Vascular surgery


Vascular surgery is the treatment of surgery on diagnosed patients with diseases of the arterial, venous, and lymphatic systems (excluding the intracranial and coronary arteries).


Vascular surgery is indicated when a patient has vascular disease that cannot be treated by less invasive, nonsurgical treatments. The purpose of vascular surgery is to treat vascular diseases, which are diseases of the arteries and veins. Arterial disease is a condition in which blood clots, arteriosclerosis, and other vascular conditions occur in the arteries. Venous disease involves problems that occur in the veins. Some vascular conditions occur only in arteries, others occur only in the veins, and some affect both veins and arteries.


As people age, vascular diseases are very common. Since they rarely cause symptoms in the early stages, many people do not realize that they suffer from these diseases. Of the eight million people in the United States who may have peripheral vascular disease (PVD), a large percentage are males. In the majority of cases, the blockage is caused by one or more blood clots that travel to the lungs from another part of the body. Factors that increase the chances of vascular disease include:


Vascular surgery involves techniques relating to endovascular surgeries including: balloon angioplasty and/or stenting, aortic and peripheral vascular endovascular stent/graft placement, thrombolysis, and other adjuncts for vascular reconstruction.

The vascular system is the network of blood vessels that circulate blood to and from the heart and lungs. The circulatory system (made up of the heart, arteries, veins, capillaries, and the circulating blood) provides nourishment to the body's cells and removes their waste. The arteries carry oxygenated blood from the heart to the cells. The veins return the blood from the cells back to the lungs for reoxygenation and recirculation by the heart. The aorta is the largest artery leaving the heart; it then subdivides into smaller arteries going to every part of the body. The arteries, as they narrow, are connected to smaller vessels called capillaries. In these capillaries, oxygen and nutrients are released from the blood into the cells, and cellular wastes are collected for the return trip. The capillaries then connect to veins, which return the blood back to the heart.

The aorta stems from the heart, arches upward, and then continues down through the chest (thorax) and the abdomen. The iliac arteries, which branch out from the aorta, provide blood to the pelvis and legs. The thoracic section of the aorta supplies blood to the upper body, as it continues through the chest. The abdominal section of the aorta, which supplies blood to the lower body, continues through the abdomen.

Vascular diseases are usually caused by conditions that clog or weaken blood vessels, or damage valves that control the flow of blood in and out of the veins, thus robbing them of vital blood nutrients and oxygen. A few common diseases affecting the arteries are peripheral vascular disease (PVD), carotid artery disease, and aortic aneurysms (AAA).

Surgery is used to treat specific diseased arteries, such as atherosclerosis, to help prevent strokes or heart attacks, improve or relieve angina or hypertension, remove aneurysms, improve claudication, and save legs that would otherwise have to be amputated. The choices involve repairing the artery, bypassing it, or replacing it.

As people age, atherosclerosis, commonly called hardening of the arteries, occurs with the constant passage of blood through the arteries. It can take on a number of forms, of which atherosclerosis (hardening of the innermost portion) is the most common. This occurs when fatty material containing cholesterol or calcium (plaque) is deposited on the innermost layer of the artery. This causes a narrowing of the inside diameter of the blood vessel. Eventually, the artery becomes so narrow that a blood clot (thrombus) forms, and blocks blood flow to an entire portion of the body. This condition is called PVD or peripheral arterial disease. In another form of atherosclerosis, a rough area or ulcer forms in the diseased interior of the artery. Blood clots then tend to develop on this ulcer, break off, and travel further along, forming a blockage where the arteries get narrower. A blockage resulting from a clot formed elsewhere in the body is called an embolism.

People who have few areas affected by PVD may be treated with angioplasty by opening up the blood vessel with a balloon placed on the end of a catheter. A stent is often used with angioplasty to help keep the artery open. The type of surgery used to treat PVD is based upon the size and location of the damaged artery. The following are surgery techniques used for severe PVD:

An aneurysm occurs when weakened blood vessels bulge like balloons as blood flows through them. Once they have grown to a certain size, there is a risk of rupture and life-threatening bleeding. There are two types of aortic aneurysms: abdominal aortic aneurysm (AAA) and thoracic aortic aneurysm. This classification is based on where the aneurysm occurs along the aorta. Aneurysms are more common in the abdominal section of the aorta than the thoracic section.

