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Vascular surgery is a surgical subspecialty in which
vascular disease Vascular disease is a class of diseases of the vessels of the circulatory system in the human body, body, including blood vessels – the arteries and veins, and the lymphatic vessels. Vascular disease is a subgroup of cardiovascular disease. Diso ...
s involving the
arteries An artery () is a blood vessel in humans and most other animals that takes oxygenated blood away from the heart in the systemic circulation to one or more parts of the body. Exceptions that carry deoxygenated blood are the pulmonary arteries in ...
,
vein Veins () are blood vessels in the circulatory system of humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and feta ...
s, or
lymphatic vessels The lymphatic vessels (or lymph vessels or lymphatics) are thin-walled vessels (tubes), structured like blood vessels, that carry lymph. As part of the lymphatic system, lymph vessels are complementary to the cardiovascular system. Lymph vessel ...
, are managed by medical therapy, minimally-invasive catheter procedures and surgical reconstruction. The specialty evolved from
general A general officer is an Officer (armed forces), officer of high rank in the army, armies, and in some nations' air force, air and space forces, marines or naval infantry. In some usages, the term "general officer" refers to a rank above colone ...
and cardiovascular surgery where it refined the management of just the vessels, no longer treating the heart or other organs. Modern vascular surgery includes open surgery techniques, endovascular (minimally invasive) techniques and medical management of vascular diseases - unlike the parent specialities. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system excluding the coronaries and intracranial vasculature. Vascular surgeons also are called to assist other physicians to carry out surgery near vessels, or to salvage vascular injuries that include hemorrhage control, dissection, occlusion or simply for safe exposure of vascular structures.


History

Early leaders of the field included Russian surgeon
Nikolai Korotkov Nikolai Sergeyevich Korotkov, also Korotkoff (; – 14 March 1920) was a Russian Empire, Russian surgeon, a pioneer of 20th-century vascular surgery, and the inventor of auscultatory technique for blood pressure, blood pressure measurement. B ...
, noted for developing early surgical techniques, American
interventional radiologist Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs both ...
Charles Theodore Dotter Charles Theodore Dotter (14 June 1920 – 15 February 1985) was a pioneering American radiologist who is credited with developing interventional radiology. Dotter, with his trainee Dr Melvin P. Judkins, described angioplasty in 1964. Dotter rec ...
who is credited with inventing minimally invasive angioplasty (1964), and Australian Robert Paton, who helped the field achieve recognition as a specialty. 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 most notable historic figure in vascular surgery is the 1912 Nobel Prize winning surgeon, Alexis Carrel for his techniques used to suture vessels.


