Blog – Vascular Care n Cure Clinic – Dr. Aniruddha Bhuiyan

Yes !! Stenting is also done outside the heart …

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vascularandendovascularsurgery, vascularsurgery

vascularandendovascularsurgery, vascularsurgery

Infra-renal aortic stenosis is where the narrowing of the blood vessel in the abdomen occurs below the level of the kidneys. This condition involves the constriction of the main artery responsible for carrying oxygen-rich blood from the heart to the lower body. It occurs when the aortic artery narrows due to the accumulation of plaque or calcification, impeding the smooth flow of blood. Left untreated, it can increase the risk of complications such decreased lower limb perfusion or gangrene.

Stenting is a commonly used treatment modality for infra-renal aortic stenosis. During the procedure, a thin, expandable tube called a stent is inserted into the narrowed section of the aorta. The stent acts as a scaffold, widening the artery and restoring proper blood flow to the lower body. This minimally invasive approach offers several advantages over traditional open surgery, including reduced hospitalization time, quicker recovery, and lower risk for high-risk patients.

What is Diabetic Footwear ?

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Diabetic footwear is a specialized type of footwear designed for individuals with diabetes to reduce the risk of foot complications. People with Type II DM are prone to foot problems due to nerve damage and poor blood circulation, which makes it crucial for them to wear shoes that provide proper support and protection.

Diabetic footwear are designed with several key features that make them suitable for individuals with diabetes. Firstly, they have a roomy and large toe box, which provides ample space for the toes to move and prevents friction and pressure on the toes, which can lead to blisters, corns and other foot injuries.

Secondly, diabetic footwear have a deep and cushioned heel, which provides stability and support to the foot, preventing it from sliding forward and causing discomfort. Additionally, these shoes have a firm and supportive midsole, which helps to distribute weight evenly across the foot, reducing the risk of foot injuries.

Thirdly, diabetic footwear come with a non-binding and seamless interior, which reduces the risk of friction and pressure on the foot. This helps to prevent the formation of blisters and calluses, which can be extremely painful and lead to further complications.

Diabetic footwear are made from high-quality materials, which are breathable, durable, and moisture-wicking. This helps to keep the feet cool and dry, reducing the risk of fungal infections, which are common in individuals with diabetes.

Diabetic footwear is also designed to be adjustable, allowing individuals to customize the fit of the shoe to their specific needs. This is important because people with diabetes may experience changes in the shape and size of their feet, and the adjustable design of diabetic shoes makes it easier to accommodate these changes.

In conclusion, diabetic footwear is an essential part of foot care for individuals with diabetes. It provides proper support, protection, and comfort, reducing the risk of foot complications and ensuring that individuals with diabetes can maintain their mobility and independence. It is recommended that people with diabetes consult with a vascular surgeon to determine their specific needs and choose the right pair of diabetic footwear.

Lymphovenous Disorders

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Lymphovenous diseases are conditions that affect the lymphatic system and the veins. The lymphatic system is a network of vessels and tissues that helps to remove excess fluid, waste products, and other substances from the body. It also plays a role in the immune system, helping to defend the body against infection and disease. The veins are blood vessels that carry blood back to the heart. When there is a problem with the lymphatic system or the veins, it can cause a variety of symptoms and complications. Some examples of lymphovenous diseases include lymphedema, deep vein thrombosis, and chronic venous insufficiency.

There is essentially accumulation of body fluid / blood in the tissues leading to abnormal enlargement of the body or its parts. It can cause tissues to become extremely large at any place in the body, however most frequently occurs in the legs. It can be caused due to multiple factors and is mostly treated by normal physicians with compression and reassurance. These conditions can hence foster long term disability.

A Vascular Surgeon determines the cause of these malformations, treats them and ultimately remove the excess tissue causing the recurrent ulcers.

This is a patient in his middle ages with a slow growing mass in his right calf slowly over 10 years duration. He predominantly had a standing job due to which he was adviced long term use of compression bandages and garments. However in view of recurrent ulcers at the base of the swelling, he started seeking opinions and landed up with us.

Kindly visit your Vascular and Endovascular Surgeon for any Lymphovenous Disorders.

Peripheral Vascular Disease

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Peripheral Vascular Disease and Diabetic Foot

Peripheral vascular diseases had been treated in India from decades especially in the lower socioeconomic strata with amputation and wound management. It was painful to see artificial limbs on people who especially could have walked had the repair of their blood vessels been done on time when their legs still survived.

