Richard Evans - Vascular Surgeon

This is the dilatation or ballooning of a section of the aorta, which is the main artery coming out of the heart. An aneurysm usually occurs because of an underlying weakness in the wall of the aorta at that point. Aneurysms will often run in families and are much more common in men. Smokers are also at greater risk.

Usually, you will not have any symptoms from the aneurysm and it may only be discovered through an ultrasound scan or a CT scan. If the aneurysm grows beyond a certain size treatment will be required. Sometimes, aneurysms may cause symptoms such as tenderness, back pain or an awareness of a pulsating lump in your abdomen.

You have two carotid arteries, one on either side of your neck, that supply blood to your brain. Carotid artery disease occurs if these arteries become narrowed because of atherosclerosis (a build up of fat and cholesterol deposits on the inner walls of the vessels). If a clot forms in one of the carotid arteries and reduces or stops the flow of blood to part of your brain, it may cause a TIA (mini-stroke) or stroke.

You have an increased risk of developing carotid artery disease if you:

Treatment involves lifestyle changes eg, stopping smoking, exercising more, dietary changes and medications, such as regular low-dose Aspirin and a statin (anti-cholesterol medication). If there is severe narrowing of the carotid arteries, or you have had a recent stroke, surgery to treat the narrowed segment will be required.

Peripheral arterial disease refers to the narrowing of arteries outside the heart and brain, usually as the result of atherosclerosis or ‘hardening of the arteries’ (a build up of fatty deposits on the inner wall of arteries). When the arteries become narrowed, the flow of blood to the target organs or tissues is reduced.

The arteries commonly affected are those carrying blood to the kidneys, intestines, arms and legs, and the carotid arteries as above. Peripheral arterial disease is common in your legs and may present with a dull, cramping leg pain that occurs when you walk or run but stops when you stand still. This is known as ‘intermittent claudication’.

Treatment for peripheral arterial disease may involve medication and/or surgery.

These are bulging veins that lie just beneath the skin (superficial veins). They occur when the walls of a vein are weak or damaged or if the valves in the vein that normally stop the blood from flowing backwards are impaired, resulting in pooling of the blood and stretched veins. Besides being unattractive, varicose veins can be painful and cause inflammation or ulceration.

The following different types of surgery are available if varicose veins require treatment:

Richard Evans treats varicose veins using Venaseal™ adhesive sealing. Tiny, controlled amounts of medical-grade glue are injected into the vein via a thin tube, using a special dispenser gun. All the while progress is monitored onscreen using ultrasound. Once the adhesive is in place along the vein, pressure is applied to the leg to seal the vein. Typical treatment time is about 30-60 min. Patients need to wear compression stockings for about 10 days afterwards. Adhesive sealing is often accompanied by sclerotherapy.

Sclerotherapy – a tiny needle is used to inject a chemical solution into the vein that causes the vein to collapse. This approach is recommended for small varicose veins or spider veins that typically appear on the upper legs. 

Varicose veins may be treated using laser therapy. Surgery is rarely required these days. Laser treatment is done as a day case, under local anaesthetic. Most patients can return to work after several days. Laser treatment is often accompanied by sclerotherapy – see above.

Hyperhidrosis is excessive sweating that may occur over the entire body or only in certain parts, most commonly the face, underarms, palms of the hands and soles of the feet. When it affects the palms and armpits, it may be socially and functionally problematic.

Primary  hyperhidrosis is caused by overactivity of the nerves that carry messages to the affected sweat glands, usually  in the armpits and palms of the hands. These nerves are part of the 'sympathetic' nervous system, which means that they are 'involuntary' or not under our conscious control.

Treatment may be with topical antiperspirants, oral medications, Botox (botulinum toxin) or may involve a surgical procedure known as Endoscopic Thoracic Sympathectomy (ETS). This is a minimally invasive procedure, which interrupts the nerves that supply the sweat glands. Sometimes ETS may be effective in the treatment of problematic facial flushing.

Vascular ulcers are open wounds on the skin of the legs that do not heal or that keep coming back after they have healed. Ulcers may be caused by infection, minor trauma or pressure on the skin. They may progress because there is not enough blood being supplied through the arteries to heal the ulcers. Leg ulcers may also be caused by leg oedema (fluid) or varicose veins.

Arterial or ischaemic ulcers are typically the result of atherosclerosis or 'hardening of the arteries’ (a build up of fatty deposits on the inner wall of arteries). When the arteries become narrowed, the flow of blood to the tissues is reduced. These ulcers are usually found on the toes, heels or lower legs and are often painful. Treatment for arterial ulcers may involve angioplasty and stents or bypass surgery.

Venous ulcers occur when impaired blood flow in the veins causes pooling of blood in the legs. These ulcers are often associated with varicose veins. Venous ulcers are usually found on the lower leg between the knee and the ankle and the leg is often swollen and discoloured. Compression or pressure bandages are the main treatment for venous ulcers although surgery may be required in some patients.

Richard Evans Vascular also offers vascular ultrasounds to help diagnose conditions like varicose veins, spider veins, blood clots, blocked arteries for intermittent claudication, ulcers, TIAs, stroke, and aneurysms.

IANZ accredited.