Most blood clots originate in the legs, but they can also form in the veins of arms, the right side of the heart, or even at the tip of a catheter placed in a vein. The following venous disease conditions usually occur in the veins of the legs:

Carotid artery disease is a condition in which the arteries in the neck that supply blood to the brain become clogged; this condition can cause a stroke.

Lymphatic obstruction involves blockage of the lymph vessels, which drain fluid from tissues throughout the body and allow immune cells to travel where they are needed. Some of the causes of lymphatic obstruction (also known as swelling of the lymph passages), include infections such as chronic cellulitis, or parasitic infections such as filariasis, trauma, tumors, certain surgeries including mastectomy, and radiation therapy. There are rare forms of congenital lymphedema that probably result from abnormalities in the development of the lymphatic vessels. Most patients with lymphedema will not need surgery, as the symptoms are usually managed by other techniques. Surgical therapy for lymphedema includes removal of tissue containing abnormal lymphatics, and less commonly, transplant of tissue from areas with normal lymphatic tissues to areas with abnormal lymphatic drainage. In rare cases, bypass of abnormal lymphatic tissue is attempted, sometimes using vein grafts.

Other examples of vascular surgery include:


In order for a patient to be diagnosed with a vascular disease, they must be clinically evaluated by a vascular surgeon, which includes a history and physical examination . A vascular surgeon also treats vascular disorders by non-operative means, including drug therapy and risk factor management.

The symptoms produced by atherosclerosis, thrombosis, embolisms, or aneurysms depend on the particular artery affected. These conditions can sometimes cause pain, but often there are no symptoms at all.

A physician has many ways of feeling, hearing, measuring, and even seeing arterial blockages. Many arteries in the body can be felt or palpated. A doctor can feel for a pulse in an area he or she believes afflicted. Usually the more advanced the arteriosclerosis, the less pulse in a given area.

As the artery becomes blocked, it can cause a noise very much like water roaring over rocky rapids. Your physician can listen to this noise (bruit) directly, or can use special amplification systems to hear the noise.

There are other tests that can be done to determine if arterial blood flow is normal:

There may be no symptoms of vascular disease caused by blood clots until the clot grows large enough to block the flow of blood through the vein. The following symptoms may then come on suddenly:

The physician will probably do an evaluation of all organ systems including the heart, lungs, circulatory system, kidneys, and the gastrointestinal system. The decision whether to have surgery or not is based on the outcome of these evaluations.

For high-risk patients undergoing vascular surgery, research has shown that taking oral beta-blockers one to two weeks before surgery and continuing for at least two weeks after the operation can significantly reduce the chance of dying or having a heart attack. Scientists suspect that the drug improves oxygen balance in the wall of the heart and stabilizes plaques in the arteries.


The length of time in intensive care and hospitalization will vary with each surgery, as will the recovery time, depending on numerous factors. Because surgery for an AAA is more serious, the patient can expect to be in intensive care for 24 hours, and in the hospital for five to 10 days, providing the patient was healthy and had a smooth operative and postoperative course. If there are complications, the hospital stay will likely increase. It may take as long as six months to fully recover from surgery for an AAA.

Living a "heart-healthy lifestyle" is the best way of preventing and controlling vascular disease: do not smoke; eat nutritious foods low in fat; exercise; maintain a healthy weight; and control risk factors such as high blood pressure, high cholesterol, diabetes, hypertension, and other factors that contribute to vascular disease.

Medications that may be used to treat PVD include:


All surgeries carry some risks. There is a risk of infection whenever incisions are required. Operations in the chest or those that involve major blood vessels carry a higher risk of complications. Patients who smoke, have high blood pressure, chronic lung or kidney disease, or other illnesses are at greater risk of complications during and after surgery. Other risks of vascular surgery include:

The patient should discuss risks with their surgeon after careful review of the patient's medical history and a physical examination.

Normal results

The success rate for vascular surgery varies depending on a number of factors which may influence the decision on whether to have surgery or not, as well as the results.

The chance that an aneurysm will rupture generally increases with the size of the aneurysm; AAAs smaller than 1.6 in (4 cm) in diameter have up to a 2% risk of rupture while ones larger than 2 in (5 cm) in diameter have a 22% risk of rupture within two years.

Arterial bypass surgery and peripheral bypass surgery have very good success rates. Most of those who undergo AAA surgery recover well, except in the case of a rupture. Most patients who have a ruptured aortic aneurysm die. Surgery for an already ruptured aneurysm is not usually successful, due to excessive, rapid blood loss.