85% of lower limb amputations are caused by diabetic foot ulcers which often begin as a small wound on the foot. Diabetic foot complications can lead to multiple amputations very quickly, with studies showing that up to 74% of diabetic patients get subsequent amputations within the first 5 years of their first amputation. Studies also found that 22% of diabetic patients did not survive the first year after their first lower limb amputation due to multiple complications.

This was the story of vascular diseases in the past. However with the advent of vascular and endovascular surgery, we do have the option now to salvage diseased limbs via bypass or angioplasty to improve blood flow in the oxygen deprieved extremities. Although we have a large number of diabetics and smokers in the country, proper case selection and good wound care can really make the difference.

Our clinic has been started with an intention to treat diabetic foot infections with a multidisciplinary approach. The aim is to give a systematic protocol oriented management to cure these non healing wounds. With glycemic control, medications and diet, the clinic aims to treat infected wounds with good wound dressings, proper footwear and revascularize ischaemic wounds with open vascular and/or endovascular procedures.

We cater to advanced wound care catered to all sections of society. With a tertiary care setup, a dedicated team of specialists and support staff, we aim to reduce the amputation burden of diabetic foot wounds and provide quality of life to those who learn to live with peripheral vascular disease

`Therapies offered for peripheral vascular diseases include :`

Peripheral Angiography and Angioplasty
Endovascular Stenting for diffuse diseases
Advanced therapies of Atherectomy, Lithotripsy for calcified lesions
Drug eluting balloons and stents for difficult arteries
Vein or Graft Bypass for long segment blocks
Long segment Bypass (AortoFemoral, Axillofemoral, AortoPopliteal, Aortodistal)
Endarterectomy or complete removal of plaque
Thrombectomy or removal of fresh clots
Catheter Directed Thrombolysis or breakdown of the fresh clots via minimally invasive methods and aspiration
Stem Cell Therapy for No Option Limbs

Varicose Veins

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What are Varicose Veins ?

Varicose veins are dilated and engorged veins in the legs due to leakage of blood going down the leg on prolonged standing and may lead to pain, discolouration and ulcers which do not heal easily. They are usually familial or occupation driven mostly due to prolonged standing hours. They start as small veins at the ankle and progress to large dilated veins sometimes visible throughout the leg. They can be associated with bleeding or ulcer formation which is quite painful and the ulcers may not heal with conventional wound care.

Why do Varicose Veins occur ?

Blood flows via 2 channels, ‘good’ blood from the heart to the foot and ‘bad’ blood from the foot back into the heart. The flow of blood in these veins are assisted with valves which push blood from down to up and from outside to inside and up.

These valves can get dilated with the veins, leading to valve dysfunction and hence leakage. The leakage is not significant while sleeping or keeping the legs straight; however on long hours of keeping the legs down, they lead to dilatation and engorgement of the veins, thus leading to the symptoms of varicose veins.

Can you Prevent Varicose Veins ?

Avoid long hours of standing or keeping legs down
Exercise or walk regularly to keep blood flowing
Keep weight under control
Wear stockings if having high risk of varicose veins

When to meet a Vascular Surgeon for Varicose Veins ?

Skin ulceration of flaking
Bleeding varicose veins
Pain over the varicose veins
Redness over the area over the varicose veins

Treatment options of Varicose Veins

Medicines – Vein strengthening medications
Compression therapy – Compression stockings are used as frontline therapy for varicose veins to see if compression relieves the symptoms. In case of venous ulcer, 4 layer bandaging can be done.
Endovenous Therapy for Varicose Veins included Endovenous Laser Ablation, Radiofrequency Ablation, Endovenous Glue Ablation, Endovenous Microwave Ablation and Sclerotherapy
Microphlebectomy : Hooking of small veins with mini incisions over the skin
Open Surgical Stripping of the veins – Not recommended with current modalities

After the procedure :

Stockings are recommended only for a few weeks post procedure until the post operative inflammation subsides. However treatment of varicose veins does not guarantee the advent of new veins as varicose veins can occur to any normal vein due to age. Hence lifestyle modification is required to prevent more varicose veins.

Deep Venous Thrombosis

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These are blockage of deep veins which does not allow the blood to return back into the heart leading to massive swelling In the limbs.If the blood clots break away, they can fly into the lungs, causing life threatening pulmonary embolism. Hence Deep Venous Thrombosis (DVT) need to be detected early and treatment can be offered to the patients.

Risk factors

Age : Elderly age group individuals are more prone for DVT.

Smoking: Smoking influences how blood clots, which can increase chances of DVT.

Genetics: Presence of procoagulant factors or absence of anticoagulant factors can trigger DVT.

