Vascular surgery is a medical specialty devoted to the diagnosis and treatment of diseases affecting the vascular system—the body’s network of arteries, veins, and lymphatic vessels. This field addresses conditions impacting circulation throughout the entire body, excluding the coronary arteries of the heart and the intracranial arteries within the brain. Vascular surgeons manage these conditions using a full spectrum of approaches, including medical therapy, traditional open surgical reconstruction, and minimally invasive endovascular techniques. The goal is to restore healthy blood flow, prevent serious complications like stroke or limb loss, and improve a patient’s overall quality of life.
Arterial Blockages and Flow Restriction
Conditions involving a reduction or complete blockage of blood flow within the arteries are a primary focus of vascular surgeons. This flow restriction is caused by atherosclerosis, a chronic process where plaque builds up inside the arterial walls, causing them to harden and narrow. This narrowing leads to ischemia, a lack of oxygen supply to the tissues downstream from the blockage.
One of the most common manifestations is Peripheral Artery Disease (PAD), which typically affects the arteries supplying the legs, causing pain during walking known as claudication. Advanced PAD becomes Critical Limb Ischemia (CLI), a severe condition characterized by rest pain, non-healing wounds, or tissue death (gangrene) in the extremities. Intervention is often required to salvage the limb and prevent amputation.
Vascular surgeons employ various methods to restore flow. Minimally invasive approaches involve passing a catheter through a small puncture to perform angioplasty, where a balloon is inflated to compress the plaque. This is frequently followed by the placement of a stent, a small mesh tube left permanently in the artery to keep the vessel open.
For more extensive blockages, open surgical options include an endarterectomy, which involves surgically opening the artery to scrape out the plaque lining. Alternatively, bypass surgery uses a natural vein or a synthetic graft sewn in to reroute blood flow around the diseased segment.
The same atherosclerotic process can affect the carotid arteries in the neck, the main vessels supplying blood to the brain. Carotid Artery Disease is important because plaque instability or severe narrowing can lead to a stroke. Treatment options include carotid endarterectomy (open surgical removal of plaque) or carotid artery stenting (a catheter-based approach to dilate the artery and place a stent).
Vascular Wall Weakness and Aneurysms
A major category of arterial disease treated by vascular surgeons involves the weakening and subsequent ballooning of the arterial wall, known as an aneurysm. Unlike blockages, aneurysms present a danger of rupture, which can cause life-threatening internal bleeding. These weakened areas occur most frequently in the aorta, the body’s largest artery, leading to Abdominal Aortic Aneurysms (AAA) or Thoracic Aortic Aneurysms (TAA).
The decision to repair an aneurysm is based on its size and growth rate, as larger aneurysms carry a greater risk of rupture. Repair aims to reinforce the vessel wall and divert blood flow away from the diseased segment. Traditional open repair involves a large incision to surgically remove the damaged section of the aorta and replace it with a synthetic fabric graft sewn into place.
A less invasive alternative is Endovascular Aneurysm Repair (EVAR) or Thoracic Endovascular Aortic Repair (TEVAR). This procedure uses small incisions to pass a catheter-based stent graft—a fabric tube supported by a metal frame—through the vessel and deploy it inside the aneurysm. The stent graft creates a new inner lining for the artery, relieving pressure and sealing off the aneurysm sac. Vascular surgeons also treat peripheral aneurysms, such as those found behind the knee.
Venous System Disorders
Vascular surgeons manage conditions of the venous system, which returns deoxygenated blood from the body back to the heart. These disorders affect the low-pressure side of the circulatory system. One acute condition is Deep Vein Thrombosis (DVT), the formation of a blood clot within a deep vein, most commonly in the legs.
If a DVT is extensive or causes severe symptoms, a vascular surgeon may perform a thrombectomy (removal of the blood clot), sometimes using catheter-directed medication to dissolve the clot. Chronic Venous Insufficiency (CVI) develops when vein valves become damaged, allowing blood to flow backward and pool in the legs. This reflux causes symptoms like swelling, skin changes, and the development of varicose veins.
Initial management for CVI and varicose veins includes conservative measures such as wearing compression stockings. When symptoms persist, minimally invasive procedures close off the faulty veins. Techniques like endovenous thermal ablation use heat to seal the affected vein, rerouting blood to healthy vessels. For smaller veins, sclerotherapy (liquid or foam injections) may be used, while surgical ligation and stripping involve removing or tying off the varicose vein entirely.
Specialized Vascular Access and Interventions
Vascular surgeons possess the technical skills for several specialized procedural interventions, including the creation and maintenance of dialysis access for patients with kidney failure. This is accomplished by surgically connecting an artery and a vein (often in the arm) to create an arteriovenous (AV) fistula or by using a synthetic tube to create an AV graft.
These access points provide the high, continuous blood flow required for hemodialysis treatments. Surgeons manage complications with these sites, such as blockages or infections, ensuring ongoing treatment proceeds smoothly.
In the acute care setting, vascular surgeons manage vascular trauma or injuries sustained in accidents. These urgent interventions focus on rapid hemorrhage control and the repair of damaged arteries and veins. They utilize both open surgical techniques and endovascular methods to address injuries like lacerated vessels or blunt aortic trauma.