Vascular surgery procedures are used to treat this type of arterial disease (as well as conditions affecting the veins), and frequently involve the surgical removal of hardened deposits, or bypass surgery to divert blood flow around an occluded vessel.
Some aortic aneurysms, which may occur in the chest or the abdominal area, can require the use of highly specialized surgical procedures that are performed using cardiopulmonary bypass (a heart-lung machine). The principle behind this type of surgery is to remove the weakened and enlarged section of the aorta and replace it with an artificial prosthesis.

In comparison, surgery to treat carotid stenosis  consists of the removal of hardened deposits from the affected artery, followed by carotid reconstruction. In many patients, this procedure helps to prevent an impending stroke, i.e. an interruption in the flow of blood to the brain. At the start of the procedure, which is usually performed under general anesthesia, the surgeon exposes the carotid artery via an incision in the neck. They will make an opening along the artery and remove the plaque (hardened fatty deposits) from the narrowed section. The carotid artery is then sealed using a special patch made of venous tissue or synthetic material. Alternatively, the surgeon may dissect the carotid artery and evert the vessel wall (effectively turning it inside out) to remove any plaque deposits. Afterwards, the surgeon will re-establish the correct connection between the blood vessels, and patients are often able to leave hospital after only a few days.

The surgical removal of hardened deposits from stenotic sections is also an option in the treatment of peripheral arterial disease (PAD) .  For instance, in order to ensure normal blood flow to the legs, hardened deposits affecting the veins in the upper thigh can sometimes be surgically removed via an incision in the groin.

In patients with PAD, a second surgical option also exists, which involves bypass grafting to divert blood flow around the stenotic section, an approach which is particularly useful if longer sections are affected by narrowing. Bypass surgery is not merely used to divert blood flow around stenotic areas affecting one of the legs. It can also be used to establish a new route between the iliac or femoral arteries on one side of the body, and the femoral artery on the other side of the body (cross-over bypass).
For bypass surgery involving the limbs, vascular surgeons may use vein grafts made from the patient's own veins (similar to coronary artery bypass), or synthetic grafts.

In many cases of arterial disease requiring treatment, catheter-based procedures can offer an alternative to open surgery. The decision as to which approach might be best for a particular patient has to be made on a case-by-case basis.