What do vascular surgeons do?

Vascular surgery is a specialty dealing with diseases affecting the vascular system including diseases of arteries, veins and lymphatic vessels. Many patients referred to a vascular specialist do not require surgical or radiological intervention, but rather reassurance and lifestyle advice (lose weight, take regular exercise) coupled with measures to reduce their future risk of heart disease and stroke (antiplatelet and lipid-lowering therapy, blood pressure control). Additionally smoking is a major cause of vascular disease and over 80 per cent of vascular patients are current or ex-smokers.

Some referred patients require further investigation by clinical vascular scientists or radiologists, with a view to interventional radiology treatments such as balloon angioplasty or stenting. Only a small proportion will require surgery.

As many as 50 per cent of patients with vascular disease present urgently or as an emergency, and in the past have often been managed by a general surgeon. However vascular surgery has now emerged as a separate specialty from its background as a subspecialty of general surgery.

Patients requiring vascular surgery suffer from many different vascular disorders that adversely affect quality of life, such as intermittent claudication, varicose veins, lymphatic disorders, hyperhidrosis, thoracic outlet syndrome, vascular malformations and many more. The core activities of the vascular specialist include:

  • Preventing death from abdominal aortic aneurysm
  • Preventing stroke due to carotid artery disease
  • Preventing leg amputation due to peripheral arterial disease
  • Symptom relief from peripheral arterial and venous disease
  • Healing venous leg ulceration
  • Promoting cardiovascular health
  • Improving quality of life in patients with vascular disease
  • Assisting colleagues from other specialties with the control of vascular bleeding
  • Assisting colleagues in the management of the vascular complications of diabetes and renal disease
  • Providing a renal access service for patients requiring haemodialysis

Main operations

Among the main procedures undertaken by vascular surgeons are:

  • Carotid artery surgery/endarterectomy
  • Open aneurysm repair and open vascular bypass repair
  • Thrombectomy

Developments

Endovascular surgery is a rapidly advancing field, where the surgeon works via a needle puncture and is able to ‘recanalize’ narrowed or blocked arteries, and prevent dangerously dilated arteries (aneurysms) from bursting by inserting an artificial artery inside the abnormal segment. Compared to open surgery, endovascular surgery has shown many short term advantages such as reduced early mortality, length of hospital stay and quality of life. While issues of long term durability and cost remain, further research and technological developments may go some way to address these challenges.

Haemodialysis Access

The following are two methods of haemodialysis access.

AV fistula: A method of haemodialysis access in which a piece of a vein is taken from the arm or leg and sewn into a nearby artery. The sewn-in vein eventually enlarges, becoming stronger and thicker.

AV graft:  A method of haemodialysis access in which a prosthetic graft is sewn between an artery and vein in the arm or leg.

Surgical Options

For many vascular patients, surgery is the medical option that best meets their needs. Our vascular surgeons perform a wide range of procedures with the goal of achieving the best patient outcomes.

Open Abdominal Aortic Surgery

This open surgery involves an abdominal incision to gain access to the abdominal aorta. For aneurysms, the aneurysm is opened and a fabric graft is sutured into the proximal and distal ends of the aorta and fixed into place. The dilated portion of the aorta is then closed over the graft. For patients with blockages in the aorta or iliac vessels, a graft is sewn in to redirect blood around the areas of blockage.

  • Abdominal aortic aneurysms.
  • Aorto -iliac occlusive disease.

Bypass Surgery

A surgical procedure to redirect blood flow around an area of blockage. The procedure creates an alternate channel for blood flow, bypassing an obstructed or damaged vessel. The graft may come from a healthy section of the patient’s own vein, or a synthetic material may be used. Bypass grafting is a treatment for the following conditions:

  • Vertebrobasilar disease.
  • Peripheral Arterial Disease (PAD)
  • Renal Vascular Disease
  • Mesenteric Vascular Disease

Open Carotid and Femoral Endarterectomy

This procedure involves the surgical removal of plaque build-up on the inner lining of the artery. Endarterectomy is a treatment for the following conditions:

  • Cerebrovascular disease
  • Peripheral Arterial Disease (PAD)
  • Vertebrobasilar Disease

Thoracic Outlet Surgery OR Cervical Rib surgery.

This is an open surgical procedure to decompress the thoracic outlet in patients with neurogenic, venous or arterial thoracic outlet syndrome.

Thoracic Outlet Syndrome