Vascular surgery
Encyclopedia
Vascular surgery is a specialty of surgery in which diseases of the vascular system, or arteries
and vein
s, are managed by medical therapy, minimally-invasive catheter procedures, and surgical reconstruction. The specialty evolved from general and cardiac surgery. Early pioneers of the field include Russian surgeon Nikolai Korotkov
, noted for developing early surgical techniques, and the Australian Robert Paton, often credited with helping the field achieve recognition as a speciality. Edwin Wylie of San Francisco was one of the early American pioneers who developed and fostered advanced training in vascular surgery and pushed for its recognition as a specialty in the United States in the 1970s. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system except that of the heart and brain. Cardiothoracic surgeons
manage surgical disease of the heart
and its vessels. Neurosurgeons and interventional neuroradiologists
manage surgical disease of the vessels in the brain
(e.g. intracranial aneurysms).
The specialty continues to be based on operative arterial and venous surgery but since the early 1990s has evolved greatly. There is now considerable emphasis on minimally invasive alternatives to surgery. The field was originally pioneered by interventional radiologists
, chiefly Dr. Charles Dotter, who invented angioplasty. Further development of the field has occurred via joint efforts between interventional radiology
, vascular surgery, and interventional cardiology. This area of vascular surgery is called Endovascular Surgery or Interventional Vascular Radiology, a term that some in the specialty append to their primary qualification as Vascular Surgeon. Endovascular and endovenous procedures can now form the bulk of a vascular surgeons practice.
The development of endovascular surgery has been accompanied by a gradual separation of vascular surgery from its origin in general surgery. Most vascular surgeons would now confine their practice to vascular surgery and similarly general surgeons would not be trained or practice the larger vascular surgery operations or most endovascular procedures. More recently, professional vascular surgery societies and their training programme have formally separated "Vascular Surgery" into a separate specialty with its own training program, meetings, accreditation. Notable societies are Society of Vascular Surgery (SVS), USA; Australia and New Zealand Society of Vascular Surgeons (ANZ SVS). Local societies also exist e.g. Melbourne Society of Vascular Surgeons (MVSA). Larger societies of surgery actively separate and encourage specialty surgical societies under their umbrella e.g. Royal Australasian College of Surgeons (RACS).
for transplantation, renal transplantation, pancreatic solid organ transplantation Organ transplant
.
Vascular surgeons will frequently have close associations with specialist interventional radiologists for a combined treatment of certain conditions. The radiologists contribute to endovascular cases management, sometimes with angioplasty and stenting, but also in specific areas of expertise e.g. sclerotherapy for vascular anomalies and arteriovenous malformations (AVMs), coil embolisation of bleeding visceral arteries in trauma or for occlusion of tumour supplying arteries as a prelude to operation, CT-guided procedures such as lumbar chemical sympathectomy.
Common medical associations are the involvement providing surgical opinions and treatment for a multidisciplinary clinic with vascular surgeons, vascular nurses, wound management nurses, podiatrists, prosthetists, rehabilition physicians, vascular physicians, endocrinologists, etc. to manage high risk foot disease patients.
Less common operative surgical associations are: sympathectomy (ETS
, Endoscopic thoracic sympathectomy
), lumbar sympathectomy, Hyperhidrosis
surgery); vascular access for chemotherapy etc. patients; dialysis/ECMO (extra-corporeal membrane oxygenation) for patients in Intensive Care Wards; vascular mobilisation for access associated with other specialist operations e.g. extensive orthopaedic spinal and pelvic surgery, retroperitoneal cancer dissections, renal tumour surgery.
, endovenous laser treatment
are rapidly replacing major surgery in many first world countries. These newer procedures provide reasonable outcomes that are comparable to surgery with the advantage of short hospital stay (day or overnight for most cases) with lower morbidity and mortality rates.
The durability of endovascular arterial procedures is generally good especially when viewed in the context of their common clinical usage i.e. arterial disease occurring in elderly patients and usually associated with concurrent significant patient comorbidities especially ischaemic heart disease. The cost savings from shorter hospital stays and less morbidity are considerable but are somewhat balanced by the high cost of imaging equipment, construction and staffing of dedicated procedural suites, and of the implant devices themselves.
