Vascular Surgery

Overview

Vascular surgery encompasses a range of medical procedures, both open surgeries and minimally invasive procedures, aimed at addressing issues related to your blood vessels. The intricate network of arteries, veins, and capillaries that form your circulatory system plays a vital role in transporting blood to and from your heart, providing nourishment to your body’s tissues and organs. Vascular diseases have the potential to harm your blood vessels, increasing the risk of various health complications.

Vascular surgeons are specialized healthcare professionals who diagnose and treat conditions affecting the vessels. While medication and lifestyle modifications can be effective in managing some vascular diseases, there are instances where surgical interventions become necessary to prevent the condition from worsening.

Procedures used in vascular surgery include those that:

• Repair damage to your blood vessels caused by vascular disease.
• Reduce your chance of problems from these diseases.
• Establishing access to your blood vessels for medical procedures like dialysis.

Reasons for undergoing the procedure

Should you suffer from any of the following conditions, you might require vascular surgery:

• Blood clots
• Aortic aneurysm
• Visceral and peripheral arterial aneurysms
• Carotid artery disease
• Peripheral Artery Disease (PAD)
• Mesenteric artery ischemia
• Popliteal Artery Entrapment Syndrome (PAES)
• Renal artery stenosis
• Thoracic outlet syndrome
• Chronic venous insufficiency
• Deep Vein Thrombosis (DVT)
• Varicose veins
• Fibromuscular Dysplasia (FMD)
• May-Thurner syndrome

A vascular surgeon assesses your condition and determines the most appropriate course of action. Some people require both medicine and surgery or other procedures.

Types of vascular surgery

Numerous vascular surgeries and procedures address various problems related to blood vessels. The kind of vascular surgery you require will depend on your particular situation.

Vascular surgery to repair aortic aneurysms

A weak part in your aorta, the largest artery in your body, is called an aortic aneurysm. If an aneurysm is causing symptoms or getting too large, surgery may be necessary to repair it. The purpose of aortic aneurysm repair is to prevent major complications like an aneurysm rupture or dissection.

Aortic aneurysms are repaired by vascular surgeons using the following techniques and procedures:

• Aneurysm surgery (open): A lengthy incision is made in your abdomen or chest by a surgeon. The aneurysm, or damaged section of your aorta, is removed and replaced with a graft, which is a fabric tube. Your aorta receives a new lining from the graft, enabling blood flow to travel through it safely.
• Thoracic Endovascular Aneurysm Repair (TEVAR): Your descending aorta’s thoracic aortic aneurysms are treated with this minimally invasive surgery. Ascending aortic aneurysms now need open surgery to be repaired.
• Endovascular Aneurysm Repair (EVAR): Abdominal aortic aneurysms (AAAs) are treated using this minimally invasive surgery. The section of the aorta that passes through your belly is where these aneurysms develop. EVAR eliminates the need for a lengthy surgical incision by making tiny punctures in your skin. At the location of your aneurysm, your surgeon inserts a stent graft, which is a fabric tube with a metal mesh frame. This stent graft offers blood flow a new route.

Vascular surgery to treat peripheral artery disease (PAD)

The condition characterized by the buildup of plaque within the arteries that provide blood to your arms, legs, or pelvis is referred to as Peripheral Arterial Disease, or PAD. PAD can have a detrimental impact on your overall quality of life, particularly if you encounter symptoms such as intermittent claudication. Additionally, PAD raises the risk of complications, including an increased susceptibility to blood clots and critical limb ischemia, which can manifest as pain at rest, the potential for infected wounds leading to gangrene.

The way vascular surgeons treat PAD is by:

• Endarterectomy: This involves surgically removing plaque from one of your arteries. The femoral arteries, which go from the groin to your leg, can be cleaned of plaque by a femoral endarterectomy. Plaque in the iliac arteries and lower aorta is removed during an aortoiliac endarterectomy to treat aortoiliac occlusive disease.
• Peripheral artery bypass surgery: Your blood flow will have a bypass, or detour, created by a surgeon to get around the obstruction in your artery. In order to create this bypass, your surgeon will use artificial material or a healthy vein from another area of your body. Those with severe PAD benefit from this operation.
• Angioplasty and stenting: One minimally invasive procedure is an angioplasty. It opens up an artery that has narrowed as a result of plaque accumulation. To allow blood to flow through your clogged artery, a surgeon will inflate a little balloon inside of it. In addition, a stent—a wire mesh tube—is frequently inserted to maintain your artery open. A coating on the stent used in drug-coated balloon angioplasty helps keep your artery from narrowing once more.
• Atherectomy: This process is minimally invasive procedure. A surgeon uses a catheter with a blade at the tip to remove plaque from inside your artery. Because it lessens the amount of plaque lining your artery walls, surgeons refer to this procedure as “debulking.” This process could be combined with balloon angioplasty to get your artery ready for the stent to be placed in it.

