What is vascular surgery?
Vascular surgery refers to a variety of different procedures to treat injuries and disorders of the arteries, veins and lymph vessels. Vascular surgery procedures are performed on the aorta and arteries and veins in the neck, abdomen, pelvis, legs and arms, excluding those in the heart and brain. Cardiothoracic surgeons perform surgery on the coronary arteries and those leaving and entering the heart; neurosurgeons (and neurovascular) surgeons focus on intracranial vessels.
Types of vascular surgery
Vascular procedures include:
Amputation including procedures to save limbs from disease, burns, infection an
Aneurysm repair including abdominal aortic aneurysms
Angioplasty and stenting including procedures on the renal (kidney) arteries
Atherectomy and endarterectomy of non-coronary (heart) arteries
Vascular access procedures including arteriovenous (AV) fistula creation for dialysis
Vascular bypass surgery including peripheral vascular bypass
Depending on the procedure and the patient, a vascular surgeon may have an option of either open or endovascular surgery. Open surgery is more invasive and typically comes with more risks to the patient, especially if the person has other health conditions. However, the surgeon has a full view of the surgical area. Endovascular surgery, also called endovascular intervention, often involves a catheter and is performed under X-ray guidance. It is less invasive and has a significantly reduced recovery time than open surgery.
Why is vascular surgery performed?
You might need vascular surgery if your condition cannot be treated with medication or lifestyle changes. If the condition is in the early stages, some vascular surgeons may recommend watch-and-wait monitoring with some lifestyle modifications, such as quitting smoking or controlling diabetes. If your doctor thinks surgery is necessary, be sure to ask about all risks and advantages.
Some of the conditions in which vascular surgery may be necessary include:
Aneurysm. Depending on the size of the aneurysm, endovascular surgery or watchful waiting may be appropriate. Otherwise, open surgery may be necessary.
Blood clots. Deep vein thrombosis and PE may require surgery if medication does not dissolve the clot or in emergency situations
Peripheral artery disease. Open vascular bypass surgery may be necessary for advanced disease. Endovascular peripheral bypass procedures may be options.
Trauma including procedures to stop internal bleeding (hemorrhage) and repair blood vessel damage
Vein disease. Many types of vein surgeries are available to treat painful varicose veins, chronic venous insufficiency, and other serious problems like deep vein thrombosis. Vascular surgery includes procedures to treat spider veins.
Who performs vascular surgery?
Vascular surgeons perform most surgeries involving blood and lymphatic vessels, excluding those of the heart (the coronary arteries) and brain (intracranial arteries and veins). These specialists care for patients starting with evaluation and diagnosis through surgical treatment and long-term monitoring. Vascular surgeons will determine what course of treatment is the most beneficial for the patient depending on the condition and the stage when it’s diagnosed.
General surgeons and critical care (trauma) surgeons also perform vascular surgery. Prior to 2006, vascular surgery was an additional training pathway after general surgery. Now, doctors have the option of pursuing board certification in vascular surgery directly. The required skills and expertise are the same regardless of the pathway.
How is vascular surgery performed?
Surgeons use both open and endovascular techniques, or a combination of the two to perform vascular surgery. When endovascular surgery is possible, it has many advantages, including a shorter recovery time and less risk of complications because it involves smaller incisions—sometimes just one incision—to access the treatment area. Not all vascular diseases can be treated with an endovascular approach, particularly if the patient has advanced disease. Open surgery with a larger incision to access the treatment area is a more traditional approach to vascular surgery and is required in many cases to complete the necessary repairs or remove diseased tissue.
In some cases, when invasive open surgery is not necessary but standard endovascular surgery is not an option for the patient, surgeons perform a complex endovascular repair. These surgeries are not available at all hospitals.
If possible, ask well in advance of surgery about the specific procedure and surgical approach—open or endovascular—your surgeon recommends and why. Ask for as much detail and information as you wish, including the benefits and risks. It’s easier to prepare and plan for recovery when you know your options and what to expect with your surgery.
What to expect for open vascular surgery
For open surgery, you can expect the following events:
A nurse will stay with you before surgery to make sure you understand and sign the surgical consent form and answer your questions.
A member of the treatment team will transport you to the operating suite.
You will receive a general anesthetic and possibly an epidural catheter to administer pain medication.
