Expert Surgical Care for Circulatory System and Blood Vessel Disorders
Painful leg cramping, dangerous aneurysms, amputation risk from poor circulation, varicose veins, blocked carotid arteries risking stroke, or vascular trauma, blood vessel problems profoundly affect circulation, mobility, limb survival, and life itself.
Our vascular surgeons provide expert medical and surgical treatment for arterial, venous, and lymphatic conditions using modern techniques, including minimally invasive endovascular procedures.
Our Vascular Surgeon
Medical Disclaimer: This information is for educational purposes and does not replace professional medical evaluation and care. Vascular disease requires assessment by qualified HPCSA-registered vascular surgeons. Please consult with specialist vascular surgeons for comprehensive evaluation and individualized treatment recommendations. For vascular emergencies, including ruptured aneurysm, acute limb ischaemia, or major vascular trauma, seek immediate emergency care or contact emergency services.
What Vascular Conditions and Problems Do We Treat?
Vascular surgery addresses diseases affecting arterial, venous, and lymphatic circulation throughout the body.
Peripheral Arterial Disease (PAD)
Atherosclerotic occlusive disease of arteries supplying legs, extremely common, affecting 12-20% of people over 60, higher in smokers and diabetics. Caused by atherosclerotic plaque progressively narrowing and eventually occluding arteries.
Abdominal Aortic Aneurysm (AAA)
Focal dilatation of the abdominal aorta (normal diameter 2 cm, aneurysm defined as over 3 cm). Occurs in 4-8% of men over 65, less common in women. Risk factors: smoking (most important, 6-fold increased risk), male gender, age, family history, atherosclerosis, and hypertension.
Aortic Dissection
Tear in aortic intima allowing blood to enter aortic wall creating false lumen. Classified by location: Type A (ascending aorta, surgical emergency, requiring immediate cardiac surgery), Type B (descending aorta, managed medically unless complicated by rupture, malperfusion, refractory pain, or expansion, then requiring TEVAR or open repair). Presents with sudden severe “tearing” chest or back pain, hypertension or hypotension, pulse deficits, end-organ malperfusion. Type A dissection without surgery has 50% mortality at 48 hours, requires emergency cardiac surgery. Type B dissection managed with aggressive blood pressure control, pain management, monitoring complications, mortality 10-15% with medical management, higher with surgery (performed only when complications exist).
Carotid Artery Disease
Carotid Stenosis. Atherosclerotic narrowing of carotid arteries supplying brain. Causes stroke via two mechanisms: thromboembolism (plaque rupture releasing emboli occluding cerebral vessels, most common) or hypoperfusion (critically reduced flow, less common, typically during hypotensive episodes in patients with severe bilateral stenosis).
Acute Limb Ischaemia
Sudden arterial occlusion causing acute severe reduction in limb perfusion, limb-threatening emergency requiring urgent intervention (within 6-12 hours) preventing irreversible muscle/nerve damage, limb loss, systemic complications (myoglobinuria from muscle breakdown causing renal failure, metabolic acidosis, hyperkalaemia causing cardiac arrest).
Varicose Veins & Chronic Venous Insufficiency
Dilated tortuous superficial leg veins from venous valve incompetence causing reflux (backward flow). Extremely common, affecting 25-30% of adults, higher in women, older individuals, those with family history, prolonged standing occupations.
Deep Vein Thrombosis (DVT)
Blood clot in deep veins (typically legs). Common, 1-2 per 1000 annually, higher in hospitalised patients, post-surgery, malignancy, thrombophilia, and immobilization.
Lymphoedema
Chronic limb swelling from lymphatic system dysfunction. Primary lymphoedema (congenital malformation, Milroy disease, lymphoedema praecox, lymphoedema tarda) or secondary lymphoedema (from infection, filariasis common in tropical areas, recurrent cellulitis; malignancy, lymph node involvement; surgery/radiation, lymph node dissection and radiation for cancer; trauma).
Vascular Malformations
Congenital abnormalities of vascular development, arteriovenous malformations (AVM, abnormal connections between arteries and veins), capillary malformations (port-wine stains), venous malformations, lymphatic malformations (cystic hygroma, lymphangioma).
Most require multidisciplinary management (vascular surgeon, interventional radiologist, plastic surgeon). Treatment options: sclerotherapy, embolization, surgical excision, laser therapy, or observation (many malformations are cosmetic concerns without functional problems, treatment sometimes more morbid than disease).
Why Choose Botshilu for Vascular Surgery
Vascular surgery requires exceptional technical skill, a comprehensive understanding of vascular anatomy and pathophysiology, and both open surgical and endovascular expertise, given modern hybrid approaches.
Botshilu’s Vascular Surgery services offer:
Experienced Vascular Surgeons:
Our vascular surgeons have completed comprehensive training, medical school, general surgery training, specialised vascular surgery fellowship, registration with HPCSA as vascular specialists or general surgeons with vascular expertise, years of clinical experience treating diverse vascular pathology, and ongoing professional development maintaining current knowledge of evolving techniques and technologies. When facing limb-threatening ischaemia, life-threatening aneurysm, or disabling vascular disease, a surgeon’s experience and expertise matter profoundly.
