Atrium Health Navicent Heart & Vascular Care

Vascular Surgery

Doctor stitching up a patients knee

Vascular Surgery in the Field of Vein Disorders and Diseases

Vascular surgery is a narrow surgical field that covers diseases of the vascular system, veins, and arteries, which are dealt with using surgical reconstruction, medical therapy, and minimally invasive catheter placement. This specialty was gradually developed from general as well as cardiac surgery.

Purpose of the Vascular System

The vascular system consists of vessels. Their job is to carry blood throughout the body. The process starts as blood is pumped out of the left side of the heart and to the rest of the body. As the blood begins its journey, it is carried from the heart by the arteries. The blood goes to every cell in the body leaving nutrients needed and picking up carbon dioxide and waste.

On the trip, back the blood travels through the veins making a pass through the liver and kidneys to drop off the waste that was collected. The entire process begins again when the blood returns to the right side of the heart. When a vascular system problem occurs it can interfere with this process.

Abnormalities in the veins and arteries can include bulging, narrowing of the vessel walls, and blockages. When this occurs, the blood cannot circulate correctly. This is very serious if left untreated could result in death. Symptoms are not always obvious so many times people are not aware of vascular system problems.

Vascular System Problems

Vascular surgeons treat diseases of the vascular system except for the brain and the heart. Vascular surgery procedures will vary depending on the type of problem that is being experienced.

Veins and arteries can become blocked with age. They can become more narrow and get thicker and stiffer. This condition is called arteriosclerosis. When plaque and cholesterol build up in medium and large arteries it results in atherosclerosis, which is a form of arteriosclerosis. Peripheral Arterial Disease or PAD occurs when the arteries in the legs narrow.

Peripheral Vascular Surgery

There has been many new and promising developments in vascular surgery procedures. Practically all vascular surgeries today include at least one minimally invasive choice. One example is angioplasty with stent placement for blockage of arteries in the legs or PAD. Tests to determine how much of a blockage there is will be performed beforehand.

This procedure opens blood vessels that have become blocked. A medical "balloon" is used to open up the artery by pressing against the inside wall. Then a metal stent is put in place to keep the artery open. Angioplasty for a blockage in the legs can be done in one of the following places:

  • The artery in your lower leg
  • The artery in your pelvis or hip
  • The artery directly behind your knee
  • The artery in your thigh
  • The aorta or main artery from the heart

Angioplasty is often an alternative for many people and can improve blood flow. This often negates the need for bypass surgery. However, if it does not improve blood flow, bypass surgery is the next step.

Peripheral artery disease is more common among men over age 50, but it does affect women as well. There are certain risk factors that increase the chance of developing this disease. People with a history of cerebrovascular disease, kidney disease, heart disease, diabetes, high cholesterol, smoking, and high blood pressure have a higher risk.

Arterial Embolism

Vascular disease also includes arterial embolisms. One clot or several clots typically cause them, but can also be caused by a piece of plaque. The clots or the plaque forms elsewhere in the body and travels.

Embolism can occur when a clot or plaque blocks the flow of blood. The tissues do not receive oxygen or blood and they become damaged. Arterial emboli usually occur in the feet and legs but can occur in the arms, heart, brain, eyes, intestines, and kidneys.

The following are some of the symptoms associated with arterial embolism in the arms or legs:

  • Muscle pain in the arm or leg
  • Cool feel to fingers or hands
  • The arm or leg may feel cold
  • The arm or leg may look pale in color
  • Legs or arms may feel weak
  • Tingling or numbness in the legs or arms
  • Muscle spasms in the legs or arms
  • A decreased pulse or no pulse in the arms or legs

An arterial embolism is a very serious condition and needs to be treated immediately. A vascular surgeon will need to perform one of the following procedures if medicine does not help or is not an option:

  • Clot removal with surgery (embolectomy) on the artery or by using a balloon catheter.
  • Opening the artery using a balloon catheter, this may require a stent to keep it open.
  • The use of an arterial bypass to reroute the blood.

Vascular surgeons can treat a wide range of problems from aortic aneurysm disease to arterial disease affecting the peripheral vascular system, cerebrovascular occlusive disease, renal artery disease, and varicose veins. Vascular surgery is still based on "operative arterial and venous surgery". There have been many breakthroughs and improvements to methods that were used as late as the 1990s and continuing research assures there will be more to come.