The benefits for younger patients and in venous disease are less persuasive but there are strong trends towards nonoperative treatment options driven by patient preference, health insurance company costs, trial demonstrating comparable efficacy at least in the medium term.
A recent trend in the USA is the stand-alone day angiography facility associated with a private vascular surgery clinic, thus allowing treatment of most arterial endovascular cases conveniently and possibly with lesser overall community cost.
Similar non-hospital treatment facilities for non-operative vein treatment have existed for some years and are now widespread in many countries.
An emerging trend based on such venous clinics is the treatment of varicose veins by non-vascular surgeons e.g. cosmetic physicians, phlebologists, radiologists, etc. These practices aim to offer a complete varicose and surface vein treatment without surgery.
, it is now considered a specialty in its own right. As a result, there are two pathways for training in the United States. Traditionally, a five year general surgery residency is followed by a 1-2 year (typically 2 years) vascular surgery fellowship. An alternative path is to perform a five or six year vascular surgery residency.
Programs of training are slightly different depending on the region of the world one is in.
studied methods like these as part of a National Institute of Health grant to study thrombosis; results from this large, multicenter randomized trial of clot busting therapy treatments were published in the New England Journal of Medicine
in 1998.
- Netherland Vascular Study.
- Framingham heart study. http://highwire.stanford.edu/cgi/searchresults?andortopics=and&pubdate_year=&volume=&firstpage=&author1=&author2=&title=&titleabstract=&fulltext=framingham+heart+study&andorexacttitle=and&andorexacttitleabs=&andorexactfulltext=and&src=ml&jc_favj=&fmonth=Jan&fyear=1812&tmonth=Oct&tyear=2208&flag=&RESULTFORMAT=1&hits=10&hitsbrief=&sortspec=relevance&sortspecbrief=&resourcetype=1&tdatedef=24+Oct+2008&fdatedef=1+January+1812&Highwire results for Framingham heart Study]
- MASS Trial. – the Multicentre Aneurysm Screening Study (MASS) trial. Four centres (about 7000 men); screening (and treatment) vs. control group. AAA-related mortality in the screening arm reduced by about 40%; emergency ruptured AAA reducted by about 70%; disruption to elective work was reduced; and better management of risk factors and ITU/HDU beds. The overall survival benefits remain difficult to estimate, nevertheless, screening for AAA is recommended [level of recommendation: B].
- UK Small Aneurysm Trial: 1090 patients; AAA 4-5.5 cm; Immediate surgery vs. ultrasound surveillance (and treatment for rapid expansion or AAA >5.5); 30-day mortality after elective AAA repair is 5.8%. No difference in survival.
- ADAM VA Cooperative Group Trial. 73451 VA patients screened with no known hx of aneurysm; Age 50-79; AAA 4.0-5.4 cm; similar conclusion to Uk Small Aneurysm Trial.
- Joint Vascular Research Group Trial. 284 patients; Study the relationship between intraoperative intravenous heparinisation, blood loss during surgery and thrombotic complications. Conclusion: Intraoperative heparin, given before aortic cross clamping, is an important prophylaxic against perioperative MI in aortic aneurysm surgery.
- HOPE (Heart Outcomes Prevention Evaluation) study - 4046 patients with PAD. In this subgroup, there was a 22% risk reduction in patients randomized to ramipril
compared with placebo,which was independent of lowering of blood pressure.
Artery
Arteries are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries....
and vein
Vein
In the circulatory system, veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood to the heart...
s, are managed by medical therapy, minimally-invasive catheter procedures, and surgical reconstruction. The specialty evolved from general and cardiac surgery. Early pioneers of the field include Russian surgeon Nikolai Korotkov
Nikolai Korotkov
Nikolai Sergeyevich Korotkov was a Russian surgeon, a pioneer of 20th century vascular surgery, and the inventor of auscultatory technique for blood pressure measurement.-Associated eponyms:...
