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Vascular surgery
Risk factors such as smoking, high blood pressure and diabetes facilitate atherosclerosis and the weakening of the arteries. In many cases, vascular surgery can help to prevent severe complications of vascular disease, including reduced blood flow to the brain and limbs.
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What is vascular surgery?
Vascular surgery is often used to treat narrowed arteries - this may involve the surgical removal of hardened deposits, or bypass grafting, to divert blood flow around an occluded vessel. One highly specialized vascular surgery procedure - aortic aneurysm repair - is used in patients whose aorta has dilated and is at risk of rupture, and involves the use of vascular prostheses to repair or replace affected sections.
What conditions can be treated using vascular surgery?
The conditions frequently treated using vascular surgery include:
- carotid stenosis
- Chronic narrowing of the blood vessels in the pelvis or the legs (to peripheral arterial disease); less commonly, acute blockages affecting vessels in the limbs, e.g. thromboembolism.
- aortic aneurysm (Enlargement of the aorta)
How can vascular surgery help?
In a large proportion of cases, the patient's vascular disease is caused by fatty deposits building up on the arterial walls (atherosclerosis), accompanied by a gradual weakening of the arteries. This process is facilitated by risk factors such as smoking, high blood pressure and diabetes, as well as abnormalities in lipid metabolism. Atherosclerosis is characterized by the narrowing (stenosis) of blood vessels and, while it can develop anywhere in the body, the condition has a tendency to develop at specific sites.
Stenosis of the coronary arteries, for instance, can lead to coronary heart disease , and patients with this condition often require bypass surgery. Other sites often affected by stenosis include the carotid arteries, the renal arteries, and the arteries of the pelvis and lower limbs. In addition, enlarged areas of the aorta known as aortic aneurysms are also more likely to develop in patients with atherosclerosis and weakening of the vessel walls.
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.
to Peripheral arterial disease (PAD)
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.
Where can I find out more about vascular surgery?
General information
Deutsche Gesellschaft für Gefäßchirurgie (German Society of Vascular Surgery)
General information
Deutsche Gesellschaft für Thorax-, Herz, und Gefäßchirurgie (German Society for Thoracic and Cardiovascular Surgery)