Pregnancy: Pregnancy builds the strain in the veins in the pelvis and legs due to the foetus. Individuals with an acquired coagulating issue are particularly in danger. Anti-conception medication pills (oral contraceptives) can build the blood’s capacity to clump.

Obesity: Being overweight builds the strain in the veins in the pelvis and legs.

Cancer: Cancer can cause a high degree of blood clots.

Idiopathic: Blood coagulation in a vein can happen with no recognizable factors

Pulmonary embolism (PE): PE is a possibly dangerous complication related with DVT. It happens when blood coagulation (clots) in a leg or other body region breaks free and blocks blood vessels in the lung.

Postphlebitic disorder: Post clots in the veins, the valves can get destroyed leading to leakage within all the veins. Thus when a person keeps the legs down, it leads to leakage, discolouration of the legs, ulcers and even bleeding.

Treatment plan ranges from therapeutic anticoagulation (blood thinning), removal of the clots by aspiration or thrombolysis, making place in the vein loaded with old clots with angioplasty or placement of stents or even protecting the lungs with placement of IVC filter.

Dialysis Access ( AV Fistula)

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An AV fistula is a connection between an artery and a vein, created by a vascular surgeon. An AV fistula is typically located in your forearm or arm. After the AV fistula matures, the enlarged veins will be capable of delivering the amount of blood flow necessary to provide an adequate long term hemodialysis treatment. AV fistulas are natural conduits and are hence preferred mode of dialysis.

Benefits of an AV fistula

Stays longer than different types of vascular access
No artificial device
Reduces dialysis time
Less infection
Less blood clots compared to other methods
Done under local anesthesia

How is an AV fistula made?

The most vital phase in AV fistula creation is to assess your veins (veins and conduits), to guarantee they are sufficiently large to support a fistula. The most vital phase in the assessment will be an actual assessment of your arms performed by your vascular surgeon. The subsequent stage will include the utilization of harmless or negligibly intrusive tests like ultrasound. These tests will decide if your veins can support an AV fistula. These tests are frequently called as “vessel planning.”

To make an AV fistula, the vascular surgeon will give anaesthesia locally and will make a little cut on the skin to isolate the arteries and the veins to be connected. This association makes blood to route from the artery into the vein, thus broadening the vein and thickening the vein walls. After the AV fistula has been made, it requires a month or two for the fistula to develop to utilise for hemodialysis.

AV Graft : If AV fistula is not feasible, then an artifical tube in inserted in the arm connecting the artery at the elbow and then vein at the shoulder. The AV Graft is an artificial conduit and hence prone for infection. However it gives better patency compared to any other synthetic dialysis modality.

Permcath : If no blood vessel access can be establised in the upper limb, an artificial tube is tunneled in the chest or thigh and placed just near the heart inside the veins. This is called a permcath (Permanent Tunelled Catheter). It should be placed primarily if there is no suitable arteriovenous access for atleast 6 months duration.

Aneurysm Repair (Open + Minimally Invasive)

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An abdominal aortic aneurysm is an enlarged dilated blood vessel, which supplies blood to body and lower limbs. The aneurysms usually remain silent, until they rupture and cause death. Large aneurysms can cause abdominal discomfort and back pain but are usually missed. Countries like USA & UK have screening programs where aneurysms are picked up during routine scans in people who are at high risk. In India, there is no data about the incidence of aneurysms because of lack of awareness and lack of screening programs unlike in western countries.

Albeit an aneurysm might happen in any conduit, they are most normal in the chest and and abdominal regions. In the abdominal aorta, the most well-known area of an AAA is simply underneath the renal arteries. The most widely recognized complications emerging from an abdominal aortic aneurysm (AAA) are intense pain from ischemia, thromboembolism and rupture of the aneurysm leading to morbidity and conceivable death.

Abdominal aortic aneurysms have to be treated when they grow up to morethan 5cm in size, because there is a growing risk of sudden rupture beyond this size.The average growth rate of aneurysms is around 0.4cm per year if untreated. We have no idea as to how many sudden deaths in elderly are due torupture of aneurysms, especially in our country where hypertension, smoking and fatty food intake is highly prevalent. Size is the best determinant of rupture where 40% of untreated aneurysms 5.5-6cm or larger will rupture within 5 years. The average survival without treatment is around 17 months.

Although there is seriousness attached to this condition, there is no need to worry, as these can be tackled very efficiently by key-hole surgeries (EVAR). Open aneurysm repair is reserved for difficult anatomies and younger presentations in most cases. With adequate planning and good aneurysm morphology, EVAR has the ability to treat almost any aneurysm with minimal mortality and morbidity ates. We are proud to be able to serve patients with this modern modality.

