Vascular surgery is the surgical discipline that deals with the totality of vessels in the human body, except for the brain and heart vessels (coronary arteries) that are in the field of cardiac surgery.
As the name suggests, arterial surgery deals with arterial lesions, which in more than 90% of cases are atheromatous and are mainly located on the bifurcations. In addition to age, gender and heredity, the four main risk factors for atherosclerosis are: smoking, diabetes, high cholesterol and high blood pressure. These lesions may be constriction (stenosis), slowing blood flow, occlusion (thrombosis), causing acute arterial ischemia (sudden absence of oxygenation), dilatation (aneurysm), or even dissection. The medical opinion is based on the anamnesis and the results of a complete clinical examination, mainly dopplerography and an ankle brachial index calculation. Depending on the pathology (type and place of lesion) and the patient (age, anamnesis, etc.), a surgeon can be appointed:
- Normal surgery (by opening an artery): endarterectomy or bypass surgery.
- minimally invasive percutaneous surgery using endovascular methods: angioplasty with or without recanalization and / or stenting, by placing inside cylinders, stents, endoprostheses that allow treatment without an autopsy.
In any case, surgical treatment is accompanied by medication and control of risk factors, namely: cessation of smoking, leading a healthy lifestyle and taking specific drugs (platelet antiaggregants).
Depending on the location of the arterial lesions, the symptoms may be very different.
Carotid artery stenosis (arteries supplying the brain) may be responsible for: a transit ischemic attack (TIA), which leaves no consequences, or stroke (acute cerebral circulation disorder), the consequences of which are often dramatic (hemiplegia – unilateral paralysis, aphasia – disturbance or loss of speech, visual impairment, etc.).
If the narrowing of the arteries exceeds 70%, surgical intervention is shown. In this case, the gold standard remains an endarterectomy, which consists in removing the plaque of the atheroma, preferably under local regional anesthesia.
Obliterating arteriopathy in the lower limbs affects all arteries from the aorta to the most peripheral arteries of the foot and fingers. It is responsible for intermittent lameness and gait disturbance. In later stages, bedsore pain that interferes with sleep, skin lesions such as necrosis or acute ischemia can be observed. For this pathology, treatment in more than 70% of cases is endovascular (dilatation and/or stenting), but it may also include endarterectomy or bypass surgery.
Aneurysms may affect all arteries, but the most affected are the infarrenal areas of the abdominal aorta. Clinical signs are often absent. An aneurysm is detected during the physical examination. Treatment is surgical if the diameter of the aneurysm exceeds 50 mm. Depending on the patient, you can choose either open surgery (flatplate plastic surgery) or aortic endoprosthesis transfer implantation.
Mainly deals with the problems of chronic superficial venous insufficiency, which is the cause of varicosity and its complications. It is the most common chronic disease, affecting ¾ of the population over 65 years.
Other areas of application
The vascular surgeon takes part in the treatment of renal or digestive artery stenosis, deep vein thrombosis or embolization in small pelvic varicose veins. He performs treatment of arteriovenous fistulas for dialysis. He can also treat upper aperture syndrome, ventricular stem compression stenosis or trophic disorders, namely diabetic foot syndrome. Finally, it can operate on or treat trauma in the case of blood vessels. Surgery on lymphatic vessels is rare. The variety of these pathologies and their spread require from the doctor of this specialty a high qualification and experience in both classical and endovascular methods.