Surgical therapy for lymphedema has met with limited success, and requires significant experience and technical expertise.

Morbidity and mortality rates

Peripheral vascular disease affects 10 million people in the United States, including 5% of those over 50. Only a quarter of PVD sufferers are receiving treatment. More than five million people in the United States develop DVT each year. More than 600,000 Americans experience a pulmonary embolism every year. Of those, approximately 200,000 people die from the condition.


There a few alternatives to treating vascular disease, although extensive research has not been done. Acupuncture is used to aid in hypertension and chelation therapy is thought to stabilize the effects of vascular disease. The focus should be on maintaining a proper diet and being aware of a family history of vascular disease so as to catch it as early as possible.



Cameron, John L. Current Surgical Therapy. 7th ed. Philadelphia: Mosby, 2002.

Hoballah, Jamal J. Vascular Reconstructions: Anatomy, Exposures, and Techniques. Berlin: Springer Verlag, 2000.


Abir, Farshad, Iannis Kakisis, and Bauer Sumpio. "Do Vascular Surgery Patients need a Cardiology Work-up? A Review of Pre-operative Cardiac Clearance Guidelines in Vascular Surgery." European Journal of Vascular and Endovascular Surgery 25, no. 2 (2003): 110–117.

Moore, Wesley S., M.D., G. Patrick Clagett, M.D., Frank J. Veith, M.D., Gregory L. Moneta, M.D., Marshall W. Webster, M.D. et al. "Guidelines for Hospital Privileges in Vascular Surgery: An Update by an Ad Hoc Committee of the American Association for Vascular Surgery and the Society for Vascular Surgery." Journal of Vascular Surgery 36, no. 6 (2002): 1276–1282.


American Board of Vascular Surgery (ABVS). 900 Cummings Center. #221-U Beverly, MA 01915. .

The National Heart, Lung and Blood Institute. 6701 Rockledge Drive, P.O. Box 30105, Bethesda, MD 20824-0105. (301) 592-8573. E-mail:, .

National Institutes of Health (NIH), Department of Health and Human Services. 9000 Rockville Pike. Bethesda, MD 20892.

The Society for Vascular Surgery. 900 Cummings Center, #221-U Beverly, MA 01915. .

Society of Interventional Radiology. 10201 Lee Highway, Suite 500. Fairfax, VA. 22030. (800) 488-7284. E-mail:, .

The U.S. Department of Health and Human Services. 200 Independence Avenue, S.W., Washington, D.C. 20201. (877) 696-6775.

Valley Baptist Heart and Vascular Institute. 2101 Pease Street, P.O. Drawer 2588. Harlingen, TX 78550. (956) 389-4848.


Society of Interventional Radiology. Vascular Diseases. 2003 [cited May 29, 2003]. .

Crystal H. Kaczkowski, MSc


A vascular surgeon performs the procedure in a hospital operating room . Applicants for residency training in vascular surgery must have successfully completed a general surgery residency and be eligible for the board examination in general surgery. An individual must meet the standards set by the Vascular Surgery Board of the American Board of Surgery for cognitive knowledge and hypothetical case management. At the completion of a vascular surgery residency, both a written and oral examination must be completed before certification. A vascular surgeon is required to undergo periodic written reexamination.


Also read article about Vascular Surgery from Wikipedia

User Contributions:

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Sep 28, 2009 @ 10:10 am
Educational and worth reading. Less of technical jargon than most articles.
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Jun 20, 2010 @ 3:03 am
I'm having vascular surgery in a few days and I'd like to know if there is any problem in travelling by plane after a month? And is it possible to go to the beach? If so, what special care should I have?
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Mar 2, 2011 @ 7:07 am
save for reference re post op fem pop surgery and lymphatic drainage
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Oct 10, 2011 @ 10:22 pm
ive had bypass on my artiery in my lower leg 11 monts ago ,ive had a 7 hr flight and my leg has swollen up is it ok to keep travelling ,

