Vascular Surgery

Vascular surgery is a specialty dealing with diseases affecting the vascular system including diseases of arteries, veins and lymphatic vessels.

Many patients referred to a vascular specialist do not require surgical or radiological intervention, but rather reassurance and lifestyle advice (smoking cessation, regular exercise) coupled with measures to reduce their future risk of heart disease and stroke (antiplatelet and lipid-lowering therapy, blood pressure control). Advance care planning is central to this due to the recognition that the prognosis of critical limb threatening ischaemia (CLTI) is poor, with over half of patients dead at three years, and many patients are frail, or have significant co-morbidity (cardiac, respiritory and cancer).

Over 80 per cent of vascular patients are current or ex-smokers.

Increasingly vascular surgeons are managing complications of diabetic foot disease. This is likely to increase as obesity and diabetes become more prevalent.  Many people with vascular disease present urgently or as an emergency, and require time-critical management of sepsis (for the diabetic foot) or revascularisation (acute or chronic limb ischaemia).

Vascular surgeons also reduce the risk of recurrent stroke in people with symptomatic carotid artery stenosis by offering carotid endarterectomy.

Patients requiring vascular surgery suffer 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:

• Preventing death from aortic aneurysm and acute aortic syndrome.
• Preventing stroke due to carotid artery disease
• Preventing leg amputation due to peripheral arterial disease or diabetic foot sepsis
• Symptom relief from peripheral arterial and venous disease
• Healing venous leg ulceration
• Promoting cardiovascular health
• Surgery for thoracic outlet syndrome
• Assisting colleagues from other specialties with the control of vascular bleeding
• Assisting colleagues in the management of the vascular complications of diabetes and renal disease
• Providing a renal access service for patients requiring haemodialysis
• Trauma surgery

Open surgery

• Abdominal aortic aneurysm repair
• Lower limb arterial bypass
• Carotid endarterectomy
• Femoral endarterectomy
• Major lower limb amputation

Endovascular (including endovenous) procedures

Endovascular surgery is a rapidly advancing field, where the surgeon works via a needle puncture and is able to ‘recanalise’ narrowed or blocked arteries, and prevent dangerously dilated arteries (aneurysms) from bursting by inserting an artificial artery inside the abnormal segment. Compared to open surgery, endovascular surgery has shown many 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, further research and technological developments may go some way to address these challenges.

• Endovascular abdominal aortic aneurysm repair (EVAR)
• Lower limb angioplasty +/- stent
• Carotid artery stent
• Endovenous ablation for varicose veins