Definition and Overview
A vascular surgery is a life-saving surgical procedure that is performed in any part of the vascular or circulatory system to treat certain diseases including stroke and aneurysm. To understand why it is sometimes performed, one must know how the vascular system works.
The blood is one of the most important components of the body since it transports the nutrients to different cells. Serving as “highways” are the different parts of the circulatory system namely the arteries, veins, and capillaries (or collectively known as blood vessels).
The arteries are the ones that bring blood from the heart to various parts of the body. The blood then goes back to the heart through the veins. In between them are capillaries that deliver blood to other parts.
The system also includes the heart, which is its “central” component, a hollow muscular organ found in between the lungs, and it pumps blood in between chambers. The lymphatic system works alongside the vascular system since the lymphs are composed of blood and water. Its job is to keep the lymphatic fluid in the right amount by constantly draining it.
Sometimes, however, any or multiple parts of these systems are affected due to:
Unhealthy lifestyle – smoking and eating unhealthy food can increase the risk of stenosis (blockage of the blood vessels) as plaques build up on the walls.
Old age – as a person ages, he or she becomes more at risk of developing vascular-related disease including stroke and aneurysm.
Injury that can cause physical trauma on any of the parts of the body
Presence of other existing diseases such as cancer and diabetes
To treat, eliminate, manage, or delay the disease, vascular surgery may have to be performed.
Who Needs It and Expected Results
People who have been diagnosed with a vascular-related disease, especially if it has already progressed or has worsened, may be advised to undergo a surgery. These conditions include but are not limited to:
- Brain or stomach aneurysm
- Peripheral artery disease
- Deep vein thrombosis
- Transient ischemic attacks
- Varicose and spider veins
- Pulmonary embolism
- Stenosis of the valves and blood vessels
- Insufficient oxygen intake
- Hyperlipidemia (high cholesterol and/or triglycerides)
Those who have been diagnosed with diabetes or obesity may also be likely to undergo vascular surgery due to the complications of these diseases. For instance, diabetes can lead to neuropathy or nerve damage. As the nerves and blood vessels deteriorate, the amount of oxygen and nutrients the tissues receive decreases. This will then lead to the death of the tissue, a condition called necrosis.
On the other hand, obesity is now considered the cause of metabolic syndrome, a series of conditions that increase the risk of hypertension, cardiovascular disease, and even cancer, all of which can have a strong negative impact on the vascular system.
Vascular surgery is performed for different reasons. Sometimes the main objective is to delay or eliminate the problem. A good example is the addition of a stent in between the walls of the arteries or veins to prevent hypertension by allowing a more efficient blood flow.
It can also be performed to control or manage the symptoms of a more complicated underlying disease. For instance, lymphedema is a common consequence of mastectomy, one of the standard treatments for breast cancer. This can be treated through the removal of all or partial lymph nodes.
How Is It Done?
A patient who is suspected of having a medical condition that affects the vascular system will have to go through a series of tests. The most popular is called electrocardiography (ECG or EKG), an exam that measures the electrical activity of the heart. It uses electrodes that are attached to the body and a transducer that delivers sound waves. The body then reacts to the sound waves by bouncing them off. This “communication” is translated by a machine, which then creates an image.
Another possible test is angiography (or angiogram), which determines the presence of any blockage or narrowing of the blood vessels that may lead to thrombosis or aneurysm. This involves catheterization (insertion of the catheter) to introduce a contrast dye. The dye then allows the areas of concern to appear more clearly during an imaging test. The doctor may also request for a CT, PET, or MRI scan, as well as other ultrasounds. Standard exams such as physical and medical history will also be carried out.
Depending on the findings, the doctor may recommend a minimally invasive or an open surgical procedure. An open surgery uses a huge incision usually in between the chest while a minimally invasive operation utilizes a few small incisions and a probe such as endoscope or laparoscope. These instruments allow doctors to see in real time the exact condition of the blood vessels or the organs. Then, they operate using very small surgical tools.
Risks and Complications
Compared to other surgeries, operations performed on the vascular system possess a higher risk. These procedures can touch on major or vital organs such as the abdomen, brain, and heart. Due to the small size of certain blood vessels, it certainly is possible to cause damage to the healthy ones, further complicating the health issue.
Also, recovery time usually takes longer, especially if the procedure is complex or open surgery. Bruising and swelling are expected within the next 24 hours or a few days (depending on the extent of the surgery). The one thing the patient should watch out for is bleeding. Not all types of bleeding can be seen (a condition called internal bleeding), so it’s essential that patients follow after-care instructions and for doctors to continuously monitor the patient’s progress.
Some operations such as carotid endarterectomy can cause either brain damage or stroke, or sometimes it mimics the latter. Meanwhile, nerve injuries can affect not only the central area but also other parts of the body since the vascular system operates like a vast network. For instance, if a nerve in the spine is damaged, the patient may not be able to use his or her limbs.
- National Heart Lung and Blood Institute web site. "What is the heart?" Accessed Dec. 15, 2011.
- Neschis DG. The cardiovascular system. In: Bope ET, Kellerman R, eds. Conn's Current Therapy 2012. 1st ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 7.