You may get a catheter in your bladder or a breathing tube to connect you to a ventilator.
The surgeon will make an incision near the affected blood vessel(s) and complete the surgery. Surgical time depends greatly on the reason for surgery.
You will have stitches to close the incision site.
After surgery, you may have an intravenous (IV) catheter line in your arm or hand and attached tubes to collect fluid that accumulates from the surgical area.
A team member will take you to a room in the intensive care unit (ICU) or post-anesthesia care unit (PACU).
What to expect for endovascular surgery
The initial steps are like open surgery, with some notable differences:
You will receive a local or regional anesthetic to numb just part of your body. General anesthesia may also be an option.
The incision site will be cleaned and shaved. A common incision site area is the groin to gain access to the femoral artery.
The surgeon will make an incision and insert a guide wire. Using a contrast dye and X-rays to track the wire’s location, the surgeon threads it to the treatment area, such as an aneurysm or an obstructed artery.
After the wire is in the right place, the surgeon inserts a catheter over the wire. The catheter is equipped with the surgical instruments necessary to complete the surgery, such as a graft for aneurysm repair or a specialized catheter for balloon angioplasty and stenting.
You will receive stitches (sutures) to close the incision. Sometimes skin stitches need to be removed once healing is complete.
What are the risks and potential complications of vascular surgery?
All kinds of surgery come with potential risks and complications. Open surgery usually has more serious potential complications than endovascular surgery. Discuss with your surgeon the risks and potential complications of the procedure you are having.
Potential complications of open vascular surgery
In general, surgical complications include:
Allergic or other reaction to the anesthetics
Blood clot, which can cause a loss of blood flow to your legs or feet or travel to your lungs and cause a pulmonary embolism
Heart attack or arrhythmia (irregular heart rhythm)
Infection of the graft
Injury to the bowel, kidneys, or spinal cord during the operation
Potential complications of endovascular surgery
When complications arise, they often include:
Blocked or fractured graft
Blood leaking around the graft
Infection at the incision site
Damage to surrounding blood vessels or organs
Rarely, a burst artery, aneurysm rupture, kidney damage, or paralysis
Reducing your risk of complications
You can reduce your risk of some complications by:
Alerting your healthcare providers if you have allergies to anesthetic medicines or contrast dyes
Following your doctor’s orders for physical activity and wound care after surgery
Notifying your doctor immediately of any concerns, such as bleeding, infection, fever, or increase in pain
Taking your medications as directed
How do I prepare for vascular surgery?
Your doctor will give you clear instructions to follow in preparation for surgery. Preparations may include:
Possibly stopping some of your medications such as blood thinners
Not eating or drinking for at least eight hours before the surgery
Not taking aspirin for one week before surgery
Not shaving the surgical site for at least two days before surgery
What can I expect after my vascular surgery?
Knowing what to expect makes it easier to plan and prepare for a successful recovery. Be sure to follow up with your doctor as scheduled in the days, weeks and months following your surgery.
How long will it take to recover?
After open vascular surgery, you should expect five to 10 days in the hospital and about three months of recovery time at home. Keep the surgical area clean and dry—you might need sponge baths rather than regular showers for a while. You will probably be sore, so ask your doctor about what medications you can take for pain. You might need help with household tasks and other daily activities for a week or two. Don’t drive until you get approval from your doctor.
After endovascular surgery, you will have about two to three days in the hospital and about four to six weeks of recovery time at home before returning to your normal activities. You might feel tired or lose your appetite for up to two weeks after the surgery.
For graft surgery to repair an aneurysm or other vessel damage, you will follow up with your doctor after two weeks. You will have imaging tests to make sure the graft is working. Make sure you get approval from your doctor about pain medications and when it’s okay to drive.
When should I call my doctor?
Call your doctor if you notice:
Fever or chills
Bleeding or drainage from your incision site
How might vascular surgery affect my everyday life?
Vascular surgery can not only be lifesaving procedure, but it can reduce your risk of developing other serious health problems, such as heart attack, stroke, or kidney disease. If you have vascular surgery for peripheral artery disease, you will likely have better blood flow and experience fewer symptoms, such as intermittent claudication. For aneurysm, vascular surgery will help reduce the risk of life-threatening bleeding and give you peace of mind.