Vascular Surgery

The surgical specialty which deals with disorders of the circulatory system, including those of the arteries, veins and lymphatic vessels, is called vascular surgery. These specialists treat varying conditions, such as aneurysms and atherosclerosis.

Aneurysms are abnormal dilations in vessel walls, while atherosclerosis refers to narrowing/hardening of the arteries. Vascular surgeons are specially trained to repair blood vessels in nearly all parts of the body, with the exception of the brain and heart. They also deal with peripheral vascular disorders like ulcers on the lower extremities and poor circulation. Surgical approaches to vascular repair may be endovascular (i.e. closed) or open surgery.

Endovascular surgery

Procedures that fall under the umbrella of endovascular surgery include thrombolytic catheter therapy, angioplasties and stenting. Angioplasty may be done with or without stenting, and is a minimally invasive operation conducted to improve the passage of blood through the affected veins and arteries.

Typically, an imaging technique, like fluoroscopy, is required to guide a catheter with a balloon tip into the vessel and advance the tip toward the blockage or narrowing in the artery. Once at the site of interest, the balloon is inflated in order to open up the vessel. Once the vessel is opened, the balloon is deflated and withdrawn.  

If stenting is done during angioplasty, then a minute wire tubular mesh is inserted in the area of the vessel that has been dilated with the balloon. This allows for the vessel to remain open. Angioplasty is performed in conditions such as atherosclerosis, peripheral artery disease, narrowing of the kidney arteries, coronary artery disease and carotid artery stenosis, among others.

Major complications associated with angioplasty are fairly rare. However, risks include infection, stroke, and heavy bleeding. If contrast material is used to conduct the procedure, there is a risk of renal toxicity and impaired renal function.

Thrombolytic catheter therapy is a minimally invasive method to dissolve blood clots in vessels, thereby preventing damage to vital organs and tissues due to the impedance of blood flow. In this procedure X-rays are used to guide a catheter inserted through the skin into a blood vessel where it is advanced until it reaches the area where the clot has formed or is lodged.

Contrast material is used to pinpoint the exact site of the blood clot. The clot may then be dissolved with the use of pharmacotherapy and/ or mechanical devices, which are quicker-acting than the former.

Other procedures done under the auspices of endovascular surgery include the insertion of filters in the vena cava and endoluminal stenting. Vena cava filters are small mechanical devices that are positioned in the vena cava with the purpose of preventing large blood clots that have formed within the deep veins of the legs from travelling into the pulmonary arteries. Clots reaching the arteries of the lungs may cause pulmonary embolism, which is a life-threatening condition.

Aneurysms of the aorta as well as aortic dissections may be treated with the use of endoluminal stent grafts. This requires the placement of a reinforcing tube within the affected parts of the artery.

Open vascular surgery

Open vascular surgery includes techniques that are concerned with direct vessel repair by means such as suturing the vessel to stop leakage or bleeding. Endarterectomy is another open vascular surgical operation that is concerned with the removal of plaques from the wall of the blood vessel.

The procedure is most commonly performed on the carotid artery situated in the neck, with the hope of reducing the incidence of stroke in the patient due to narrowing of the artery. Ironically, however, the procedure itself may precipitate a stroke during the operation. This does not, however, outweigh the potential benefit in high-risk patients.

Another open vascular surgical procedure is bypass surgery, which uses synthetic or natural grafts to re-route the flow of blood through a vessel. This re-routing is often necessary due to blockage. Bypass surgeries do not seek to remove the block from the vessel or cure the disease responsible for it.

They function primarily in the capacity of vessel detours. The prognosis after treatment, as it pertains to the bypass, is dependent on factors, such as the overall health of the patient and the condition of the arteries. More importantly, the type of graft used is a determining factor. Natural grafts generally last longer than their synthetic counterparts.

Reviewed by Liji Thomas, MD

References

  1. http://www.nuhcs.com.sg/wbn/slot/u1748/Patients_and_Visitors/Patient%20Education%20Brochures/vascular10.pdf
  2. https://www.radiologyinfo.org/en/info.cfm?pg=angioplasty
  3. https://www.radiologyinfo.org/en/info.cfm?pg=thrombo
  4. https://vascular.org/patient-resources/vascular-treatments/surgical-bypass

Further Reading

Last Updated: Apr 4, 2017

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