Vascular surgery to manage problems with your carotid arteries

The condition characterized by the buildup of plaque in the carotid arteries, responsible for supplying blood to the brain, is known as carotid artery disease. This condition is detrimental because the plaque accumulation in these arteries reduces the blood flow to the brain. Vascular surgery is an effective intervention that can lower the risk of serious consequences, such as Transient Ischemic Attacks (TIA) and strokes, by improving blood flow. In cases of carotid artery disease, surgical intervention may be necessary. In case of carotid artery disease, you can require:

• Carotid angioplasty and stenting: Through the use of balloons and stents, your arteries are opened during this treatment, improving blood flow to your brain.
• Carotid endarterectomy: This procedure improves blood flow by removing plaque from your carotid arteries through a neck incision.

Vascular surgeries that treat other problems with your carotid arteries include:

• Carotid body tumor surgery: Masses that develop in blood vessels close to your carotid arteries are known as carotid body tumors. These tumors may compress blood vessels and nerves, resulting in symptoms such as difficulty swallowing and hoarseness. These tumors can be successfully removed surgically, avoiding further problems.
• Carotid artery aneurysm surgery: A carotid artery aneurysm is a bulging carotid artery that increases the risk of a transient ischemic attack (TIA) or stroke. Your blood flow can be safely restored and the aneurysm repaired via open surgery or endovascular stent grafting.

Vascular surgery to treat venous diseases

Blood with low oxygen content is gathered by your veins and returned to your heart. One-way valves in the veins in your legs aid in blood flow upward against gravity, returning blood to your heart. Venous diseases deteriorate the leg vein valves, impairing their normal function. Blood starts to collect in the veins in your legs as a result. You could develop problems (such as blood clots or sores or ulcers caused by venous stasis) as well as symptoms (such as swelling or pain in your legs).

Venous diseases and their aftereffects are treated by vascular surgery. In the event of a venous disease, you can require:

• Endovenous thermal ablation: This is a minimally invasive procedure, a substitute for stripping and ligation. A diseased vein is sealed using a laser or high-frequency radio waves. The vein remains in your leg, but its blood flow has stopped. You can find out if you’re a candidate for this treatment from your surgeon.
• Sclerotherapy: Spider veins and varicose veins are treated using this minimally invasive technique. To seal off your vein, your surgeon will inject a chemical solution into it. The majority of patients with tiny varicose or spider veins benefit most from sclerosing veins.
• Vena cava filter placement: A metal device called a vena cava filter is inserted into your inferior or superior vena cava by a surgeon. These are large veins that return your body’s low-oxygen blood to your heart. The blood then moves to your lungs to take up oxygen. Blood can pass through the filter like a sieve, but any blood clots are caught before they can enter your heart. Individuals with Deep Vein Thrombosis (DVT) benefit from it. It lessens the possibility of a blood clot entering your lungs, or pulmonary embolism. The filter might be temporary (removed by your surgeon when you’re no longer at risk) or permanent.
• Bypass surgery for venous disease: This assists those who have a blocked vein due to severe venous disease. A graft is made by a surgeon from a vein somewhere else in your body that is healthy. They employ this graft to open up a fresh channel for blood to pass through the obstruction.
• Vein ligation and stripping: By excising unhealthy veins, this procedure addresses varicose veins. By reducing symptoms and encouraging venous ulcer healing, it benefits those who suffer from chronic venous insufficiency.

Vascular surgery to treat other conditions

Additional forms of vascular surgery consist of:

• Popliteal Artery Entrapment Syndrome (PAES) surgery: Compression of the popliteal artery in the lower leg is the result of PAES. In order to release the compression on your artery, surgery involves removing a tiny portion of the muscle.
• Renal artery angioplasty and stenting: Renal artery stenosis is slowed down in progression by this minimally invasive technique. Your kidneys receive better blood flow when a narrowed renal artery is widened.
• Thrombolytic therapy: This process, also known as thrombolysis, breaks up blood clots. It can be used by surgeons in critical cases, such as stroke patients. In patients with peripheral artery disease or deep vein thrombosis, they also utilize it to disintegrate blood clots.
• Thoracic outlet syndrome surgery: Thoracic outlet syndrome is characterized by the compression of arteries, veins, and/or nerves in the upper chest. In order to increase blood flow and manage symptoms, you could require surgery if the syndrome damages affects your veins or arteries.
• Dialysis access creation and maintenance: By performing the function that your kidneys would typically perform (removing toxins from your blood), dialysis helps people with renal failure live longer. You must undergo an access site creation operation in order to start dialysis. Your body can connect to a dialysis equipment through this access point, which functions as an artificial kidney. Your surgeon might make an arteriovenous (AV) fistula in order to provide access. Alternatively, they might join an artery and vein with an AV graft. In an emergency, they could temporarily access your veins by inserting a catheter.
• Surgeries and procedures to treat mesenteric ischemia: Reduced blood flow to your digestive organs is known as mesenteric ischemia. To address this issue, you may require either a minimally invasive technique (balloon and stent) or open surgery (such as an endarterectomy or bypass).

Risks

Just like any other surgical procedure, vascular surgery carries significant risks. These risks can vary depending on the specific surgical technique but may include:

• Stroke
• Seizures
• Brain damage
• Blood vessel injury
• Nerve injury
• Bruising, redness or pain
• Hypersensitivity responses to drugs, dyes, or anesthetic
• Heart attack
• Arrhythmia
• Infection
• Bleeding
• Blood clots

Several factors can increase your risk of complications, including:

• Old age
• How serious your illness is.
• The blood vascular blockage’s location.
• A previous stroke history.
• Conditions that coexist, such as diabetes or kidney disease.

Reducing your risk can be achieved by seeking care at a high-volume hospital with a wealth of experience in vascular surgery. It’s essential to have a discussion with your surgeon about their expertise and their track record of results.

Before the procedure

Before your procedure, your surgeon will go over what to expect from them. Depending on the type of surgery you need, preparation can start days or weeks in advance and typically entails tests and a physical examination. You will be informed about the necessary steps to prepare on your own.

Medical history and physical exam

You and your surgeon discuss your symptoms, general health, and previous medical conditions. You’ll talk about any allergies you may have as well as your existing prescriptions.

Testing

Before undergoing vascular surgery, you may need to undergo various tests, which can include:

• Electrocardiogram (EKG)
• Ankle-brachial index
• Echocardiogram (echo)
• Doppler ultrasound
• Angiogram
• Computed Tomography (CT) angiogram
• Magnetic Resonance Angiogram (MRA)

Preparing on your own

Exams and tests are performed by your surgeon. To ensure a good surgery, though, you might have to take care of things on your own. You will receive specific instructions from your surgeon, which you should adhere to. You may learn the following from these instructions:

• What adjustments you ought to make to your regular medicine regimen.
• Which Over-the-Counter (OTC) medications are best avoided.
• The best time to cut back on food or liquids the night before surgery.
• When to give up smoking or vaping (if you need help quitting, consult your surgeon).
• If you have any questions concerning these instructions, speak with your doctor.

During the procedure

The specific procedure you’ll undergo and the nature of your medical condition will dictate the course of your surgery. Your surgeon will provide you with comprehensive instructions and guidance. It’s essential to determine whether your surgery will be performed as an open procedure or a minimally invasive one, as the approach to accessing your blood vessels will be determined by this initial decision.

• Open surgery: In order to immediately access the blood vessel that requires therapy, your surgeon will make a lengthy incision.
• Endovascular surgery: This operation involves minimal invasiveness. Rather than making a large incision, your surgeon makes tiny ones or makes skin punctures. A catheter, or tiny tube, is inserted into an opening and guided to the area that requires medical attention. Recovery is typically less complicated than with open surgery.

Discuss the kind of surgery you require and why you need it with your surgeon.

After the procedure

The aftermath is highly variable and depends on the procedure you had. Procedures such as aneurysm repair surgery necessitate an Intensive Care Unit (ICU) stay. You can drive yourself home the same day after certain operations, like sclerotherapy, which don’t even require a hospital stay.

Discuss with your surgeon your expectations for the hours and days after your procedure. You will receive instructions from your surgeon on how to take care of any incisions and how to take care of yourself.

Outcome

The duration of your recovery is contingent upon the specific procedure you undergo. To gain a better understanding of what to expect, it’s advisable to have a discussion with your surgeon. In general, following the procedure, you may need to refrain from certain activities for a day or two. These activities might include driving a car, climbing stairs, returning to work, and lifting heavy objects.