Vascular Surgery

Modern surgery has developed to such an extent that the body of knowledge and technical skills required have led to surgeons specialising in particular areas, usually an anatomical area of the body or occasionally in a particular technique or type of patient.

There are ten surgical specialties and this briefing covers vascular surgery.

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 in the UK 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
Endovascular aneurysm repair
Thrombectomy

Developments

Endovascular surgery is a rapidly advancing field, where the surgeon works via a needle puncture and is able to ‘recanalise’ 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.