula or stent, a Doppler scan when needed, and monitoring of blood sugar, blood pressure, cholesterol and medicines; never stop a blood thinner or any other medicine on your own.

The hospital is contracted with more than 40 payers, including insurance companies, professional syndicates and government bodies, and cover depends on the payer and the terms of the contract. Details are on the Insurance page.