Evolution

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 like Dr.
Charles Dotter Charles Theodore Dotter (14 June 1920 – 15 February 1985) was a pioneering American radiologist who is credited with developing interventional radiology. Dotter, with his trainee Dr Melvin P. Judkins, described angioplasty in 1964. Dotter rec ...
, who invented angioplasty using serial dilatation of vessels. The surgeon Dr. Thomas J. Fogarty invented a
balloon catheter A balloon catheter is a type of "soft" catheter with an inflatable "balloon" at its tip which is used during a catheterization procedure to enlarge a narrow opening or passage within the Human body, body. The deflated balloon catheter is position ...
, designed to remove clots from occluded vessels, which was used as the eventual model to do endovascular angioplasty. Further development of the field has occurred via joint efforts between
interventional radiology Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as Fluoroscopy, x-ray fluoroscopy, CT scan, computed tomography, magnetic resonance imaging, or ultraso ...
, vascular surgery, and
interventional cardiology Interventional cardiology is a branch of cardiology that deals specifically with the catheter based treatment of structural heart diseases. Andreas Gruentzig is considered the father of interventional cardiology after the development of angioplast ...
. 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 (e.g., EVAR,
carotid stenting Carotid artery stenting is an endovascular procedure where a stent is deployed within the lumen of the carotid artery to treat narrowing of the carotid artery and decrease the risk of stroke. It is used to treat narrowing of the carotid artery i ...
) can now form the bulk of a vascular surgeon's practice. The treatment of the aorta, the body's largest artery, dates back to Greek surgeon Antyllus, who first performed surgeries for various aneurysms in the second century AD. Modern treatment of aortic diseases stems from development and advancements from
Michael DeBakey Michael Ellis DeBakey (September 7, 1908 – July 11, 2008) was an American general and cardiovascular surgeon, scientist and medical educator who became Chairman of the Department of Surgery, President, and Chancellor of Baylor College of Medi ...
and Denton Cooley. In 1955, DeBakey and Cooley performed the first replacement of a thoracic aneurysm with a homograft. In 1958, they began using the
Dacron Polyethylene terephthalate (or poly(ethylene terephthalate), PET, PETE, or the obsolete PETP or PET-P), is the most common thermoplastic polymer resin of the polyester family and is used in fibres for clothing, containers for liquids and foods ...
graft, resulting in a revolution for surgeons in the repair of aortic aneurysms. He also was first to perform cardiopulmonary bypass to repair the ascending aorta, using antegrade perfusion of the brachiocephalic artery. Dr. Ted Diethrich, one of Dr. DeBakey's associates, went on to pioneer many of the
minimally invasive Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by definitio ...
techniques that later became hallmarks of endovascular surgery. Dietrich later founded the Arizona Heart Hospital in 1998 and served as its medical director from 1998 to 2010. In 2000, Diethrich performed the first endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm. Dietrich trained several future leaders in the field of endovascular surgery at the Arizona Heart Hospital including Venkatesh Ramaiah, MD who succeeded him as medical director of the institution in 2010. The development of endovascular surgery has been accompanied by a gradual separation of vascular surgery from its origin in
general surgery General surgery is a Surgical specialties, surgical specialty that focuses on alimentary canal and Abdomen, abdominal contents including the esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, Appendix (anatomy ...
. Most vascular surgeons would now confine their practice to vascular surgery and, similarly, general surgeons would not be trained or practise the larger vascular surgery operations or most endovascular procedures. More recently, professional vascular surgery societies and their training program have formally separated vascular surgery into a separate specialty with its own training program, meetings and accreditation. Notable societies are
Society for Vascular Surgery A society () is a group of individuals involved in persistent social interaction or a large social group sharing the same spatial or social territory, typically subject to the same political authority and dominant cultural expectations. ...
(SVS), USA; Australia and New Zealand Society of Vascular Surgeons (ANZSVS). Local societies also exist (e.g., New South Wales Vascular and Melbourne Vascular Surgical Association (MVSA)). Larger societies of surgery actively separate and encourage specialty surgical societies under their umbrella (e.g.,
Royal Australasian College of Surgeons The Royal Australasian College of Surgeons (RACS) is the leading advocate for surgical standards, professionalism and surgical education in Australia and New Zealand. Known by its common acronym RACS, it is a not-for-profit organisation, supp ...
(RACS)).