thanks kyle
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Mar 26, 2012 @ 9:09 am
my husband just had a fem-pop now experiencing nose bleed, tho has stopped. It isn't from dry air, or nose picking..and blood pressure jumps...he had 2 units blood during surgery and 2 units two days out from surgery...any connection? He has no energy and lays around. I get him to walk so as to avoid blood clots. I just am concerned about the energy factor and of course nose bleeds if they continue.
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Oct 27, 2012 @ 11:23 pm
I am doing a Psychlogy of death and human exp. The information in this article is wonderful, except that I need an approxamate cost of this type of procedure. A round about figure would be beneficial. Thank you so much.
Lori Goulet
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Nov 3, 2012 @ 5:17 pm
Hi i have to go have a bypass on my arm i already had a artora bypass all the way to my legs. i have to go this week and i don't seem to find allot of information about the arms. im so worried.
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Feb 3, 2013 @ 6:18 pm
I had vascular surgery inboth of my lege i get stingers or pain in some of thoese areas is it comon is there anything i can do to help with the pain its mostly at night when i lay down. THANKS
Neale Johnston
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Mar 30, 2013 @ 7:19 pm
Please advise how long the expected recovery time for vascular leg surgery should be?
william rumptz
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Jul 23, 2013 @ 9:21 pm
hello 3/08 had leg blood clot behind knee 1/2012 had narrowing of artery behind left knee prior was right was checked out mri etc found out needed aaa bypass had done by awesome dr besides normal pain i am having bad lower back pain everyday meds take it away but its been a month since surgery forgot surgery was done 6/2013 i can take pain pretty good but this is getting no better i will be seeing my doc in 3 days see what he says as i said prior my dr. was awesome.i am 51 yrs old was a smoker now done my father had anureyems in his brain and heart surgeries 3 times he passes at 66years old i am curious the pain i am having in my lower back be kidneys see what dr says my doctor is dr, cohn at memorial hospital in savannah georgia my spelling and grammer is bad but you get the point thanks chating william
joe cummings
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Sep 30, 2013 @ 2:14 pm
am about to have 9th stent implanted 10/04. i am used to procedure, but last implant failed & i also ended-up with "drop-foot" which has caused me to have several falls until i became used to lifting the foot when i walk. i have been in PT 2 times weekly but no improvement; although PT has helped with other pain. per cardiologist suggestion, have consulted vascular surgeon who tells me by-pass is my only alternative. i am really concerned as i have all the bad points (diabetes,hypertension, a-fib,etc.). i would like to hear my chances from aa different view. i smoked for 53 yrs., but have been quit since 01/10. i am 69 y.o. would i be better-off losing the leg below the knee or risking surgery?
vincent regan
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Oct 3, 2013 @ 5:17 pm
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Jul 3, 2014 @ 11:11 am
I had a stint put in the abdominal area,for a 100% block artery,I was off work for 2 weeks and went back to work after that,and worked 2 days and the discomfort in the abdominal area is increasing and my left leg is aching as well,my job is a shunt driver,so I'm getting in and out of the truck 30 times a day,was told to avoid stairs when I left the Hospital,will this ruin the stint or collapse it ? should I stop working ?,tried to call the surgeon but he's on holidays
lall sukram
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Aug 9, 2014 @ 10:10 am
hi, I am doing research on vascular surgery. would appreciate your help with this. what are the types, indications, risk factors for vascular surgery. I thank you in advance.
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Nov 15, 2014 @ 12:12 pm
my brother had accident of his right leg when he admitted in hospital and his right leg broken with high blood flow when doc not done any surgery of his leg, he only gave gulclose and blood in 48 hours then we realized that there was not any improvement of brother condition so we shift he in another hospital. there dr. said that it was to late join his leg so dr. cut his leg. i have opinion is vascular surgery is important to save my brother leg? and when that surgery can do?
Nugget Gregory
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Jan 27, 2015 @ 3:15 pm
I recently had a heart cath. Afterwards I developed a blood clot in the illiac artery which required emergency surgery to remove the clot. I am home now and have a lot of pain in groin, hip, inner and outer thigh. Sometimes I have a warm sensation around the shin area. Is this normal and what do I watch for that would be abnormal after this surgery?
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Feb 8, 2015 @ 4:16 pm
I had iliac stent n iliac embolectomy done recently prior nmumbness needles n pins feeling is back n also now in thigh that was cleaned out n now I have severe pain in the heal on same side thought this was supposed to make these symptoms better not worse
