A vascular surgeon is a medical specialist focused on the diagnosis and treatment of diseases affecting the circulatory system, including the body’s arteries, veins, and lymphatic vessels. Their expertise covers the entire vascular network, excluding vessels supplying the heart and brain. For the lower extremities, these surgeons manage complex conditions that threaten circulation, mobility, and limb viability. This specialized field combines advanced non-operative management with sophisticated endovascular and open surgical techniques to restore proper blood flow.
Diagnosing Vascular Issues in the Legs
The process of care begins with a precise evaluation to determine the cause and extent of circulatory impairment. Vascular surgeons frequently employ the Ankle-Brachial Index (ABI) as a foundational, non-invasive screening tool. This test compares the systolic blood pressure measured at the ankle to the pressure measured in the arm, producing a ratio that indicates the severity of arterial blockage. A ratio below 0.9 suggests the presence of Peripheral Artery Disease (PAD).
Further diagnosis often relies on Duplex Ultrasound, which combines traditional imaging with Doppler technology to visualize vessel structure and measure blood flow in real-time. This technique pinpoints the exact location and degree of arterial narrowing or venous valve dysfunction without using radiation. When detailed anatomical mapping is necessary for procedural planning, a vascular surgeon may order computed tomography angiography (CTA) or magnetic resonance angiography (MRA). These cross-sectional imaging tests provide a high-resolution, three-dimensional view of the arterial tree, confirming the length and complexity of blockages before intervention.
Restoring Arterial Blood Flow
The primary goal of arterial intervention is to increase the flow of oxygen-rich blood to the leg, addressing blockages caused by atherosclerosis, the underlying cause of Peripheral Artery Disease. For less extensive blockages, endovascular procedures offer a minimally invasive approach to revascularization. Angioplasty involves inserting a catheter with a balloon tip into the blocked artery, then inflating the balloon to compress the plaque against the vessel wall and open the channel.
Stenting is frequently performed immediately following angioplasty, deploying a small, expandable metal mesh tube to act as a scaffold and keep the artery patent. Modern techniques, such as drug-eluting balloons or stents, release medication that prevents scar tissue from forming and causing the vessel to narrow again (restenosis). These catheter-based approaches allow for shorter recovery times and are often performed under local anesthesia.
For more complex or lengthy arterial blockages, especially those that failed prior endovascular attempts, a vascular surgeon may perform open bypass surgery. A common example is the femoral-popliteal (fem-pop) bypass, which reroutes blood flow around the diseased segment. This procedure involves sewing a graft, either a harvested segment of the patient’s own vein (autologous graft) or a synthetic tube, to a healthy artery section above the blockage and another below it. The choice between an endovascular procedure and open surgery is dependent on the location, length, and severity of the blockage, as well as the patient’s overall health status.
Treating Venous Disorders
In contrast to arterial disease, venous disorders involve problems with blood flow out of the leg, primarily due to faulty valves that cause blood to pool. Chronic Venous Insufficiency (CVI) and symptomatic varicose veins are managed through specialized, minimally invasive techniques. Endovenous thermal ablation, using radiofrequency (RFA) or laser energy, is a standard treatment for larger, underlying varicose veins. A thin catheter is threaded into the diseased vein and heat is applied, causing the vein to close and seal shut, with blood flow rerouting to healthier veins.
For smaller, superficial varicose veins and spider veins, the surgeon may use sclerotherapy, which involves injecting a liquid or foam chemical solution into the vessel. This sclerosant irritates the vein lining, causing it to collapse and eventually be absorbed by the body. Another option is ambulatory phlebectomy, where the visible sections of varicose veins are removed through tiny incisions using specialized hooks. These procedures are typically done in an outpatient setting under local anesthesia.
Vascular surgeons also manage acute Deep Vein Thrombosis (DVT), a condition where a blood clot forms in a deep leg vein. While most DVT is managed with anticoagulant medication to prevent the clot from growing, a surgeon may intervene for extensive clots. Catheter-directed thrombolysis involves threading a catheter directly into the clot and delivering clot-dissolving drugs over several hours to restore vein patency. In rare, severe cases, a mechanical thrombectomy may be performed to surgically remove the clot.
Limb Preservation and Specialized Wound Care
A significant function of the vascular surgeon is leading specialized “limb salvage” efforts for patients facing the threat of amputation, particularly those with diabetes and advanced PAD. These conditions often result in chronic, non-healing foot ulcers because the tissue lacks the necessary oxygen and nutrients for repair. The surgeon’s primary role in this scenario is to ensure that the underlying blood flow is maximally restored through revascularization procedures.
Without sufficient blood supply, advanced wound dressings and local treatments will fail to achieve healing. Once flow is restored, the vascular surgeon coordinates with a multidisciplinary team, including podiatrists and infectious disease specialists, to manage complex open wounds. This collaborative approach ensures the patient receives surgical debridement to remove dead tissue, infection control, and advanced wound care to facilitate closure. The successful healing of the ulcer, supported by restored circulation, is the ultimate measure of successful limb preservation.