Currently

Arterial and venous disease treatment by
angiography Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and the heart chambers. Modern angiography is perfo ...
,
stenting In medicine, a stent is a tube usually constructed of a metallic alloy or a polymer. It is inserted into the lumen (hollow space) of an anatomic vessel or duct to keep the passageway open. Stenting refers to the placement of a stent. The wor ...
, and non-operative varicose vein treatment
sclerotherapy Sclerotherapy (the word reflects the Greek ''skleros'', meaning ''hard'') is a procedure used to treat blood vessel malformations ( vascular malformations) and also malformations of the lymphatic system. A medication is injected into the vessels ...
,
endovenous laser treatment Endovenous laser treatment (ELT) is a minimally invasive ultrasound-guided technique used for treating varicose veins using laser energy commonly performed by a phlebologist, interventional radiologist or vascular surgeon. Methods Endovenous las ...
have largely replaced major surgery in many first world countries. These 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. Historically performed by interventional radiologists, vascular surgeons have become increasingly proficient with endovascular methods. 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 ischemic 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 United States 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.
NHS England NHS England, formally the NHS Commissioning Board for England, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning si ...
conducted a review of all 70 vascular surgery sites across England in 2018 as part of its Getting It Right First Time programme. The review specified that vascular hubs should perform at least 60 abdominal aortic aneurysm procedures and 40 carotid endarterectomies a year. 12 trusts missed both targets and many more missed one of them. A programme of concentrating vascular surgery in fewer centres is proceeding. Vascular surgery encompasses surgery of the
aorta The aorta ( ; : aortas or aortae) is the main and largest artery in the human body, originating from the Ventricle (heart), left ventricle of the heart, branching upwards immediately after, and extending down to the abdomen, where it splits at ...
,
carotid arteries In anatomy, the left and right common carotid arteries (carotids) () are arteries that supply the head and neck with oxygenated blood; they divide in the neck to form the external and internal carotid arteries. Structure The common carotid ...
, and lower extremities, including the iliac, femoral, vascular trauma and tibial arteries. Vascular surgery also involves surgery of veins, for conditions such as
May–Thurner syndrome May–Thurner syndrome (MTS), also known as the iliac vein compression syndrome, is a condition in which compression of the common venous outflow tract of the left lower extremity may cause discomfort, swelling, pain or iliofemoral deep vein thro ...
and for
varicose veins Varicose veins, also known as varicoses, are a medical condition in which superficial veins become enlarged and twisted. Although usually just a cosmetic ailment, in some cases they cause fatigue, pain, itch, itching, and cramp, nighttime leg cram ...
. In some regions, vascular surgery also includes dialysis access surgery and transplant surgery.


Management of arterial diseases

The management of arterial pathology excluding coronary and intracranial disease is within the scope of vascular surgeons. Disease states generally arise from narrowing of the arterial system known as
stenosis Stenosis () is the abnormal narrowing of a blood vessel or other tubular organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture). ''Stricture'' as a term is usually used when narrowing ...
or abnormal dilation referred to as an
aneurysm An aneurysm is an outward :wikt:bulge, bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel wall. Aneurysms may be a result of a hereditary condition or an acquired disease. Aneurysms can also b ...
. There are multiple mechanisms by which the arterial lumen can narrow, the most common of which is
atherosclerosis Atherosclerosis is a pattern of the disease arteriosclerosis, characterized by development of abnormalities called lesions in walls of arteries. This is a chronic inflammatory disease involving many different cell types and is driven by eleva ...
. Symptomatic stenosis may also result from a complication of arterial dissection. Other less common causes of stenosis include fibromuscular dysplasia, radiation induced fibrosis or cystic adventitial disease. Dilation of an artery which retains histologic layers is called an aneurysm. An aneurysms can be fusiform (concentric dilation), saccular (outpouching) or a combination of the two. Arterial dilation which does not contain three histologic layers is considered a
pseudoaneurysm A pseudoaneurysm, also known as a false aneurysm, is a locally contained hematoma outside an artery or the heart due to damage to the vessel wall. The injury passes through all three layers of the arterial wall, causing a leak, which is contai ...
. Additionally, there are a number of congenital vascular anomalies which lead to symptomatic disease that are managed by the vascular surgeon, a few of which include
aberrant subclavian artery Aberrant subclavian artery, or aberrant subclavian artery syndrome, is a rare anatomical variant of the origin of the right or left subclavian artery. This abnormality is the most common Congenital disorder, congenital Blood vessel, vascular anoma ...
,
popliteal artery entrapment syndrome The popliteal artery entrapment syndrome (PAES) is an uncommon pathology that occurs when the popliteal artery is compressed by the surrounding popliteal fossa myofascial structures. This results in claudication and chronic leg ischemia. This con ...
or persistent sciatic artery. Vascular surgeons treat arterial diseases with a range of therapies including lifestyle modification, medications, endovascular therapy and surgery.