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May 15, 2015 @ 11:23 pm
My husband had a AAA with thrombus, operation done on 24th April 15, hopital stay 17 days as had temperature and vomiting till last Sunday was booked for gastroscopy, had a sudden change around and stopped vomiting 10/5/15, so it did not go ahead Gastroscopy. He has had flushing on face since Friday 8th May 2015, sometimes above eyebrows, and behind eyes were worse this symptom started last , and still continues, flushed feeling on face can come and go still there, if that leaves he said he will be alright, he was discharged on the 12th of May 15, VEin specialist, Gastro specialist Kidney specialist all not sure what the cause is even local GP, said could be mild infection as crp is 21mg/L it was 270 after operation, HB is 10.4 g/dl should be between 10.0-18.0 RCC 3.63 x10^12/L, should be between 4.50-6.50, MCHC 31.5 g/dL 32.0-16.0, platelets 515 (160-450)Film : red cells: Rouleau X2+, While cells and Platelets show normal morphology, Comment There is mild anaemia, There is mild thrombocytosis, what does it mean does it mean he still has a clot somewhere if so how can they find it, Urine examination all normal except chemistry, Protein +, Blood/Hb++ states Haemolysed blood detected by dipstick biochemistry. No casts or crystals seen(unspun urine) Culture No growth, Serium Plasma Biochemistry Est.GFR (ML/min) 81 per 1.73sqm(>60), can anyone tell me why the hot flushes, and the blood test, has anyone ever had this issue after a AAA operation, does it mean he has another thrombus as per blood test results, just checked tempreature 36.4, blood pressure was 140/84, pulse was 88, however the Omron blood pressure monitor also detected an irregular puluse, he is feeling the flushes and have just gone to bed, he never had irregular heart rate before until after and during the operation, even in hospital it was irregular but they did not get a cardio doctor to check on him, they did echo, and a few and a few ECG docotr said it was all normal, please any information if anyone has gone through ths will be helpful, as the doctors said they have not come accross this a all, Looking for answers. God Bless you all
Roger Crews
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Sep 4, 2016 @ 5:17 pm
I had Thrombectomy done 3 weeks ago and now my left leg is now as big as it was before in my leg calf area and swollen left ankle and discolored as it was before. They removed several blood clots in left leg. I'm wearing compression stockings on left leg.?Has my blood clots came back . Should I contact my doctor right away ? What should I do ?
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Sep 16, 2016 @ 9:21 pm
My son, Bill had left leg artery surgery 8/12. I don't know all technical medical terms. He seemed to be having a sucessful recovery. 43 years old. Walking each day as insrructed by physician. Two weeks later he had two embolisms to his lungs & died within an hour. Thank God he knew the Lord, but so frustrating- so strong & healthy.
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Nov 8, 2016 @ 11:23 pm
Dr said that I have small very small arties and that he is talking about replaceing the arties form the aortor to the kidneys, am having trouble with block in the legs and having taird and weakness in legs and some pain. have had concerable damage to the left leg 40 years ago in a accident double compound fractures and the leg broken in 18 places as such I know that I would have concidalbe problems with the leg as I got older. I don't know excitedly what he means or what's to do said maijore surgery and cutting me open from the mid chest down, I know I would be stupid if I weren't scard. and I am my concerns are what would happen if I didn't have the surgery? would I be at risk of loseing my legs, 1 or life and at some point would I have to have this done anyway. or is it just a matter of disconfront and pain.
selling and that. I don't know what to do.?
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Nov 18, 2016 @ 5:17 pm
Hi I had a stent graft done on a pseudo aneurism op (right artery in abdomen) and I have been discharged about 3 weeks now. The aneurism was or still is 12x6x6 cm i still get pains and I feel a pulse were this aneurism is. How long for the aneurism to clot and will the aches and pains subside? I feel better than before less back pain but still nerve pain going down my right leg. Any answers on this.? I would appreciate some input.

Thank you
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Jun 22, 2017 @ 4:04 am

My father underwent surgery last month on 9/6/2017 to be exact. The procedure was an AXILLO-FEMORAL: (BIFEMORAL + 50%) and they basically said it was the rechanneling of his arteries. He had alot of complications after the procedure. He suffered from renal failure as well as a heart attack. After almost a month in hospital he was eventually discharged.

However he has a huge bulge in his side and you can actually feel the graft or pipping that was used to do the bypass. i just want to know is that normal???
hemant vartak
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Jan 12, 2019 @ 11:11 am
I had my father age 88yrs who has gone vesculer surgery he has gone through two operation his feet was cold above knee after operation now his kknee is cold below ankle there are no signs of gangrene increasing can he walk

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