Comprehensive Vascular Services:
We provide a full range of vascular care, including non-invasive vascular assessment, medical management, endovascular interventions, open vascular surgery, venous surgery, diabetic foot care and limb salvage, vascular trauma surgery, dialysis access surgery, and vascular wound care.
This comprehensive capability enables treating nearly all vascular conditions, from routine varicose veins to complex limb salvage, from elective aneurysm repair to emergency vascular trauma.
Hybrid Operating Theatre:
Modern vascular surgery often combines open and endovascular techniques, hybrid procedures utilising the advantages of both approaches. Dedicated hybrid operating theatres with fixed imaging equipment enable performing open surgery with intraoperative angiography, endovascular procedures with immediate open surgical backup, and combined procedures (open femoral exposure with endovascular intervention on proximal vessels). We provide hybrid capabilities when needed for complex vascular interventions.
Limb Salvage and Diabetic Foot Care:
Diabetes causes aggressive peripheral arterial disease combined with neuropathy and immunocompromise, creating devastating foot complications, infections, ulcers, gangrene threatening amputation. We provide comprehensive limb salvage including aggressive medical management (optimising diabetes control, cardiovascular risk factors), wound care (debridement, infection control, offloading pressure, advanced dressings), revascularisation (bypass to tibial or pedal vessels restoring perfusion enabling healing), minor amputations (toe, transmetatarsal, preserving ambulation when selective amputation combined with revascularization suffices), and multidisciplinary care (coordinating with endocrinologists, infectious disease specialists, podiatrists, orthotists, wound care nurses, physiotherapists).
Limb salvage requires commitment, multiple procedures sometimes, prolonged healing, and uncertain outcomes. But preserving ambulation profoundly affects independence and quality of life, making limb salvage attempts worthwhile when feasible before resorting to major amputation.
Dialysis Access Surgery:
Chronic kidney disease patients requiring haemodialysis need vascular access. We create dialysis access, including arteriovenous fistulas, arteriovenous grafts, and central venous catheters.
Vascular Trauma Surgery: Vascular injuries from penetrating trauma (gunshot, stab wounds) or blunt trauma (motor vehicle accidents causing vessel disruption) require urgent surgical expertise.
Lymphoedema Management: Lymphatic system dysfunction causes chronic limb swelling (lymphoedema, primary from congenital malformation, secondary from infection, malignancy, surgery, radiation). We diagnose lymphoedema (clinical diagnosis, lymphoscintigraphy when available), coordinate conservative management (compression garments, manual lymphatic drainage, pneumatic compression devices, skin care preventing infections), and occasionally surgical treatment (debulking procedures, lymphovenous anastomosis, vascularized lymph node transfer, complex procedures with limited availability, reserved for severe refractory cases).
Multidisciplinary Vascular Care:
Optimal vascular outcomes require team approaches. Our vascular surgeons work closely with interventional radiologists (performing complex endovascular procedures, providing advanced imaging), cardiologists (managing cardiovascular disease, vascular patients often have coronary disease; optimizing cardiac function before major vascular surgery), nephrologists (managing dialysis access, addressing kidney disease affecting surgical risk), endocrinologists (optimizing diabetes control essential for wound healing and surgical outcomes), infectious disease specialists (managing complex vascular infections, prosthetic graft infections), haematologists (managing thrombophilia, hypercoagulable states), wound care specialists and stomal therapists, physiotherapists and occupational therapists (rehabilitation after amputation, mobility training), and prosthetists/orthotists (providing prostheses after amputation, orthoses for diabetic foot protection).
Your Vascular Surgery Team
Vascular Surgeon
Vascular Surgeons are specialist doctors who have completed medical school plus 5-6 years of surgical training with specialized vascular surgery training. They’re registered with HPCSA as vascular surgery specialists or general surgeons with vascular subspecialty. They’re experts in open vascular surgery, endovascular techniques, vascular diagnosis, and medical management of vascular disease.
Interventional Radiologists
Interventional Radiologists (when available) complement vascular surgeons performing complex endovascular procedures, often working collaboratively on difficult cases requiring combined expertise.
Laboratory Technologists
Vascular Laboratory Technologists perform non-invasive vascular assessments, arterial duplex, venous duplex, ABI, providing crucial diagnostic information guiding treatment.
Anaesthetists
Anaesthetists provide anaesthesia for vascular surgery, often complex cases in patients with significant cardiovascular comorbidities requiring specialized anaesthetic management.
Intensive Care Unit (ICU) Staff
They will care for you immediately after surgery. You’ll spend your first day or two in ICU, where you’ll be closely monitored. This is standard practice for all cardiothoracic patients, not because something’s wrong, but because it’s the safest way to recover.
Physiotherapists
They help you with breathing exercises and gentle movement after surgery to prevent complications like pneumonia or blood clots.