Aneurysms


Aortic aneurysms

;Abdominal An
abdominal aortic aneurysm Abdominal aortic aneurysm (AAA) is a localized enlargement of the abdominal aorta such that the diameter is greater than 3 cm or more than 50% larger than normal. An AAA usually causes no symptoms, except during rupture. Occasionally, abdo ...
(AAA) refers to aneurysmal dilation of the aorta confined to the abdominal cavity. Most commonly, aneurysms are asymptomatic and located in the infrarenal position. Often, they are discovered incidentally or on screening exams in patients with risk factors such as a history of smoking. Patients with aneurysms which have a diameter less than 5 cm are at <1% rupture risk per year. When the aneurysm meets size criteria it can be treated with aortic replacement or EVAR. ;Thoracic
Thoracic aortic aneurysm A thoracic aortic aneurysm is an aortic aneurysm that presents primarily in the thorax. A thoracic aortic aneurysm is the "ballooning" of the upper aspect of the aorta, above the diaphragm. Untreated or unrecognized they can be fatal due to dissec ...
s are contained in the chest. Aneurysms of the descending aorta can often be treated with thoracic endovascular aortic repair or TEVAR. Treating aneurysms which involve the ascending aorta are generally within the scope of cardiac surgeons, but upcoming endovascular technology may allow for a more minimally invasive approach in some patients. ;Thoracoabdominal Thoroacoabdominal aneurysms are those which span the chest and abdominal cavities. The Crawford classification was developed and describes five types of thoracoabdominal aneurysms. File:AAA-X4.jpg, Abdominal aortic aneurysms can be classified as infrarenal, juxtarenal, pararenal or suprarenal as depicted in the illustration. File:D3ON0p6B.jpg, The Crawford Classification (Extent I-IV) and the Safi modification (Extent V) for thoracoabdominal aortic aneurysms is pictured above.


Other arterial aneurysms

In addition to treating aneurysms which arise from the
aorta The aorta ( ; : aortas or aortae) is the main and largest artery in the human body, originating from the Ventricle (heart), left ventricle of the heart, branching upwards immediately after, and extending down to the abdomen, where it splits at ...
, vascular surgeons also treat aneurysms elsewhere in the body. ;Visceral arteries Visceral artery aneurysms include those isolated to the
renal artery The renal arteries are paired arteries that supply the kidneys with blood. Each is directed across the crus of the diaphragm, so as to form nearly a right angle. The renal arteries carry a large portion of total blood flow to the kidneys. Up to ...
, splenic artery,
celiac artery The celiac () artery (also spelled coeliac in British English), also known as the celiac trunk or truncus coeliacus, is the first major branch of the abdominal aorta. It is about 1.25 cm in length. Branching from the aorta at thoracic verte ...
, and
hepatic artery The common hepatic artery is a short blood vessel that supplies oxygenated blood to the liver, pylorus of the stomach, duodenum, pancreas, and gallbladder. It arises from the celiac artery and has the following branches: Additional images ...
. Of these, data shows that splenic artery aneurysms are the most common. Indications for repair differ slightly between arteries. For instance, current guidelines recommend repair of renal and splenic artery aneurysms greater than 3 cm, and those of any size in women of childbearing age; whereas celiac and hepatic artery aneurysms are indicated for repair when their size is greater than 2 cm. This is in contrast to superior mesenteric artery aneurysms which should be repaired regardless of size when they are discovered. ;Popliteal artery A popliteal artery aneurysm is an arterial aneurysm localized in the
popliteal artery The popliteal artery is a deeply placed continuation of the femoral artery opening in the distal portion of the adductor magnus muscle. It courses through the popliteal fossa and ends at the lower border of the popliteus muscle, where it branche ...
which courses behind the
knee In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia (tibiofemoral joint), and one between the femur and patella (patellofemoral joint). It is the largest joint in the hu ...
. Unlike aneurysms located in the abdomen, popliteal artery aneurysm rarely present with rupture but rather with symptoms of
acute limb ischemia Acute limb ischaemia (ALI) occurs when there is a sudden lack of blood flow to a limb within 14 days of symptoms onset. On the other hand, when the symptoms exceed 14 days, it is called critical limb ischemia (CLI). CLI is the end stage of perip ...
due to embolization of thrombus. Thus, when a patient presents with an asymptomatic popliteal aneurysm that is greater than 2 cm in diameter a vascular surgeon are able to offer vascular bypass or endovascular exclusion depending on several factors.


