Geelong Vascular Service is about to enter its 16th year of providing care to patients with arterial and venous disease in Geelong and the wider reaches of Victoria’s South-West. Over this period we’ve enjoyed the support of many GPs with whom we have shared the vision of delivering quality and dedicated vascular surgery to their patients. It’s been our aim to consistently keep pace with advances in the field, so that our patients can be assured of always having access to the best modern vascular therapy has to offer.
Aortic aneurysms
Having introduced endoluminal stent grafting of aortic aneurysms to Geelong in 1999 as an alternative to open surgery for aneurysm repair, we now see this approach adopted as the standard of care in all centres around the World where dedicated vascular surgery is practiced. In our service, over the past 16 years, 77% of patients with abdominal aortic aneurysm have been treated by stent grafting, with a 30-day mortality of <1%. Open surgery is offered now only to those patients with an anatomical configuration that makes stent grafting unfeasible.
Carotid disease
Carotid surgery under local anaesthetic is offered as a means of providing for precise intraoperative cerebral monitoring. In Geelong we have treated over 650 patients by this approach with a periprocedural stroke and death rate of less than 1%.
Minimally invasive treatment of lower limb arterial disease has long been our clinical and research interest. In most patients, now, arterial supply to the limbs can be improved by endovascular intervention; balloon angioplasty and intra-arterial stenting. The modern vascular surgeon carries the skill of angio-intervention in his bag of tricks. Having employed this technology in over 3,000 cases, we’ve been excited with the particular results achieved in recanalising long segments of occluded femoral arteries with deployment of long stents to reperfuse an ischaemic leg, as an alternative to open surgical bypass grafting. 5-year followup of our patients represents one of the largest comparative series in the World and is awaiting publication.
Varicose veins
New to the frontier of Vascular Surgery is minimally invasive treatment of varicose veins. The practice of open venous surgery in hospital, performed under general anaesthetic and usually including deep groin dissection, has been abandoned in our service. It has been replaced with ambulatory outpatient treatment, comprising endovenous laser ablation of incompetent main-stem veins, ultra-sound guided sclerotherapy, microphlebectomies, and visual microsclerotherapy. This provides patients with walkin walk-out therapy, less perioperative discomfort, less invasive and inherently safer therapy, and early return to normal activity.
In treating over 1500 legs by this approach in the past 5 years, we have achieved primary closure rates of >99% and durable outcomes on medium term ultrasound follow-up. Our evaluation of this treatment is ongoing, but its found wide acceptance in the community of patients wanting treatment out of hospital, with no groin scar, and little disruption to their work / life balance.