Starting Endovascular Surgery in third World Countries

Professor Dr Imran Javed.MBBS, FCPS Surgery.

Associate Professor of Surgery.Fiji National University.

Green is third World

Endovascular surgeryEndovascular surgery is a form of minimally invasive surgery that was designed to access many regions of the body via major blood vessels.Basic techniques involve the introduction of a catheter percutaneous into a large blood vessel (Seldinger technique). Typically the blood vessel chosen is the femoral artery or a vein found near the groin. The catheter is injected with a radio-opaque dye that can be seen on live X-ray or fluoroscopy. As the dye courses through the blood vessels, characteristic images are seen by experienced viewers and can assist in the diagnosis of diseases such as atherosclerosis, vascular trauma, or aneurysms.Development of intravascular balloons, stents and coils have allowed for new therapies as alternatives to traditional surgeries such as Coronary artery bypass surgery (CABG), carotid endarterectomy and aneurysm clipping.

Hurdles

• Poverty & Ignorance.• Non availability of equipment.• Vascular Surgery not recognized as Specialty.• University teaching hospitals are not willing to invest in

purchasing gadgets. • Trained staff is not available.• Fear for Radiologist, Cardiologist & Surgeons.• No exchange program with advanced world.• Companies are not focusing on them.• Research in Healthcare is not a priority.

Plans

• To start with Basic Endovascular Techniques.• To convince university hospitals about long term

advantages of endovascular surgery.• Get access to Cardiac Cath Lab, Radiology Suit and OT

with Anesthesia facility.• Get the funding from Government, Universities,

Companies & Anthropologists.• Get Consumables at subsidized rates from companies.• Start Exchange programs with Advanced world

especially USA.

Timelines

• Planning: 3-6 Months.• Organization: 6 Months.• First steps:- Diagnostic Procedures: 3 Months.- Basic Endovascular Surgery: 6-9 Months.. Second step: 2-3 Years-Presentation of Data at University conference after one year of start.-Starting Exchange program with US universities.Final Steps: after 3 years.Advanced Procedures & Hybrid Techniques.

Common Procedures

• Peripheral Endovascular Surgery.• Carotid Artery Stenting.• Thoracic Aortic Aneurysmal Repair.• Abdominal Aortic Aneurysmal Repair.• Renal Artery Stenting.

Exchange Program with US

• Faculty exchange program.• Trainee exchange program.• Procurement of instruments.• Collaboration with companies.• Administrative exchanges and visits.• Research & Literature Exchange.• Social visits of Scientists.