Arterial dissections

The artery wall is composed of three concentric layers: the
intima The tunica intima (Neo-Latin "inner coat"), or intima for short, is the innermost tunica (layer) of an artery or vein. It is made up of one layer of endothelial cells (and macrophages in areas of disturbed blood flow), and is supported by an int ...
,
media Media may refer to: Communication * Means of communication, tools and channels used to deliver information or data ** Advertising media, various media, content, buying and placement for advertising ** Interactive media, media that is inter ...
and
adventitia The adventitia ( ) is the outer layer of fibrous connective tissue surrounding an organ. The outer layer of connective tissue that surrounds an artery, or vein – the tunica externa, is also called the ''tunica adventitia''. To some degree, i ...
. In general, an arterial dissection is a tear in the innermost layer of the arterial wall that makes a separation which allows blood to flow, and collect, between the layers. Arterial dissections include: an
aortic dissection Aortic dissection (AD) occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. In most cases, this is associated with a sudden onset of agonizing ches ...
(
aorta The aorta ( ; : aortas or aortae) is the main and largest artery in the human body, originating from the Ventricle (heart), left ventricle of the heart, branching upwards immediately after, and extending down to the abdomen, where it splits at ...
), a
coronary artery dissection Spontaneous coronary artery dissection (SCAD) is an uncommon but potentially lethal condition in which one of the coronary arteries that supply the heart, spontaneously develops a blood collection, or hematoma, within the artery wall due to a tea ...
(
coronary artery The coronary arteries are the arterial blood vessels of coronary circulation, which transport oxygenated blood to the heart muscle. The heart requires a continuous supply of oxygen to function and survive, much like any other tissue or organ of ...
), two types of
cervical artery dissection Cervical artery dissection is dissection of one of the layers that compose the carotid and vertebral artery in the neck (cervix). They include: * Carotid artery dissection, a separation of the layers of the artery wall supplying oxygen-bearing bloo ...
involving one of the arteries in the neck – a
carotid artery dissection Carotid artery dissection is a serious condition in which a tear forms in one of the two main carotid arteries in the neck, allowing blood to enter the artery wall and separate its layers (dissection). This separation can lead to the formation of ...
(
carotid artery Carotid artery may refer to: * Common carotid artery, often "carotids" or "carotid", an artery on each side of the neck which divides into the external carotid artery and internal carotid artery * External carotid artery, an artery on each side of ...
), and a
vertebral artery dissection Vertebral artery dissection (VAD) is a flap-like tear of the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. After the tear, blood enters the arterial wall and forms a blood clot, thickening t ...
(
vertebral artery The vertebral arteries are major artery, arteries of the neck. Typically, the vertebral arteries originate from the subclavian arteries. Each vessel courses superiorly along each side of the neck, merging within the skull to form the single, m ...
), a pulmonary artery dissection is an extremely rare condition as a complication of chronic
pulmonary hypertension Pulmonary hypertension (PH or PHTN) is a condition of increased blood pressure in the pulmonary artery, arteries of the lungs. Symptoms include dypsnea, shortness of breath, Syncope (medicine), fainting, tiredness, chest pain, pedal edema, swell ...
. Whereas cardiac surgeons are usually in charge of managing type A dissections, type B dissections are typically managed by vascular surgeons. The most common risk factor for type B aortic dissection is
hypertension Hypertension, also known as high blood pressure, is a Chronic condition, long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High blood pressure usually does not cause symptoms i ...
. The first line treatment for type B aortic dissection is aimed at reducing both
heart rate Heart rate is the frequency of the cardiac cycle, heartbeat measured by the number of contractions of the heart per minute (''beats per minute'', or bpm). The heart rate varies according to the body's Human body, physical needs, including the nee ...
and
blood pressure Blood pressure (BP) is the pressure of Circulatory system, circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term ...
and is referred to as anti-impulse therapy. Should initial medical management fail or there is the involvement of a major branch of the aorta, vascular surgery may be needed for these type B dissections. Treatment may include thoracic endovascular aortic repair (TEVAR) with or without extra-anatomic bypass such as carotid-carotid bypass, carotid-subclavian bypass, or subclavian-carotid transposition.