, noted for developing early surgical techniques, and the Australian Robert Paton, often credited with helping the field achieve recognition as a speciality. Edwin Wylie of San Francisco was one of the early American pioneers who developed and fostered advanced training in vascular surgery and pushed for its recognition as a specialty in the United States in the 1970s. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system except that of the heart and brain. Cardiothoracic surgeons
Cardiothoracic Surgery
Cardiothoracic surgery is the field of medicine involved in surgical treatment of diseases affecting organs inside the thorax —generally treatment of conditions of the heart and lungs .-Cardiac / Thoracic:...
manage surgical disease of the heart
Human heart
The human heart is a muscular organ that provides a continuous blood circulation through the cardiac cycle and is one of the most vital organs in the human body...
and its vessels. Neurosurgeons and interventional neuroradiologists
Interventional neuroradiology
Interventional Neuroradiology /Neurointerventional Surgery is an Accreditation Council for Graduate Medical Education accredited medical subspecialty specializing in minimally invasive image-based technologies and procedures used in diagnosis and treatment of diseases of the head, neck, and...
manage surgical disease of the vessels in the brain
Human brain
The human brain has the same general structure as the brains of other mammals, but is over three times larger than the brain of a typical mammal with an equivalent body size. Estimates for the number of neurons in the human brain range from 80 to 120 billion...
(e.g. intracranial aneurysms).
The Evolution of Endovascular Surgery
Interventional radiology
Interventional radiology is a specialty of radiology, in which image-guided procedures are used to diagnose and treat a multitude of diseases across all body systems...
, chiefly Dr. Charles Dotter, who invented angioplasty. Further development of the field has occurred via joint efforts between interventional radiology
Interventional radiology
Interventional radiology is a specialty of radiology, in which image-guided procedures are used to diagnose and treat a multitude of diseases across all body systems...
, vascular surgery, and interventional cardiology. This area of vascular surgery is called Endovascular Surgery or Interventional Vascular Radiology, a term that some in the specialty append to their primary qualification as Vascular Surgeon. Endovascular and endovenous procedures can now form the bulk of a vascular surgeons practice.
The development of endovascular surgery has been accompanied by a gradual separation of vascular surgery from its origin in general surgery. Most vascular surgeons would now confine their practice to vascular surgery and similarly general surgeons would not be trained or practice the larger vascular surgery operations or most endovascular procedures. More recently, professional vascular surgery societies and their training programme have formally separated "Vascular Surgery" into a separate specialty with its own training program, meetings, accreditation. Notable societies are Society of Vascular Surgery (SVS), USA; Australia and New Zealand Society of Vascular Surgeons (ANZ SVS). Local societies also exist e.g. Melbourne Society of Vascular Surgeons (MVSA). Larger societies of surgery actively separate and encourage specialty surgical societies under their umbrella e.g. Royal Australasian College of Surgeons (RACS).
Common Professional Associations
Associated areas of interest and operative surgical practice for vascular surgeons are access surgery for hemodialysis and peritoneal dialysis, organ harvestingOrgan harvesting
Organ harvesting refers to the removal, preservation and use of human organs and tissue from the bodies of the recently deceased to be used in surgical transplants on the living...
for transplantation, renal transplantation, pancreatic solid organ transplantation Organ transplant
Organ transplant
Organ transplantation is the moving of an organ from one body to another or from a donor site on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be...
.
Vascular surgeons will frequently have close associations with specialist interventional radiologists for a combined treatment of certain conditions. The radiologists contribute to endovascular cases management, sometimes with angioplasty and stenting, but also in specific areas of expertise e.g. sclerotherapy for vascular anomalies and arteriovenous malformations (AVMs), coil embolisation of bleeding visceral arteries in trauma or for occlusion of tumour supplying arteries as a prelude to operation, CT-guided procedures such as lumbar chemical sympathectomy.
Common medical associations are the involvement providing surgical opinions and treatment for a multidisciplinary clinic with vascular surgeons, vascular nurses, wound management nurses, podiatrists, prosthetists, rehabilition physicians, vascular physicians, endocrinologists, etc. to manage high risk foot disease patients.
Less common operative surgical associations are: sympathectomy (ETS
ETS
ETS is an abbreviation of:* Expiration, term of service, US Army* Euro Truck Simulator video game* The Elements of Typographic Style, a book on typography* Enterprise test software, software used by electronics manufacturers for product testing...
