Vascular surgeons diagnose and help people manage conditions that affect circulation, including diseases of the veins and arteries. Types of vascular procedures include carotid artery surgery, lower limb revascularization, and more.

They treat all parts of the vascular system, excluding the brain and heart.

Doctors may be able to treat many vascular conditions without surgery or invasive procedures. Vascular surgeons often take on a preventive role. They can advise people on adopting a healthy lifestyle and prescribe medication to minimize the risk of stroke and heart attack.

In this article, we discuss carotid artery surgery, lower limb revascularization, endovascular repair of aortic aneurysms, treatment of varicose veins, and limb amputations.

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Carotid artery surgery, or carotid endarterectomy, is a procedure that doctors use to treat carotid artery disease.

What is it?

The carotid artery transports blood to the face and brain. A person has one of these arteries on each side of their neck.

Blood flow in these arteries can become partially or completely blocked by plaque, which is a buildup of fatty material or calcium. This can cause a stroke either by reducing the flow of blood to the brain or, more commonly, by breaking loose and traveling to a part of the brain.

A doctor may perform carotid artery surgery to restore blood flow to the brain.

Why do doctors perform it?

A doctor will perform this surgery to restore normal blood flow to the brain to prevent a stroke if a person already has symptoms of reduced blood flow.

If a person is undergoing tests, and the doctor finds significant blockages that are likely to cause a stroke, they may perform the surgery preventively.

Carotid endarterectomy does not cure the condition that causes blocked arteries. The arteries can become blocked again if an underlying health condition, such as high cholesterol, is not properly managed and treated.

A vascular surgeon will perform this surgery to restore normal blood flow to the brain to prevent a stroke. Research found that, in properly selected patients, long-term stroke rates were lower after a person underwent carotid endarterectomy.

This may be necessary if the degree of narrowing exceeds 70%. Less frequently, doctors may recommend it if there are symptoms with over 50% stenosis.

Many patients whom doctors consider for carotid surgery have significant comorbidities that can affect the surgery outcome. It is therefore necessary to carry out a careful preoperative assessment, especially with regard to heart function.

Surgery poses significant risks that doctors need to carefully weigh against the risk of nonoperative management. While the aim of the surgery is to reduce the likelihood of a stroke, the surgery itself carries a risk of stroke.

Although national risk of stroke is commonly between 2 and 3% in people with no symptoms prior to surgery, and up to 5–7% in individuals with symptoms, centers and surgeons with better results are not uncommon, according to the Vascular Quality Initiative.

It can be worthwhile to ask about specific stroke rates before proceeding.

Additional risks of surgery to consider include:

What does it involve?

During a carotid endarterectomy, the following takes place:

  1. A person will usually receive general anesthesia, although some hospitals use local anesthesia. In this case, doctors will numb the part of the body they are working on, and they will likely give the person sedatives.
  2. A person will lie on their back on the operating table, with their head turned to one side to reveal their blocked carotid artery.
  3. The surgeon will make an incision into the person’s neck over the carotid artery and may place a flexible tube called a shunt into the artery. Blood will flow through the shunt around the blocked area.
  4. They will open the artery and remove the plaque.
  5. They will close the artery with stitches and usually a patch.

How long does recovery take?

After surgery, a person may need to stay in the hospital for 1–2 days and should expect to take a few weeks for a full recovery.

Their neck may be painful for a few days, and they may find it hard to swallow. They might also need to take medication to prevent clots from forming.

Doctors perform lower limb revascularization to treat peripheral artery disease (PAD), a condition that affects over 200 million people.

What is it?

There are two major techniques to perform lower limb revascularization.

Traditionally, doctors perform this surgery via incisions in the leg. During the procedure, doctors use one of the person’s own veins or an artificial vein to create an alternative conduit for blood flow. This relieves the blockage due to plaque and restores blood flow to the legs and feet.

Alternatively, doctors use less invasive endovascular techniques more frequently to avoid long incisions. They may use one of the following to open up blood flow:

  • balloons
  • stents, which are metallic mesh tubes that hold the blood vessel open
  • atherectomy devices, which can remove plaque in the blood vessels through smaller tubes

Doctors may sometimes use a combination of these techniques.

Why do doctors perform it?

Doctors perform this procedure for people with blood flow occlusion, which refers to a blockage or closing of the artery.