Visceral artery dissection

Visceral artery dissections are arterial dissections involving the
superior mesenteric artery In human anatomy, the superior mesenteric artery (SMA) is an artery which arises from the anterior surface of the abdominal aorta, just inferior to the origin of the celiac trunk, and supplies blood to the intestine from the lower part of the ...
,
celiac artery The celiac () artery (also spelled coeliac in British English), also known as the celiac trunk or truncus coeliacus, is the first major branch of the abdominal aorta. It is about 1.25 cm in length. Branching from the aorta at thoracic verte ...
,
renal arteries The renal arteries are paired arteries that supply the kidneys with blood. Each is directed across the crus of the diaphragm, so as to form nearly a right angle. The renal arteries carry a large portion of total blood flow to the kidneys. Up to a ...
,
hepatic artery The common hepatic artery is a short blood vessel that supplies oxygenated blood to the liver, pylorus of the stomach, duodenum, pancreas, and gallbladder. It arises from the celiac artery and has the following branches: Additional images ...
and others. When they are an extension of an aortic dissection, this condition is managed simultaneously with aortic treatment. In isolation, visceral artery dissections are discovered incidentally in up to a third of patients and in these cases may be managed medically by a vascular surgeon. In cases where the dissection results in organ damage it is generally accepted by vascular surgeons that surgery is necessary. Surgical management strategies depend on the associated complications, surgical ability and patient preference.


Mesenteric ischemia

Mesenteric ischemia results from the acute or chronic obstruction of the
superior mesenteric artery In human anatomy, the superior mesenteric artery (SMA) is an artery which arises from the anterior surface of the abdominal aorta, just inferior to the origin of the celiac trunk, and supplies blood to the intestine from the lower part of the ...
(SMA). The SMA arises from the abdominal aorta and usually supplies blood from the distal
duodenum The duodenum is the first section of the small intestine in most vertebrates, including mammals, reptiles, and birds. In mammals, it may be the principal site for iron absorption. The duodenum precedes the jejunum and ileum and is the shortest p ...
through two-thirds of the
transverse colon In human anatomy, the transverse colon is the longest and most movable part of the Large intestine#Structure, colon. Anatomical position It crosses the abdomen from the ascending colon at the right colic flexure (hepatic flexure) with a downward ...
and the
pancreas The pancreas (plural pancreases, or pancreata) is an Organ (anatomy), organ of the Digestion, digestive system and endocrine system of vertebrates. In humans, it is located in the abdominal cavity, abdomen behind the stomach and functions as a ...
.


Chronic mesenteric ischemia

The symptoms of chronic mesenteric ischemia can be classified as abdominal angina which is abdominal pain which occurs a fixed period of time after eating. Due to this, patient's may avoid eating, resulting in unintended weight loss. The first surgical treatment is thought to be performed by R.S. Shaw and described in the
New England Journal of Medicine ''The New England Journal of Medicine'' (''NEJM'') is a weekly medical journal published by the Massachusetts Medical Society. Founded in 1812, the journal is among the most prestigious peer-reviewed medical journals. Its 2023 impact factor was ...
in 1958. The procedure Shaw described is referred to as mesenteric
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 deposits. It is carried out by separating the plaque from the arterial wall. It was firs ...
. Since then, many advances in treatment have been made in minimally invasive,
endovascular Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs bot ...
techniques including
angioplasty Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty, is a minimally invasive procedure, minimally invasive endovascular surgery, endovascular Medical procedure, procedure used to widen narrowed or obstructe ...
and stenting.


