Assoc Prof Freeman is experienced in treating a wide range of vascular conditions.
Click a topic below to read more about that condition.
Aneurysm most commonly involves the aorta. Treatment to prevent rupture traditionally has involved open surgical repair. The majority today are managed using minimally invasive aortic endovascular stent grafting, including fenestrated and branch graft technology.
Carotid disease is a common cause of stroke. Patients often have no symptoms or may present with a transient stroke or a noise in the neck (a bruit). Carotid endarterectomy surgery or angioplasty and stenting are treatments to reduce the risk of stroke.
Atherosclerosis or "hardening of the arteries" can cause problems in the legs and feet including pain when walking (intermittent claudication) and ulcers. Treatment traditionally involved bypass surgery but increasingly today balloon angioplasty and stenting are performed.
As is the case in other parts of the circulation, the blood supply to the digestive tract (mesenteric circulation) and kidneys (renal circulation) can be compromised related to narrowing of the arteries. Some patients will benefit from balloon angioplasty and stenting.
Patients whose kidneys stop working properly may require dialysis. In order to supply blood to an artificial kidney venous catheter can be used. Alternatively a better solution is to create an arteriovenous fistula. Fistulas require ongoing surveillance in order to prevent them blocking.
Excessive sweating, particularly of the palms of the hands, can be a significant problem. It can be caused by overactivity of the sympathetic nervous system. Once other treatments have failed some patients benefit from surgery to divide the nerve causing the problem (sympathectomy).
As the nerves and vessels travel from the neck and chest out into the arm they can become compressed in the thoracic outlet. This is the space under the clavicle and on top of the first rib. Surgery to create more room for these structures can relieve problems related to compression.
Clots in the legs can cause swelling and in some people they will travel to the lung causing potentially fatal pulmonary embolism. Treatment options include thinning the blood with injections or tablets, directly dissolving the clot or placing a filter in the vena cava to prevent pulmonary embolism.
Pelvic congestion syndrome is characterised by chronic and non-specific pelvic pain and heaviness associated with the presence of ovarian vein varicosities. It can be treated using minimally invasive techniques to address the diseased veins.
When veins don’t function properly they can become varicose causing pain, swelling and skin changes. In advanced cases patients can develop ulcers. Treatment options include wearing stockings, injection sclerotherapy, surgical stripping and ablation using laser and more recently glue.
Poor circulation can cause loss of skin on the leg or foot. Dressings and antibiotics are often not enough to achieve healing. A thorough assessment of the circulation and treatment to address the underlying cause of the ulcer may assist with healing in patients with arterial and venous disease.
Patients with diabetes can develop problems with circulation, the nerves and the immune system. This puts them at risk of developing wounds and infection in the feet. Appropriate foot care can prevent problems. Some patients will however require procedures to improve the circulation.