The procedure helps lessen pain and stops tissue from decaying due to PAD. It also restores blood flow to the legs and feet.

What does it involve?

A doctor will perform a bypass, which means they will reroute the flow of blood around the blocked arteries in the leg.

The doctor may use the person’s own vein or an artificial bypass graft. This will restore blood flow to the person’s legs and feet.

How long does recovery take?

A person may need to spend 3–5 days in the hospital and can take 2–4 weeks to fully recover.

However, if the surgeon uses long incisions for the surgery, this can result in longer recovery times.

Endovascular repair is a procedure to fix an aortic aneurysm, which is a big bulge in the aorta, the large artery that transports blood from the heart through the chest and torso.

What is it?

Endovascular repair is a minimally invasive procedure that may require either general or local anesthesia.

The procedure involves a doctor repairing the aneurysm from the inside of the aorta.

Why do doctors perform it?

A doctor may perform the procedure if the aneurysm is at risk of bursting open, or rupturing. If an aortic aneurysm is large and causes symptoms or is rapidly growing, it is at risk of rupturing.

What does it involve?

A doctor may make one or two small incisions in the groin area and insert catheters into the arteries. They will then add dye into the arteries, which will cause the aorta to show up on an X-ray during the procedure.

The doctor will use the catheters to move a tube, called a stent graft, through the arteries until it reaches the aorta. They will then expand the graft inside the aneurysm. Next, they will attach the graft to the blood vessel. Once the graft is in place, the doctor will remove the catheters and stitch the incision areas closed.

When the procedure is complete, blood will flow through the stent graft in the aorta without putting pressure on the aneurysm.

How long does recovery take?

A person may spend around 1–5 days in the hospital.

If a person’s varicose veins cause discomfort, a doctor may recommend treatment.

What is it?

Doctors may recommend endovenous laser therapy (EVLT) or radiofrequency ablation (RFA) to collapse the affected veins. These less invasive procedures are an alternative to the traditional vein stripping surgery.

Why do doctors perform it?

Doctors perform these procedures to ease symptoms of varicose veins, including pain and discomfort, and to treat complications such as swelling, discoloration, and leg ulcers.

What does it involve?

During these procedures, the following takes place:

  1. A doctor will use general or local anesthesia. This prevents the person from feeling pain during the procedure.
  2. The doctor will make a small incision and insert laser fiber or a catheter, depending on the procedure.
  3. They will then activate a device with either EVLT or RFA to heat up the targeted vein and cause it to collapse.
  4. Additional procedures to remove remaining varicose veins or to tie off the source of the varicose veins may be necessary.

After the procedure, the person will need to wear compression stockings and take regular walks. When not walking, they should elevate their legs to reduce swelling.

How long does recovery take?

Most people can return to walking within 1 day.

Doctors may consider limb amputations as a last resort when other treatments have not worked.

What is it?

Amputation refers to the surgical removal of part of the body, such as an arm or leg.

Why do doctors perform it?

A person may require a vascular-related amputation if they have an advanced case of PAD, which causes a buildup of plaque in the artery wall and results in a blockage of blood flow to the limb.

If a person has both PAD and diabetes, they are at an increased risk of amputation.

Amputation can become necessary when the sores do not heal or when they turn black and die, which health experts refer to as gangrene. This becomes an emergency if an infection is also present.

Sometimes, amputation is the only cure for intractable pain caused by poor blood flow when all other attempts to restore blood flow have been unsuccessful.

What does it involve?

A doctor will typically perform the surgery using either general or spinal anesthesia.

The doctor will make an incision to allow sufficient healthy tissue to cover and protect the amputation stump. Then, they will remove the limb or part of the limb and close the stump with stitches.

When the doctor closes the stump, they may place an internal drain to collect fluid or blood, which they will later remove.

How long does recovery take?

The length of time a person takes to recover depends on the type of amputation they have had, as well as their general state of health. Full recovery — including physical rehabilitation and a prosthetic limb fitting, if necessary — may take some time.

However, incisions should heal in about 4–8 weeks.

Vascular surgeons treat a variety of conditions involving the vascular system.

Some of the most common procedures they perform are carotid artery surgery, lower limb revascularization, endovascular repair of aortic aneurysms, and treatment of varicose veins.

Limb amputation is a procedure that vascular surgeons may use as a final resort. This involves surgically removing a limb or part of a limb.