Acute mesenteric ischemia

Acute mesenteric ischemia (AMI) results from the sudden occlusion of the
superior mesenteric artery In human anatomy, the superior mesenteric artery (SMA) is an artery which arises from the anterior surface of the abdominal aorta, just inferior to the origin of the celiac trunk, and supplies blood to the intestine from the lower part of the ...
.


Renovascular hypertension

The renal arteries supply oxygenated blood to the kidneys. The kidneys serve to filter the flood and control blood pressure through the renin-angiotensin system. One cause of resistant hypertension is atherosclerotic disease in the renal arteries and is generally referred to as
renovascular hypertension Renovascular hypertension is a condition in which high blood pressure is caused by the kidneys' hormonal response to narrowing of the renal arteries, arteries supplying the kidneys. When functioning properly this hormonal axis regulates blood pres ...
. If renovascular hypertension is diagnosed and maximal medical fails to control high blood pressure, the vascular surgeon may offer surgical treatment, either endovascular or open surgical reconstruction.


Cerebrovascular disease

Vascular surgeons are responsible for treating extracranial cerebrovascular disease as well as the interpretation of non-invasive vascular imaging relating to extracranial and intracranial circulation such as
carotid ultrasonography Carotid ultrasonography is an ultrasound-based diagnostic imaging technique to evaluate structural details of the carotid arteries. Carotid ultrasound is used to diagnose carotid artery stenosis (CAS) and can assess atherosclerotic plaque morpho ...
and transcranial doppler. The most common of cerebrovascular conditions treated by vascular surgeons is
carotid artery stenosis Carotid artery stenosis is a narrowing or constriction of any part of the carotid artery, carotid arteries, usually caused by atherosclerosis. Signs and symptoms The common carotid artery is the large artery whose Common carotid artery#Clinical ...
which is a narrowing of the
carotid arteries In anatomy, the left and right common carotid arteries (carotids) () are arteries that supply the head and neck with oxygenated blood; they divide in the neck to form the external and internal carotid arteries. Structure The common carotid ...
and may be either clinically symptomatic or asymptomatic (silent). Carotid artery stenosis is caused by
atherosclerosis Atherosclerosis is a pattern of the disease arteriosclerosis, characterized by development of abnormalities called lesions in walls of arteries. This is a chronic inflammatory disease involving many different cell types and is driven by eleva ...
whereby the buildup of
atheromatous plaque An atheroma, or atheromatous plaque, is an abnormal accumulation of material in the inner layer of an arterial wall. The material consists of mostly macrophage cells, or debris, containing lipids, calcium and a variable amount of fibrous conne ...
inside the artery causes narrowing. Symptoms of carotid artery stenosis can include transient ischemic attack or
stroke Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...
. Both symptomatic and asymptomatic carotid stenosis can be diagnosed with the aid of carotid duplex ultrasound which allows for the estimation of severity of narrowing as well as characterize the plaque. Treatment can include medical therapy,
carotid endarterectomy Carotid endarterectomy is a surgical procedure used to reduce the risk of stroke from carotid artery stenosis (narrowing the internal carotid artery). In an endarterectomy, the surgeon opens the artery and removes the plaque. The plaque forms ...
or
carotid stenting Carotid artery stenting is an endovascular procedure where a stent is deployed within the lumen of the carotid artery to treat narrowing of the carotid artery and decrease the risk of stroke. It is used to treat narrowing of the carotid artery i ...
. The
Society for Vascular Surgery A society () is a group of individuals involved in persistent social interaction or a large social group sharing the same spatial or social territory, typically subject to the same political authority and dominant cultural expectations. ...
publishes clinical practice guidelines for the management of extracranial cerebrovascular disease. Less common diseases involving cerebral circulation treated by vascular surgeons include
vertebrobasilar insufficiency Vertebrobasilar insufficiency (VBI) describes a temporary set of symptoms due to decreased blood flow (ischemia) in the Posterior (anatomy), posterior circulation of the brain. The posterior circulation supplies the medulla oblongata, medulla, p ...
,
subclavian steal syndrome Subclavian steal syndrome (SSS), also called subclavian steal steno-occlusive disease, is a medical condition characterized by retrograde (reversed) blood flow in the vertebral artery or the internal thoracic artery. This reversal occurs due to pro ...
,
carotid artery dissection Carotid artery dissection is a serious condition in which a tear forms in one of the two main carotid arteries in the neck, allowing blood to enter the artery wall and separate its layers (dissection). This separation can lead to the formation of ...
,
vertebral artery dissection Vertebral artery dissection (VAD) is a flap-like tear of the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. After the tear, blood enters the arterial wall and forms a blood clot, thickening t ...
, carotid body tumor and carotid artery aneurysm among others.