Arteriovenous Malformation

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Arteriovenous malformations are an uncommon condition including unusual connections between the arteries and veins in the body. While interesting, they can be dangerous and can lead to pain and bleeding. They increase in size as time progresses and from being asymptomatic can become life threatening.

Treatment :

Embolisation : Blockage of the arterial inflow either by coils, glue or alcohol can lead to reduction in size of the malformation by cutting off the blood flow.
Sclerotherapy : It is used for slow flow malformations where the agent is directly injected into the veins to block them off.
Surgical excision : If the nidus of the AV malformation is large, it leads in recurrences. Such cases require excision and removal of the nidus.

Carotid Artery Disease (Stroke Surgery)

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Carotid artery disease restricts the blood supply to the brain due to fat deposition (plaques). Longer the disease process, greater is the degree of blockage. This decreases the blood circulation in the brain to cause a stroke.

Around 75% of all ischemic strokes occur in the neck due to blockages in the artery.Typically, a piece of the plaque breaks off and goes to the brain causing either Transient ischemic attack (TIA) or stroke.

Diagnosis is either via carotid ultrasound or angiograms.

Treatment comprises of Carotid Endarterectomy (open surgery) wherein the fat is opened and directly removed from the artery making sure that no clot goes into the brain. The artery is enlarged in the area with the help of vein / graft patch (patch plasty) to make sure no further blockage takes place.

Minimally invasive method includes carotid artery angioplasty and stenting which is done under protection of a filter (embolic protection device) in which the fat blockages are crossed and are moved away with the help of a stent.

Lymphedema

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What is lymphedema?

Lymphedema is the development of body liquid in your body’s tissues that can happen when lymph network are blocked. Lymphedema can cause tissues to become large at any place in the body, however most frequently occurs in the arms and additionally legs. Lymphedema results from cancer treatment and therapies like a surgical procedure or radiation. It can also happen because of injuries and can foster long term disability.

Lymphedema can:

lead to infected wounds
non healing ulcers
large legs with watery discharge
bad quality of life

Treatment :

Compression therapy (Stockings, Pump)
De-Bulking surgeries
Lymphatic Bypass
Vacuum Assisted Closure
Dressing for wounds

Abdominal blood vessels (blocks or bleeding)

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Treatment of abdominal blood vessels (mesenteric) is an important part of vascular and endovascular surgery and can comprise of elective cases to emergencies.

Blockage of mesenteric arteries / veins can lead to severe pain and gangrene of the intestines thus leading to death of patient if not treated on time.

Treatment of these blockages can be done by removing the blood clot and reestablishing the blood flow.

Bleeding can be an emergency and needs prompt action as well. Bleeding blood vessels can be treated with a digital substraction angiography followed by embolisation of the bleeding artery. Alternatively open surgery can also be performed for such bleeding vessels.

Aarti Gulwadi

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I took my mother for treatment at the clinic.Dr Anirudh is extremely gentle, knowledgeable and humble.He patiently listened to the health issues and advised medication.He suggested all alternatives of treatment .
The receptionist Madam,is also extremely warm and gentle.
The clinic in general has very good vibes.
Would recommend all patients suffering from any vascular issues to take guidance at VCC .
THANK YOU, VERY MUCH.
Aarti Gulwadi
Sher e punjab sty.

Pearll Philip

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Doctor Bhuiyan defies all experiences I have ever had with doctors in general. He is an Incredibly skilled doctor, he was very co-operative and transparent about the whole process. He answered all our doubts and questions about the treatment. My case was extremely complex, my leg was very close to amputation. we lost all hope but then we met doctor bhuiyan and everything went well. I HIGHLY recommend visiting him. he won’t disappoint.
– Deborah Joseph

Lochan Dabhi

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My parents consulted doc for my mom’s varicose veins. During the consultation, doctor was extremely kind and explained them the next steps. I would also like to mention that doctor took out time and explained me the entire situation and gave me proper guidance on call since I couldn’t accompany my parents to the hospital. We are very satisfied with his expertise.

Saurabh Manjrekar

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Dr is specialised in Vascular surgeries. My mother had vericose veins with infection. After the surgery, her leg was back to normal, infection went away, no pain. He was Cooperative and the information which je gave aboutthe disease and surgery was nice.

Healed varicose veins ulcer

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A wound on the leg or ankle caused by abnormal or damaged veins.

Venous ulcers are due to abnormal vein function. People may inherit a tendency for abnormal veins. Common causes of damaged veins include blood clots, injury, ageing and obesity.

Symptoms include swelling, aching and tiredness in the legs. Usually a red, irritated skin rash develops into an open wound.