, Endoscopic thoracic sympathectomy
Endoscopic thoracic sympathectomy
Endoscopic thoracic sympathectomy is a surgical procedure where certain portions of the sympathetic nerve trunk are destroyed. ETS is used to treat hyperhidrosis, facial blushing, Raynaud's disease and reflex sympathetic dystrophy. By far the most common complaint treated with ETS is palmar...
), lumbar sympathectomy, Hyperhidrosis
Hyperhidrosis
Hyperhidrosis is the condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature.-Classification:Hyperhidrosis can either be generalized or localized to specific parts of the body...
surgery); vascular access for chemotherapy etc. patients; dialysis/ECMO (extra-corporeal membrane oxygenation) for patients in Intensive Care Wards; vascular mobilisation for access associated with other specialist operations e.g. extensive orthopaedic spinal and pelvic surgery, retroperitoneal cancer dissections, renal tumour surgery.
Vascular Surgery in the Third Millennium
Arterial and venous disease treatment by angiography, stenting, and non-operative varicose vein treatment sclerotherapySclerotherapy
Sclerotherapy is a procedure used to treat blood vessels or blood vessel malformations and also those of the lymphatic system. A medicine is injected into the vessels, which makes them shrink. It is used for children and young adults with vascular or lymphatic malformations...
, endovenous laser treatment
Endovenous laser treatment
Endovenous laser treatment is a minimally invasive ultrasound-guided technique used for treating varicose veins using laser energy.-Methods:...
are rapidly replacing major surgery in many first world countries. These newer procedures provide reasonable outcomes that are comparable to surgery with the advantage of short hospital stay (day or overnight for most cases) with lower morbidity and mortality rates.
The durability of endovascular arterial procedures is generally good especially when viewed in the context of their common clinical usage i.e. arterial disease occurring in elderly patients and usually associated with concurrent significant patient comorbidities especially ischaemic heart disease. The cost savings from shorter hospital stays and less morbidity are considerable but are somewhat balanced by the high cost of imaging equipment, construction and staffing of dedicated procedural suites, and of the implant devices themselves.
The benefits for younger patients and in venous disease are less persuasive but there are strong trends towards nonoperative treatment options driven by patient preference, health insurance company costs, trial demonstrating comparable efficacy at least in the medium term.
A recent trend in the USA is the stand-alone day angiography facility associated with a private vascular surgery clinic, thus allowing treatment of most arterial endovascular cases conveniently and possibly with lesser overall community cost.
Similar non-hospital treatment facilities for non-operative vein treatment have existed for some years and are now widespread in many countries.
An emerging trend based on such venous clinics is the treatment of varicose veins by non-vascular surgeons e.g. cosmetic physicians, phlebologists, radiologists, etc. These practices aim to offer a complete varicose and surface vein treatment without surgery.
Breadth of discipline
- Arterial diseases ( especially in Diabetics )
- AneurysmAneurysmAn aneurysm or aneurism is a localized, blood-filled balloon-like bulge in the wall of a blood vessel. Aneurysms can commonly occur in arteries at the base of the brain and an aortic aneurysm occurs in the main artery carrying blood from the left ventricle of the heart...
s - IschemiaIschemiaIn medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...
- Limb ischemia
- Acute limb ischemia
- Thrombectomies
- Embolectomies
- Anti-coagulation and ThrombolysisThrombolysisThrombolysis is the breakdown of blood clots by pharmacological means. It is colloquially referred to as clot busting for this reason...
- Chronic limb ischemia
- see intermittent claudicationIntermittent claudicationIntermittent claudication is a clinical diagnosis given for muscle pain , classically in the calf muscle, which occurs during exercise, such as walking, and is relieved by a short period of rest.Claudication derives from the Latin verb claudicare, "to limp".-Signs:One of the hallmarks of arterial...
and peripheral artery occlusive diseasePeripheral artery occlusive diseasePeripheral vascular disease , commonly referred to as peripheral arterial disease or peripheral artery occlusive disease , refers to the obstruction of large arteries not within the coronary, aortic arch vasculature, or brain. PVD can result from atherosclerosis, inflammatory processes leading to... - Diabetic foot ulcers
- see intermittent claudication
- Acute limb ischemia
- Mesenteric ischemia
- Renal ischemiaRenal IschemiaRenal ischemia or ischaemia, also called nephric ischemia is the deficiency of blood in one or both kidneys, or nephrons, usually due to functional constriction or actual obstruction of a blood vessel....
