Modern surgery has grown to such an extent that the body of expertise and technical skills needed has led to doctors specializing in specific areas, usually an anatomical area of the body or occasionally in a specific technique or type of patient.
There are 10 surgical specialties and this briefing covers vascular surgery.
What do vascular surgeons do?
Vascular surgery is a specialty managing diseases affecting the vascular system including conditions of arteries, veins and lymphatic vessels. Many patients referred to a vascular specialist don’t require surgical or radiological intervention, but rather reassurance and lifestyle counsel (lose weight, take regular exercise, etc) plus other measures to decrease their future risk of heart disease and stroke (antiplatelet and lipid-lowering therapy, blood pressure control). Also smoking is a major cause of vascular disease and over 80 per cent of vascular patients are current or ex-smokers.
Some referred patients may need further investigation by clinical vascular scientists or radiologists, with a view to interventional radiology treatments such as balloon angioplasty or stenting. Only a small proportion will need surgery.
As many as 50 per cent of patients having vascular disease present urgently or as an emergency, and previously have often been managed by a general surgeon. However vascular surgery has now emerged as a separate specialty from its background as a subspecialty of general surgery.
Patients requiring vascular surgery are ill with from many different vascular disorders that adversely affect quality of life, such as intermittent claudication, varicose veins, lymphatic disorders, hyperhidrosis, thoracic outlet syndrome, vascular malformations and many more. The core activities of the vascular specialist include:
• Preventing death from abdominal aortic aneurysm
• Preventing stroke due to carotid artery disease
• Preventing leg amputation due to peripheral arterial disease
• Symptom relief from peripheral arterial and venous disease
• Healing venous leg ulceration
• Promoting/ Endorsing cardiovascular health
• Improving the quality of life in patients with vascular disease
• Helping colleagues from other specialties with the control of vascular bleeding
• Helping colleagues in the management of the vascular complications of diabetes and renal disease
• Providing a renal access service for patients needing hemodialysis
Among the major procedures undertaken by vascular surgeons are:
• Carotid artery surgery/endarterectomy
• Endovascular aneurysm repair
Endovascular surgery is a fast advancing field, where the surgeon works through a needle puncture and is able to recanalise narrowed or blocked arteries and avoid dangerously dilated arteries from bursting by inserting an artificial artery inside the abnormal segment. Compared to open surgery, endovascular surgery has shown a lot of short-term advantages such as reduced early mortality, length of hospital-stay and quality of life. While issues of long-term durability and cost remain, more research and technological developments may go some way to deal with these challenges.
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