Vascular Surgery

Vascular surgery is the surgical specialty of the circulation outside the heart. Arteries carry blood from the heart to every organ and limb, and veins return it, so problems anywhere along this network can cause pain, loss of function, stroke or, when an aneurysm bursts, life-threatening bleeding. Vascular surgeons diagnose these conditions, manage many of them with medicines and lifestyle changes, and operate when the balance of risk favours it. Their toolkit has two halves. Open surgery repairs or bypasses a vessel directly through an incision. Endovascular surgery works from inside the vessel, passing wires, balloons, stents and stent-grafts through a small puncture under X-ray guidance. Many modern operations combine the two. Cardiac surgery, such as valve repair or coronary bypass, is not part of vascular surgery, and the care of the vessels inside the skull belongs to neurosurgery and neurointerventional teams.

Aortic disease is a core area: aneurysms of the abdominal and thoracic aorta, and dissection, a tear in the aortic wall, are assessed for size, shape and growth to decide whether and how to repair them. Carotid surgery treats narrowing of the neck arteries, a cause of stroke and of brief warning episodes called transient ischaemic attacks. Peripheral arterial disease narrows or blocks the leg arteries, causing cramping pain on walking (claudication) and, in its advanced form, pain at rest, ulcers or gangrene, known as chronic limb-threatening ischaemia. Venous surgery covers varicose veins, chronic venous insufficiency with swelling and skin changes, and venous ulcers. Dialysis access surgery creates and maintains the fistulas and grafts that make kidney dialysis possible. Diabetic foot care brings vascular surgeons together with diabetes, wound and orthopaedic teams, because restoring blood flow is often the key to healing a foot wound.

For an abdominal aortic aneurysm, endovascular aneurysm repair (EVAR) places a fabric-covered stent-graft inside the aneurysm through the groin arteries, while open repair replaces the weak section with a synthetic tube through an abdominal incision. EVAR usually means a shorter stay and faster recovery but needs lifelong imaging checks, whereas open repair is a larger first operation with fewer later procedures. Carotid narrowing is treated by endarterectomy, in which the surgeon opens the artery and removes the plaque, or by stenting in selected patients. Leg arteries are reopened with balloon angioplasty and stents, or bypassed with one of your own veins or a synthetic graft. Varicose veins are closed from inside with heat from a laser or radiofrequency catheter, or with medical glue or foam, through a needle puncture. Dialysis access surgery joins an artery to a vein in the arm so that the vein becomes strong enough for repeated needling.

The first test is often a duplex ultrasound, which shows the vessels and measures blood flow without radiation or dye; it is used for carotid, leg artery and vein assessment and for planning dialysis access. The ankle-brachial index compares blood pressure at the ankle and the arm to measure leg circulation. CT angiography gives a detailed three-dimensional map of the aorta and arteries and is essential for planning aneurysm repair and sizing a stent-graft, with MR angiography as an alternative in some cases. Digital subtraction angiography, performed during a procedure, shows the vessels in fine detail and allows treatment in the same session. Many teams operate in a hybrid operating room, where open and endovascular steps can be combined without moving the patient. Because contrast dye can strain the kidneys, kidney function is checked before CT angiography and before any procedure that uses dye.

Start by sending your duplex ultrasound or CT angiography images and reports, a summary of your medical history, your heart and kidney test results and a list of your medicines, especially blood thinners. A remote review lets the team say whether you are likely to need an open or an endovascular approach and how long to plan for. Before an arterial operation, heart and lung fitness are checked, because many people with vascular disease also have heart disease. Varicose vein treatment is usually day-case, with walking encouraged the same day and compression stockings for a short period. After EVAR or carotid surgery, plan about one to two weeks nearby before flying, and longer after open aortic surgery or a leg bypass. Long-term follow-up, such as imaging after EVAR, can usually be arranged near home, with the reports shared with the team.