Treatment includes leg elevation, compression and wound care. Other surgical options include Endovenous Laser ablation, Endovenous Radiofrequency ablation, Venaseal Glue Ablation and Sclerotherapy

Concept of Angiosome and the ISSUE WITH MULTIPLE COOKS (Specialists)

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Angiosome is derieved from the anatomy concept of multiple areas of the body supplied by individual blood vessels and hence blockages of those vessels leading to death of the areas supplied by them.
However the body has a vast network of vessels and collateral circulation takes care of blood supply upto a certain extent. With large wounds and extensive infection (especially in diabetics) , more blood is needed to heal the wounds. Hence angiosomal circulation to particular areas need to be improved.
The issue with multiple cooks (specialists) : with separate doctors for blood supply improvement, wound management and wound healing, most wounds end up with major amputations and long followup periods. A Vascular and Endovascular Surgeon can bridge this divide with ability to vascularize both by open and endovascular methods, wound care, debridement and essentially heal the wound at an earlier stage mostly avoiding major amputations or limb loss.

Arteriovenous Fistula – Facts

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Arteriovenous fistulas have proven to be the longest lasting, safest method of gaining vascular access for dialysis.
Normally, blood flows from arteries into capillaries and then into veins. When an arteriovenous fistula is present, blood flows directly from an artery into a vein, bypassing the capillaries. An arteriovenous fistula for kidney dialysis is the connection of a vein and an artery in order to create a long lasting site accessing the vascular system for dialysis.

The AV fistula creation uses patients own veins and arteries without use of artificial material, thus lowering the risk of infection and complications.

However the process of dialysis can be dynamic and blood clots or blockages can occur in the AV Fistula.
Prompt restoration of the flow and correction of the narrowing is essential to maintain this lifeline for dialysis

Profile

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Dr. Aniruddha S. Bhuiyan is the first MCh qualified peripheral vascular surgeon in Mumbai. He is specialized in both open surgeries and interventional endovascular procedures for arterial, venous and lymphatic disorders.

After completing his MBBS and MS (Gen Surgery), he completed his super-speciality MCh training at MS Ramaiah Medical College and Hospitals, Bangalore. He was then selected by the Vascular Society of India to train at the prestigious National University Hospital, Singapore in advanced peripheral vascular surgeries and interventions.

After his superspeciality MCh training at MS Ramaiah Medical College and Hospitals, Bangalore, he trained at National University Hospital, Singapore in advanced peripheral vascular surgeries and interventions. He is currently attached to Holy Spirit Hospital, P.D. Hinduja Hospital Khar, Holy Family Hospital, Bharatiya Arogya Nidhi Hospital, Criticare Asia Hospital, Mumbai. He has his own private consulting at Vascular Care n Cure Clinic, Andheri East, Mumbai. He has many awards and has multiple presentations to his credit both at national and international conferences and journals.

His motto in patient care is that Saving Limbs is the key to Saving Lives of patients. In this day and age of availability of Advanced Vascular Therapies (both open surgical and minimally invasive), a new type of therapy “HYBRID” where simultaneously both open and endovascular options can be utilized can be used to treat complex vascular disorders and does not require MULTIPLE DOCTORS to treat ONE CONDITION.

I am consulting Doctor Aniruddha Bhuiyan since Oct 2020. I got severe blood clot at my right foot from knee to Foot due to which I was not able to walk even a single step in last 1 month and no one was able to completely own the treatment. When my son met Dr. Aniruddha, Doctor spent almost an hour to examine the case and was ready with proposed plan of action immediately to resolve the issue completely. He was very polite, Down to earth, supportive and explain you the issue in very general terminology to make you understand better and gives the confidence. After surgery, now I am able to walk independently and could able to save my feet. Thanks to Doctor Aniruddha. I do recommend Dr. Aniruddha Bhuiyan for Vasculasr and Endovascular related treatment.

Atmaram Mane
September 9, 2021

Very good experience with Aniruddha Sir, handles patients with warmth, having thorough knowledge and also motivates patients by boosting their confidence. He also gives detailed information about the disease so that patient can understand what exactly happened and which precautions to be taken care of.

Mahesh Bangera
September 9, 2021
This is one hell of a clinic! One of my friend with noo tattoos works really very hard in there.

Neil Pagare
September 9, 2021

Cool motive towards patients excellent in his field

Saish Gawade
September 9, 2020

Dr. Aniruddha Bhuiyan

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MS (Gen Surgery), MCh (Vascular Surgery), FVES (NUHS Singapore)

Consultant Vascular and Endovascular Surgery