Vascular Surgery for Artery and Vein Disease

Overview

Vascular (vein) surgery is performed to diagnose and treat conditions that affect the arteries, veins and lymph vessels. These conditions can include hardening of the arteries, a blockage or a rupture. Vascular surgeons have extra training in diseases that affect the vascular system and expertise in blood vessel surgery. Vascular surgeons are trained in open surgery, minimally invasive approaches and endovascular procedures. 

Types of vascular surgery include:

• Angioplasty
• Aortic stent graft repair
• Atherectomy
• Balloon embolectomy
• Carotid endarterectomy
• Carotid stenting
• Catheter-directed thrombolysis
• Endovascular aortic stent graft repair, or endovascular aneurysm repair (EVAR)
• Inferior vena cava filter
• Open aortic surgery
• Repair of aneurysms of the aorta
• Stenting
• Thoracic endovascular aneurysm repair (TEVAR)
• Thrombectomy

Candidates for vascular surgery

If you have a health condition that affects your veins and medications alone haven’t been enough to manage the condition, your physician may recommend vascular surgery. Many different vascular conditions could require surgery, including:

• Abdominal aortic aneurysm
• Aortic dissection
• Atherosclerosis
• Carotid artery disease
• Chronic venous insufficiency
• Deep vein thrombosis
• Diabetic wounds or ulcers
• Peripheral aneurysm
• Peripheral arterial disease
• Peripheral artery disease
• Spider veins
• Stroke
• Thoracic outlet syndrome
• Trauma to your veins due to accidents or injuries
• Varicose veins
• Venous ulcers

Expectations from vascular surgery

Most types of vascular surgery are performed in an operating room or lab at a hospital. You will be under general anesthesia (fully asleep) for these procedures. In many cases, vascular surgeons use minimally invasive techniques to perform surgery. With minimally invasive surgery, you will generally have smaller incisions (cuts) and a shorter downtime following surgery.

Types of vascular surgery

Heart surgeons perform a full range of advanced surgeries, including minimally invasive robotic-assisted surgery, open surgery and off-pump (beating heart) surgery. When minimally invasive approaches aren’t  possible, cardiovascular surgeons can perform the most advanced open surgeries, including:

• Aortic stent graft repair - A procedure where your surgeon reinforces the wall of the aorta, a major blood vessel, to keep the area from rupturing and causing damage. The surgeon places a stent (hollow tube made of surgical mesh or plastic) to keep the aorta open, so blood can flow through.
• Balloon embolectomy - A procedure to treat a blood clot. Your surgeon threads a catheter (thin, flexible tube) through your vein. Once in place, the surgeon inflates a tiny balloon on the end of the catheter. The balloon opens up the vein and removes the clot with it as your surgeon pulls the catheter back out of your body.
• Carotid stenting - A procedure performed when your carotid artery is narrowed or blocked. Stenting may be used to open the artery. In this procedure, your surgeon places a stent (hollow tube made of plastic or mesh) in the blocked area to permanently hold the artery open so that blood can flow through.
• Catheter-directed thrombolysis - A procedure to treat blocked veins and helps to improve blood flow. During this procedure, your surgeon uses X-ray images and specialized equipment to break up and dissolve the blockages in your veins.
• Endovascular aneurysm repair (EVAR) - Performed if you have an aortic aneurysm (weak area in the aorta, a major blood vessel). During this procedure, your surgeon places a stent (hollow tube) to reinforce the area with the aneurysm. This helps to prevent further damage and risk of rupture.
• Inferior vena cava filter (IVC) - Performed on the largest vein in the body. This vein carries blood from the lower body up to your heart and lungs. If you develop a blood clot in your IVC and cannot take blood-thinning medications, you may need a filter placed to prevent the clot from moving into your lungs. For this procedure, your surgeon uses image-guidance to place the filter in your IVC. The entire IVC filer placement procedure only takes about 30 minutes.
• Open aortic surgery - A surgery performed if you have a condition affecting your aorta (major blood vessel of the heart) and you cannot undergo minimally invasive surgery. For this procedure, your surgeon will access your heart using a larger incision (cut) across your chest. Depending on the exact type of surgery you need, open aortic surgery takes anywhere from 3 to 6 hours. After the procedure, your surgeon closes the incision with stitches and a bandage.
• Thoracic endovascular aneurysm repair (TEVAR) - A minimally invasive procedure to repair damage to the aorta, a major blood vessel that carries blood from the heart out to the rest of the body. During this procedure, your surgeon makes several small incisions (cuts) near your cut. The surgeon uses these incisions to access your aorta. During the TEVAR, your surgeon uses a specialized viewing monitor to see inside your body. On average, a TEVAR procedure typically takes about 2 hours to complete.
• Thrombectomy - Used to treat a blood clot inside a vein or artery. During this procedure, the surgeon removes the clot and repairs the blood vessel. In some cases, the surgeon may use a tiny balloon on the end of a catheter (thin, flexible tube) to open up (dilate) a narrowed blood vessel. Once the thrombectomy is complete, your surgeon will remove the surgical tools and close your incisions with bandages.

Recovery from vascular surgery

After vascular surgery, you generally spend several hours in a post-surgical recovery area. During this time, the team closely monitors you as the effects of anesthesia wear off. Depending on the type of surgery you undergo, you may spend some time in the intensive care unit (ICU) or you may go directly to a typical hospital room for your hospital stay. Your recovery time will vary based on the type of surgery you undergo and your exact situation. Your surgical team will provide you details on when you can resume your normal activities, including work or school.

When to seek care

If you think you may need to undergo vascular surgery, start by voicing your concerns and symptoms to your primary care provider. From there, your doctor may suggest seeing a cardiologist for more specialized treatment.