Vascular surgery is a specialized field focused on diagnosing and treating diseases affecting the body’s vascular system—the network of arteries, veins, and lymphatic vessels. This discipline manages all blood vessels outside of the immediate heart and brain structures, distinguishing it from cardiac surgery. Vascular surgeons utilize a range of therapies, from medical management to complex surgical reconstruction and minimally invasive procedures. When blood flow is compromised by disease, a vascular surgeon’s expertise is often needed to prevent severe complications like stroke or limb loss.
The Scope of Vascular Surgery
The vascular system comprises three main structures that fall under this specialty. Arteries carry oxygenated blood away from the heart to nourish tissues, while veins return deoxygenated blood back to the heart and lungs. The lymphatic system, a network of vessels and nodes, manages fluid balance and immune function.
The primary goal of vascular intervention is to restore and maintain adequate blood flow. When arteries are blocked or weakened, or when veins fail to return blood efficiently, the health of the limb or organ system is at risk. Interventions prevent critical consequences, such as severe tissue damage (critical limb ischemia) or the life-threatening rupture of an abnormally enlarged vessel.
Common Conditions Treated
A number of common diseases require the attention of a vascular surgeon, typically involving the narrowing, blockage, or weakening of blood vessels.
Peripheral Artery Disease (PAD)
PAD is characterized by the buildup of fatty plaque (atherosclerosis) in the arteries supplying the limbs, most often the legs. This plaque narrows the vessels, restricting blood flow. Symptoms include painful cramping during exercise (claudication) or non-healing wounds on the feet.
Abdominal Aortic Aneurysm (AAA)
An AAA is an abnormal ballooning and weakening of the wall of the aorta as it passes through the abdomen. An aneurysm develops silently, and its danger lies in the risk of rupture, which leads to massive internal bleeding and is frequently fatal. Intervention is necessary when the aneurysm reaches a size that poses a significant risk of bursting.
Carotid Artery Disease
This condition involves the narrowing of the carotid arteries in the neck, which supply blood directly to the brain. Plaque buildup here can lead to pieces breaking off and traveling to the brain, causing a transient ischemic attack (TIA) or a stroke. Surgery is often indicated to remove this plaque and reduce the risk of a future stroke.
Venous Conditions
The venous system is susceptible to conditions like Chronic Venous Insufficiency and Deep Vein Thrombosis (DVT). Chronic venous insufficiency occurs when leg vein valves fail, allowing blood to pool and flow backward, causing swelling, skin changes, and ulcers. DVT involves a blood clot in a deep vein, which can be life-threatening if it detaches and travels to the lungs (pulmonary embolism).
Traditional Open Procedures
Before widespread catheter-based techniques, open surgery was the standard for treating most vascular diseases. These traditional methods involve a larger incision to gain direct access to the diseased vessel, requiring general anesthesia. Although more invasive, these procedures remain the standard for complex cases, extensive disease, or emergencies like a ruptured aneurysm.
Bypass Grafting
Bypass grafting reroutes blood flow around an arterial blockage, especially for severe PAD. The surgeon creates a new path using a segment of the patient’s own vein or a synthetic graft material. This graft connects the artery above the blockage to the artery below it, allowing blood to flow freely and restoring circulation to the limb.
Endarterectomy and Aneurysm Repair
Endarterectomy is frequently performed on the carotid artery to prevent stroke. The surgeon makes an incision into the artery and carefully peels away the inner lining containing the atherosclerotic plaque. Once the obstructing material is removed, the artery is closed to restore the full diameter of the vessel. Open aneurysm repair involves surgically removing the weakened segment of the aorta and replacing it with a durable synthetic tube graft.
Minimally Invasive Endovascular Techniques
Modern vascular surgery has been revolutionized by minimally invasive endovascular techniques, performed through small punctures rather than large incisions. These procedures utilize specialized catheters, wires, and devices guided by real-time imaging, such as fluoroscopy, to treat the vessel from within the bloodstream. This approach results in less pain, shorter hospital stays, and quicker recovery times.
Angioplasty and Stenting
Angioplasty and stenting are frequent endovascular interventions used to treat narrowed arteries caused by plaque. A catheter with a small balloon is threaded to the blockage site and inflated to compress the plaque and widen the vessel. A wire mesh tube called a stent is often deployed afterward to act as a scaffold, keeping the artery open.
Endovascular Aneurysm Repair (EVAR)
EVAR is a minimally invasive alternative to open surgery for aneurysms. The surgeon inserts a stent graft—a fabric tube supported by a metal frame—through small groin incisions and positions it inside the aneurysm. The stent graft reinforces the weakened vessel wall, diverting blood flow through the graft and reducing pressure on the aneurysm sac, preventing rupture.
Clot Removal Techniques
For acute blockage due to blood clots, surgeons may perform thrombolysis or thrombectomy. Thrombolysis involves the targeted delivery of clot-dissolving medication directly into the clot via a catheter. Mechanical thrombectomy uses specialized devices to physically capture and remove the clot. These techniques manage acute DVT or sudden arterial occlusions, rapidly clearing the vessel and saving the affected limb.