Vascular surgeons diagnose and help people manage conditions that affect circulation, including diseases of the veins and arteries.

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 preventative role. They can advise people on adopting a healthy lifestyle and prescribe medication to minimize the risks of stroke and heart attack.

Read on for more information about 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, also called 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 the doctor performs tests on a person and finds significant blockages that are likely to cause a stroke, they may perform the surgery preventatively.

Carotid endarterectomy does not cure the disease 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.

What does it involve?

During a carotid endarterectomy:

  • A person will usually receive general anesthesia, although some hospitals use local anesthesia. In this case, the part of the body doctors are working on will be numbed, and they will likely give the person sedatives.
  • A person will lie on their back on the operating table with their head turned to one side to reveal their blocked carotid artery.
  • 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.
  • The surgeon will open the artery and remove the plaque.
  • The surgeon will close the artery with stitches and usually a patch.

How long does recovery take?

After surgery, a person may stay in the hospital for 1 or 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 need to take medication to prevent clots from forming.

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

What is it?

There are two major techniques to perform lower limb revascularization.

Traditionally, doctors perform surgery via incisions in the leg. During this procedure, doctors either 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 flow to the legs and feet.

Alternatively, doctors are using 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 are able to 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. This helps lessen pain for the person and stops tissue from decaying due to PAD. The procedure 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 large 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. The doctor 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. The doctor will then extend the graft inside the aneurysm. They will attach the graft to the blood vessel. When 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, such as pain and discomfort, and to treat complications such as swelling, discoloration, and leg ulcers.

What does it involve?

During these procedures:

  • A doctor will use general or local anesthesia. This prevents the person from feeling pain during the procedure.
  • A doctor will make a small incision and insert laser fiber or a catheter, depending on the procedure.
  • The doctor activates a device (with either EVLT or RFA) to heat up the targeted vein and cause it to collapse.
  • 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, the person should elevate their legs to reduce swelling.

How long does recovery take?

Most people can return to walking within a 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 causes 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 turn black and die, which is called 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 general anesthesia 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 having a prosthetic limb fitted, 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 last resort. This involves surgically removing a limb or part of a limb.