In the world of high-flying professions, you won't find many other unique personalities like Dr. Vishnukumar Venkateshan, a Consultant Vascular and Endovascular surgeon, now at VG Hospital and Ramakrishna Hospital Coimbatore, whose interest in the treatment of blood vessels motivated him into the fields of vascular surgery. With a dearth of vascular surgeons in our country, Dr. Vishnukumar talks about the various vascular therapies and the need to create more awareness in the field.

What is the difference between a cardiac surgeon and a vascular surgeon?

Before the advent of vascular surgery, diseases of the upper and lower limbs were managed by cardiothoracic and vascular surgeons. To explain the difference, a cardiac surgeon deals with the heart and the lungs, whereas a vascular surgeon deals with all the blood vessels in the body - other than the heart and the brain. Hence, we deal with diseases of arteries and veins going to the legs, hands, stomach, or kidneys - just to give an example. If there is any block or any issue in any of these arteries, we help remove and cure them. Also, we as vascular surgeons, are uniquely trained in both surgical as well as endovascular treatment. Normally, coronary angioplasty is done by a cardiologist and the coronary bypass is done by a cardiac surgeon. But in the vascular sector, we are trained to do both peripheral angioplasty as well as peripheral by pass. The field of vascular surgery is relatively new with advances in the field only in the last 3 decades. In fact, the demand for vascular surgeons in India is quite high compared to cardiac surgeons.

What are varicose vein problems? Do you help treat them?

Varicose veins are the most commonly treated problem in vascular surgery. Basically, it is a disorder of the veins of your lower limb. Such a problem occurs by the non-functioning valves in our veins. When the blood from your heart goes to your limbs, a certain amount of pressure is inculcated to reach the limbs by the pumping mechanism of the heart. Now, for the blood to come back from the limbs to the heart, it has to travel against gravity. Hence, there are many one-way valves inside the vein to make sure the blood goes up and doesn't fall back down. But sometimes when those valves don't function, the blood tends to stagnate in the legs. The more it continues, you get symptoms akin to swelling or twisted veins on your legs. It is not a life-threatening limb problem but in the advanced stages, you can get discoloration or even an ulcer. Varicose veins are seen only in humans and not in animals because we are the only species that walk on two legs. And that is why it is commonly seen in people who stand for a longer time like policemen, doctors, shopkeepers, and in women (post-pregnancy).

Being a pure mechanical problem, there are no medicines or injections suggested to make it work again, so the only way is to surgically remove the vein that is causing the stagnation. Previously, we used to remove them by making a small incision. But nowadays, with the advancement in technology, a minimal invasive procedure - a laser ablation (putting a needle inside the vein and passing the laser fiber inside these veins and ablating them is the commonly preferred approach.

What are other vascular problems people face? And when should they consult you?

Apart from varicose veins, some people get Gangrene (black discoloration on fingers caused due to block in blood supply). This is commonly caused due to Diabetes, Hypertension, and smoking. If you see any black discoloration on your fingers or toes, it is important to see a vascular surgeon immediately, because if you delay too much, you may need to have your fingers or toes amputated. Another common vascular problem is peripheral arterial disease (PAD), which is caused due to smoking, hypertension, high cholesterol, or diabetes. In this condition, there is a block in the arteries which supply blood to the legs. Patients with PAD may complain of pain while walking which is relieved after taking rest. As vascular surgeons, we perform a procedure called Angioplasty and Stenting in these cases to improve the blood supply to the legs and reduce the pain.It is important to consult a vascular surgeon if you have any of the following symptoms: leg pain while walking, swelling in legs, non-healing ulcers on legs or feet, black discoloration of fingers or toes, or any abnormality in the pulsations of the neck or abdomen. Early detection and treatment of vascular diseases can prevent complications such as amputations, stroke, heart attack, and kidney failure.
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