- Limb ischemia
- Extracranial cerebrovascular diseaseCerebrovascular diseaseCerebrovascular disease is a group of brain dysfunctions related to disease of the blood vessels supplying the brain. Hypertension is the most important cause; it damages the blood vessel lining, endothelium, exposing the underlying collagen where platelets aggregate to initiate a repairing process...
- Carotid EndarterectomyCarotid endarterectomyCarotid endarterectomy is a surgical procedure used to prevent stroke, by correcting stenosis in the common carotid artery...
and other carotid surgery - Surgery of the vertebral system
- Carotid Endarterectomy
- Aneurysm
- Venous disease
- Deep Vein ThrombosisDeep vein thrombosisDeep vein thrombosis is the formation of a blood clot in a deep vein. Deep vein thrombosis commonly affects the leg veins or the deep veins of the pelvis. Occasionally the veins of the arm are affected...
- ThrombophlebitisThrombophlebitisThrombophlebitis is phlebitis related to a thrombus . When it occurs repeatedly in different locations, it is known as "Thrombophlebitis migrans" or "migrating thrombophlebitis".-Signs and symptoms:...
- Varicose VeinsVaricose veinsVaricose veins are veins that have become enlarged and tortuous. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere. Veins have leaflet valves to prevent blood from flowing backwards . Leg muscles pump the veins to return blood to the heart, against the...
and Varicosities - Venous malformations
- Deep Vein Thrombosis
- Lymphatic disease
- Lymphoedema
- Vascular Medicine
- Medical disorders with a significant vascular component, for example:
- Raynaud's syndrome
- SclerodermaSclerodermaSystemic sclerosis or systemic scleroderma is a systemic autoimmune disease or systemic connective tissue disease that is a subtype of scleroderma.-Skin symptoms:...
- HyperhidrosisHyperhidrosisHyperhidrosis is the condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature.-Classification:Hyperhidrosis can either be generalized or localized to specific parts of the body...
- Medical disorders with a significant vascular component, for example:
- Migraine
Training
Previously considered a field within general surgeryGeneral surgery
General surgery, despite its name, is a surgical specialty that focuses on abdominal organs, e.g., intestines including esophagus, stomach, small bowel, colon, liver, pancreas, gallbladder and bile ducts, and often the thyroid gland . They also deal with diseases involving the skin, breast, soft...
, it is now considered a specialty in its own right. As a result, there are two pathways for training in the United States. Traditionally, a five year general surgery residency is followed by a 1-2 year (typically 2 years) vascular surgery fellowship. An alternative path is to perform a five or six year vascular surgery residency.
Programs of training are slightly different depending on the region of the world one is in.
| Country | Standards body | Professional representation | Minimum Length of training (post intern) |
|---|---|---|---|
| Australia Australia Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area... and New Zealand New Zealand New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga... |
Royal Australasian College of Surgeons Royal Australasian College of Surgeons The Royal Australasian College of Surgeons is the body responsible for training and examining surgeons in Australia and New Zealand. The head office of the College is in Melbourne, Australia.... |
Australian & New Zealand Society of Vascular Surgery (ANZSVS) | 6 years |
| United Kingdom United Kingdom The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages... |
Royal College of Surgeons of England Royal College of Surgeons of England The Royal College of Surgeons of England is an independent professional body and registered charity committed to promoting and advancing the highest standards of surgical care for patients, regulating surgery, including dentistry, in England and Wales... , Royal College of Surgeons of Edinburgh Royal College of Surgeons of Edinburgh The Royal College of Surgeons of Edinburgh is an organisation dedicated to the pursuit of excellence and advancement in surgical practice, through its interest in education, training and examinations, its liaison with external medical bodies and representation of the modern surgical workforce... |
Vascular Society of Great Britain and Ireland http://www.vascularsociety.org.uk/ | 8 years |
| USA | Accreditation Council for Graduate Medical Education Accreditation Council for Graduate Medical Education The Accreditation Council for Graduate Medical Education is the body responsible for the accreditation for graduate medical training programs for medical doctors in the United States. It is a non-profit private council that evaluates and accredits medical residency and internship programs... (ACGME), American Board of Surgery American Board of Surgery The American Board of Surgery is an independent, non-profit organization based in Philadelphia, Pennsylvania founded for the purpose of certifying surgeons who have met a defined standard of education, training and knowledge... |
American College of Surgeons American College of Surgeons The American College of Surgeons is an educational association of surgeons created in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice.-Membership:... Multiple vascular societies |
5 years ( 4 via 5-year integrated Vascular Surgery Residency) |
Research
Research in treating vascular disease is exploring new areas, such as minimally invasive techniques which are less risky and speed a patient's recovery time. Vascular surgeon Kenneth OurielKenneth Ouriel
Kenneth Ouriel is a prominent vascular surgeon and medical researcher. He has published widely in scientific and medical journals. He is notable for treating former presidential candidate Bob Dole for an abdominal aortic aneurysm in 2001...
