Vascular Surgery

A vascular surgeon is a surgeon who specialsies in managing conditions that affect the blood vessels. Their area of expertise is in performing operations to improve the circulation of blood around the body.

Medical Conditions

Peripheral vascular disease
Arteries carry blood from the heart to the rest of the body. Atherosclerosis is the process where these vessels become narrowed and blocked by fatty cholesterol deposits. As the vessels narrow people may get pain in a limb when they excercise it. A patient with a narrowed leg artery may get calf pain when they walk. This is called intermittent claudication.
As these narrowings worsen, pain may occur at rest.
Finally if an artery blocks completely the part of the body supplied by that artery may be irreversibly damaged. If this occurs to a limb it will become pale, pulseless, cold, numb and paralysed.
Vascular surgeons specialise in treating these narrowings.
Aneurysms
Some blood vessels, particularly arteries bulge and may even burst like a balloon. These localised arterial bulgings are called aneurysms.
Leg ulcers
Leg ulcers are often associated with poor blood supply. They may become infected and require surgical treatment. Again vascular surgeons specialise in this.
Venous disease.
Veins carry blood from the peripheries back to the heart. Problems with veins include bulging - varicose veins and vascular surgeons can operate to repair or remove these abnormal veins.
Abdominal aortic aneurysm
Buerger’s disease
Carotid artery disease
Critical limb ischaemia
Deep vein thrombosis
Peripheral vascular disease
Raynaud’s phenomenon
Renovascular hypertension
Varicose veins
Vascular malformation

Specialty Areas of Interest

Angiography, angioplasty and stenting
Carotid surgery
Peripheral vascular disease
Diabetic ulcers
Peripheral venous disease

Associated Tests

Angiography
An angiogram is a picture of blood vessels.
Usually a needle is placed into the upstream end of a blood vessel and radio-opaque contrast injected. The blood carries the contrast into the vessel and an image (X-Ray or CT scan) is taken. The lumen of the vessels is outlined and one can determine where narrowings lie.
Ultrasound
Ultrasound is a noninvasive, painless way of getting information about blood flow within vessels. The information may supplement that provided by the angiogram.
Ankle brachial indices

Procedures

Angioplasty
This involves unblocking a narrowed or blocked blood vessel.
Generaly a wire is passed through the narrowing in the artery. A small deflated balloon is then threaded over the wire to the site of maximal narrowing. It is inflated when in the narrowest section and this opens up the vessel.
Stenting
This involves a similar procedure except that a tiny wire cage is place over the balloon as it is passed into the area of greatest narrowing. As the balloon is inflated it expands the cylindrical wire cage and this holds the vessel open after the balloon is deflated and removed.
Embolectomy
This involves removing a clot from within a blood vessel. It is usally an open surgical technique.
Bypass operation
When a vessel is irreversibly narrowed or blocked a surgical bypass is often performed. A new segment of vessel (often a vein or another artery) is attached to the original vessel at either side of the narrowing and literally bypasses the blockage.

What to expect

History

A vascular surgeon will ask questions about your symptoms - what problems you are getting. They should ask about risk factors for vascular disease (like smoking, high blood pressure, diabetes, high cholesterol and a family history of vascular disease).

Examination

A vascular surgeon will generally examine your blood vessels, feeling for pulses, checking blood pressure and looking for evidence of vascular disease.