It’s an interesting word, vascular. Coming from the same Latin root as ‘vas’ from which we get ‘vase’, vascular means ‘of or relating to small vessels or tubes’.
Unlike ‘cardiac’ or ‘respiratory’ or ‘critical care’, however, vascular is not that familiar to anyone outside a hospital.
Inside the hospital, it has a very clear meaning, since it refers to the body’s circulation system and as the description of a particular type of medical service, it’s pretty important.
Our blood vessels are fundamental to how our bodies run and if they go wrong, even slightly, all sorts of bad things can happen.
From varicose veins, perhaps on the slightly bad end of things, to blocked or ruptured arteries – definitely very bad things – the vascular service covers them all.
Not surprisingly therefore, the advanced nurse practitioner who leads the vascular service across our hospitals is a very busy person.
“Most people think of it as varicose veins but it’s much wider than that. It actually covers all arteries below the head or the heart,” she tells me.
We are sitting in her office close to a busy ward buried somewhere in the vast labyrinth of St Thomas’ Hospital, where some of the services also provided at the Royal Brompton are based.
“We are the hub for the South East and West Kent for aneurysms and we are the biggest centre in the UK for deep veinous intervention, although it’s fair to say varicose veins, critical limb ischaemia and diabetic foot infections are our daily bread.”
In fact the team deal with between 500-600 varicose veins a year. Most of these are sealed up using a special heated catheter tube, or are injected with a special foam that has the same effect.
Perhaps more surprisingly, the next most common procedure for the team is amputation of a toe – they do one of these roughly every two weeks.
“A lot of procedures are about trying to restore blood flow to legs and feet – two thirds of the service deals with this. And many of these are urgent, needing treatment within two weeks.”
The typical cause here is diabetes, but a lot of the patients the team sees have a variety of complex, long term conditions.
“We often have very complex patients and they can go from being perfectly well to being very sick very quickly – we have developed an urgent vascular clinic to see patients within 72 hours of referral to reduce the burden on A&E.”
The deep veinous service is one of only a handful across the country. This deals mostly with deep vein thrombosis; that is, a blood clot that forms in a deep vein, most commonly in the legs –serious because the clot can break loose and travel to the lungs, causing a pulmonary embolism, which is potentially life-threatening.
The team also treat aneurysms – where arteries gradually balloon and can then suddenly rupture due to the walls of the vessel becoming weakened.
“Ruptures are not as common nowadays due to the screening and aneurysm surveillance programme” the nurse tells me. Normally, the aneurysm or ‘bulge’ is monitored very closely and dealt with before it gets close to bursting. But you can imagine how critical this is. I for one certainly can; my father died of an aneurysm.
The complaints may be common, the outcomes often severe. I ask the head of this busy team about the stresses and strains.
“It can be psychologically demanding on the team, but I am lucky – my team are easy to manage.”
I suspect modesty at play here, and ask some more questions of the manager who seems young for what she has achieved – 24 years in the NHS, 8 of them in this role.
“A happy team is a productive team. That is how I and have always run my teams. You need to trust them and not micromanage them. Some may say I am too flexible but they are the experts and I am really just the over-seer.”
I wonder about this busy job and busy team, stretched across so much of the country, looking after all our veins and arteries. So much to look after, so much to diagnose, so much to understand.
The nurse, who personally triages every single patient who is routinely referred into the department – between 50-80 per day – is looking at some notes.
They read: “The arterial Doppler scan showed no significant stenosis with biphasic to triphasic waveforms in the lower limb arteries.”
What on earth does that mean? I ask. “Their arterial supply is fine so their symptoms may be caused by incompetent veins,” the nurse says.
So there you have it in a nutshell. The vascular system. It’s complex, critical to life, and cloaked in obscure language that is only understood by the experts.
Thank goodness they are there to decipher it.