studied methods like these as part of a National Institute of Health grant to study thrombosis; results from this large, multicenter randomized trial of clot busting therapy treatments were published in the New England Journal of Medicine
New England Journal of Medicine
The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...
in 1998.
Surgical procedures
By no means exhaustive, but below are a number of common procedures and indications for vascular surgeons.| Indication/disease | Procedure |
|---|---|
| Abdominal aortic aneurysm Abdominal aortic aneurysm Abdominal aortic aneurysm is a localized dilatation of the abdominal aorta exceeding the normal diameter by more than 50 percent, and is the most common form of aortic aneurysm... |
Open AAA repair Endovascular Aneurysm Repair Endovascular aneurysm repair EVAR which stands for Endovascular Aneurysm Repair , is a type of Endovascular surgery used to treat an abdominal aortic aneurysm or Thoracic Aortic Aneurysm, the procedure then specifically termed TEVAR... (EVAR) |
| Carotid stenosis | Carotid endarterectomy Carotid endarterectomy Carotid endarterectomy is a surgical procedure used to prevent stroke, by correcting stenosis in the common carotid artery... Carotid stenting Carotid stenting Carotid artery stenting is an endovascular, catheter-based procedure which unblocks narrowings of the carotid artery lumen to prevent a stroke. Carotid artery stenosis can present with no symptoms or with symptoms such as transient ischemic attacks or cerebrovascular accidents... |
| Varicose veins Varicose veins Varicose veins are veins that have become enlarged and tortuous. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere. Veins have leaflet valves to prevent blood from flowing backwards . Leg muscles pump the veins to return blood to the heart, against the... |
Vein stripping Vein stripping Vein stripping is a surgical procedure done under general or local anaesthetic to remove varicose veins. The surgery involves making one or more incisions upon the desired area followed by insertion of a special wire into the vein. The wire is tied to and advanced through the vein to a desired... Sclerotherapy Sclerotherapy Sclerotherapy is a procedure used to treat blood vessels or blood vessel malformations and also those of the lymphatic system. A medicine is injected into the vessels, which makes them shrink. It is used for children and young adults with vascular or lymphatic malformations... and Foam sclerotherapy Sclerotherapy Sclerotherapy is a procedure used to treat blood vessels or blood vessel malformations and also those of the lymphatic system. A medicine is injected into the vessels, which makes them shrink. It is used for children and young adults with vascular or lymphatic malformations... or Endovenous Laser Treatment Endovenous laser treatment Endovenous laser treatment is a minimally invasive ultrasound-guided technique used for treating varicose veins using laser energy.-Methods:... , radiofrequency vein ablation Ambulatory phlebectomy Ambulatory phlebectomy Ambulatory phlebectomy is a treatment for superficial varicose veins. The procedure involves the removal of the varicose veins through small 2–3 mm incisions in the skin overlying the veins. The procedure may be performed in hospital or outpatient settings... |
| Peripheral arterial occlusive disease | Angioplasty Angioplasty Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size... with/out Stenting Bypass surgery Coronary artery bypass surgery Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease... Endarterectomy Endarterectomy Endarterectomy is a surgical procedure to remove the atheromatous plaque material, or blockage, in the lining of an artery constricted by the buildup of soft/hardening deposits. It is carried out by separating the plaque from the arterial wall.... Atherectomy Atherectomy Atherectomy is a minimally invasive surgical method of removing, mainly, atherosclerosis from a large blood vessel within the body. Today, it is generally used to effectively treat peripheral arterial disease of the lower extremities... |