Vascular Nurses & ICU Staff
Vascular Nurses and ICU Staff provide specialized post-operative care understanding vascular surgery-specific needs, monitoring perfusion, detecting graft thrombosis, managing anticoagulation, preventing complications.
Wound Care Specialists
Wound Care Specialists manage complex vascular wounds, providing advanced dressings, coordinating hyperbaric oxygen, addressing wound healing impediments.
Physical Therapists
Physiotherapists and Occupational Therapists provide crucial rehabilitation, supervised exercise programmes for claudication, post-amputation rehabilitation, mobility training.
Prosthetics & Orthotics
Prosthetists fit prostheses enabling ambulation after amputation, proper fitting and training dramatically affect post-amputation function.
FAQ
Frequently Asked Questions
Common Concerns and Honest Answers
No, bypass doesn't cure atherosclerosis, it bypasses blocked segment. Disease continues progressing in other vessels. Without risk factor control (smoking cessation especially, diabetes/blood pressure/cholesterol management), new blockages develop in bypass graft or other vessels. Bypass durability depends on graft type, patient factors, and ongoing medical management, vein bypass 5-year patency 60-80%, synthetic grafts 40-60%, declining further over time. Some patients require multiple revascularizations over lifetime.
Not necessarily. Diabetic foot complications require aggressive multidisciplinary management, optimizing diabetes control, treating infections, wound care, revascularization when arterial insufficiency present (wounds won't heal without adequate blood flow), minor amputations when localised gangrene (toe, transmetatarsal, preserving ambulation). Major amputation (BKA, AKA) is reserved for when revascularization fails, infection uncontrolled, or extensive tissue loss. With optimal care, 60-70% of diabetic patients with critical limb ischaemia avoid major amputation. However, outcomes depend heavily on patient factors, continuing smoking, poor diabetes control, non-compliance with wound care worsen outcomes dramatically.
Sometimes yes, sometimes no. Endovascular is less invasive but not suitable for all anatomy, long occlusions, heavily calcified vessels, lack of suitable inflow/outflow limit endovascular success. When feasible, endovascular is tried first (lower morbidity) but patency is generally lower than bypass, iliac angioplasty approaches bypass durability, but femoral-popliteal angioplasty has 50-60% patency at 3 years versus 70-80% for vein bypass. Treatment choice depends on anatomy, patient factors (surgical risk), urgency (CLI often requires durable revascularization favouring bypass), and patient preference (understanding trade-offs, faster recovery but lower durability versus major surgery with better long-term results).
Open repair: Yes, replacing aneurysm with graft, rupture risk essentially zero (graft complications rare). EVAR: Mostly, stent-graft excludes aneurysm from circulation preventing rupture, but endoleaks (persistent flow into aneurysm sac) occur in 20-30%, sometimes causing continued expansion and eventual rupture. This is why EVAR requires lifelong surveillance, CT annually detecting endoleaks or complications, reintervention when needed. EVAR isn't "fire and forget", it requires ongoing monitoring and possible reinterventions.
Depends on size. Small aneurysms (under 5.5 cm men, under 5.0 cm women) have low rupture risk, surveillance with serial imaging is appropriate. Large aneurysms (over 5.5/5.0 cm) have substantial rupture risk (10-20% per year) exceeding surgical risk, elective repair is indicated in good-risk patients. "Feeling fine" is irrelevant, aneurysms are asymptomatic until rupture (then 80-90% dead). This is why screening and surveillance exist, detecting asymptomatic aneurysms, repairing before rupture when elective surgery is safe.
Paradoxically, surgery preventing strokes carries stroke risk, perioperative stroke/death must be under 3% for asymptomatic, under 6% for symptomatic patients to maintain benefit over medical therapy alone. With experienced surgeons at high-volume centres, rates are typically 1-2% for asymptomatic, 3-4% for symptomatic, below threshold where benefit outweighs risk. This is why patient selection matters, performing CEA in appropriate patients (severe stenosis, reasonable life expectancy, low perioperative risk) where benefits clearly outweigh risks.
?" Yes, recurrence occurs in 10-20% at 5 years. Causes: inadequate initial treatment (not treating all refluxing veins), neovascularization (new vessels forming after treatment, mechanism unclear), disease progression (developing incompetence in previously normal veins). Modern endovenous techniques have lower recurrence than older surgical stripping but no treatment eliminates recurrence entirely. Wearing compression stockings, maintaining healthy weight, regular exercise reduce but don't prevent recurrence.
Yes but requires careful management. Procedures on anticoagulation include risk stratification (balancing stroke/thromboembolism risk off anticoagulation versus bleeding risk on anticoagulation), bridging when necessary (stopping warfarin pre-operatively, bridging with LMWH, shorter half-life, reversible), avoiding bridging for low stroke risk/high bleeding risk procedures, and using DOACs (shorter half-life than warfarin, no bridging needed, stop 48-72 hours before surgery, resume 24-48 hours after when haemostasis achieved). Some vascular procedures (carotid endarterectomy, peripheral bypass) can be performed safely continuing anticoagulation or with brief interruption.