| Acute limb ischaemia | Balloon embolectomy Embolectomy Embolectomy is the emergency surgical removal of emboli which are blocking blood circulation. It usually involves removal of thrombi , and is then referred to as thrombectomy. Embolectomy is an emergency procedure often as the last resort because permanent occlusion of a significant blood flow to... Thrombectomy Bypass surgery Coronary artery bypass surgery Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease... |
| Aortic dissection Aortic dissection Aortic dissection occurs when a tear in the inner wall of the aorta causes blood to flow between the layers of the wall of the aorta and force the layers apart. The dissection typically extends anterograde, but can extend retrograde from the site of the intimal tear. Aortic dissection is a medical... |
Open repair Thoracic Endovascular Aneurysm Repair (TEVAR) |
Major Trials in Vascular Surgery
- Edinburgh Artery Study. *http://highwire.stanford.edu/cgi/searchresults?andortopics=and&pubdate_year=&volume=&firstpage=&author1=&author2=&title=&titleabstract=&fulltext=Edinburgh+Artery+Study+&andorexacttitle=and&andorexacttitleabs=&andorexactfulltext=and&src=ml&jc_favj=&fmonth=Jan&fyear=1812&tmonth=Oct&tyear=2208&flag=&RESULTFORMAT=1&hits=10&hitsbrief=&sortspec=relevance&sortspecbrief=&resourcetype=1&tdatedef=24+Oct+2008&fdatedef=1+January+1812&Highwire results for Edinburgh Artery Study]- Netherland Vascular Study.
- Framingham heart study. http://highwire.stanford.edu/cgi/searchresults?andortopics=and&pubdate_year=&volume=&firstpage=&author1=&author2=&title=&titleabstract=&fulltext=framingham+heart+study&andorexacttitle=and&andorexacttitleabs=&andorexactfulltext=and&src=ml&jc_favj=&fmonth=Jan&fyear=1812&tmonth=Oct&tyear=2208&flag=&RESULTFORMAT=1&hits=10&hitsbrief=&sortspec=relevance&sortspecbrief=&resourcetype=1&tdatedef=24+Oct+2008&fdatedef=1+January+1812&Highwire results for Framingham heart Study]
- MASS Trial. – the Multicentre Aneurysm Screening Study (MASS) trial. Four centres (about 7000 men); screening (and treatment) vs. control group. AAA-related mortality in the screening arm reduced by about 40%; emergency ruptured AAA reducted by about 70%; disruption to elective work was reduced; and better management of risk factors and ITU/HDU beds. The overall survival benefits remain difficult to estimate, nevertheless, screening for AAA is recommended [level of recommendation: B].
- UK Small Aneurysm Trial: 1090 patients; AAA 4-5.5 cm; Immediate surgery vs. ultrasound surveillance (and treatment for rapid expansion or AAA >5.5); 30-day mortality after elective AAA repair is 5.8%. No difference in survival.
- ADAM VA Cooperative Group Trial. 73451 VA patients screened with no known hx of aneurysm; Age 50-79; AAA 4.0-5.4 cm; similar conclusion to Uk Small Aneurysm Trial.
- Joint Vascular Research Group Trial. 284 patients; Study the relationship between intraoperative intravenous heparinisation, blood loss during surgery and thrombotic complications. Conclusion: Intraoperative heparin, given before aortic cross clamping, is an important prophylaxic against perioperative MI in aortic aneurysm surgery.
- HOPE (Heart Outcomes Prevention Evaluation) study - 4046 patients with PAD. In this subgroup, there was a 22% risk reduction in patients randomized to ramipril
Ramipril
Ramipril is an angiotensin-converting enzyme inhibitor, used to treat high blood pressure and congestive heart failure.-Mechanism of action:ACE inhibitors lower the...
compared with placebo,which was independent of lowering of blood pressure.
External links
- Society for Vascular Surgery (U.S.)
- European Journal of Vascular and Endovascular Surgery: the official journal of the European Society for Vascular Surgery.