Peripheral arterial disease

Peripheral artery disease Peripheral artery disease (PAD) is a vascular disorder that causes abnormal narrowing of arteries other than those that supply the heart or brain. PAD can happen in any blood vessel, but it is more common in the legs than the arms. When narr ...
PAD is the abnormal narrowing of the arteries which supply the limbs. Patients with this condition can present with
intermittent claudication Intermittent claudication, also known as vascular claudication, is a symptom that describes muscle pain on mild exertion (ache, cramp, numbness or sense of fatigue), classically in the calf muscle, which occurs during exercise, such as walking, ...
which is pain mainly in the calves and thighs while walking. If there is progression, a patient may also present with
chronic limb threatening ischemia Chronic limb-threatening ischemia (CLTI), previously known as critical limb ischemia (CLI), is a severe manifestation of peripheral artery disease that results in significantly reduced blood flow to the lower extremities, leading to ischemic rest ...
which encompasses pain at rest and non-healing wounds. Vascular surgeons are experts in the diagnosis, medical management, endovascular and open surgical treatment of PAD. A vascular surgeon may diagnose PAD using a combination of
history History is the systematic study of the past, focusing primarily on the Human history, human past. As an academic discipline, it analyses and interprets evidence to construct narratives about what happened and explain why it happened. Some t ...
,
physical exam In a physical examination, medical examination, clinical examination, or medical checkup, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions ...
and
medical imaging Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to revea ...
. Medical imaging may include ankle-brachial index,
doppler ultrasonography Doppler ultrasonography is medical ultrasonography that employs the Doppler effect to perform imaging of the movement of tissues and body fluids (usually blood), and their relative velocity to the probe. By calculating the frequency shift of a ...
and
computed tomography angiography Computed tomography angiography (also called CT angiography or CTA) is a computed tomography technique used for angiography—the visualization of arteries and veins—throughout the human body. Using contrast injected into the blood vessels, im ...
, among others. Treatments are individualized and may include medical therapy, endovascular intervention or open surgical options including
angioplasty Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty, is a minimally invasive procedure, minimally invasive endovascular surgery, endovascular Medical procedure, procedure used to widen narrowed or obstructe ...
,
stent In medicine, a stent is a tube usually constructed of a metallic alloy or a polymer. It is inserted into the Lumen (anatomy), lumen (hollow space) of an anatomic vessel or duct to keep the passageway open. Stenting refers to the placement of ...
ing,
atherectomy Atherectomy is a minimally invasive technique for removing atherosclerosis from blood vessels within the body. It is an alternative to angioplasty for the treatment of peripheral artery disease, but the studies that exist are not adequate to deter ...
,
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 deposits. It is carried out by separating the plaque from the arterial wall. It was firs ...
and
vascular bypass A vascular bypass is a surgical procedure performed to redirect blood flow from one area to another by reconnecting blood vessels. Often, this is done to bypass around a diseased artery, from an area of normal blood flow to another relatively norm ...
, among others. File:Blausen Peripheral Arterial Disease eng.svg, Illustration of
atherosclerosis Atherosclerosis is a pattern of the disease arteriosclerosis, characterized by development of abnormalities called lesions in walls of arteries. This is a chronic inflammatory disease involving many different cell types and is driven by eleva ...
causing arterial obstruction which clinically presents at peripheral artery disease. File:Pad abi ENG.svg, ABI testing is used by vascular surgeons in the diagnosis of PAD. The blood pressure in the arm and leg are compared as a ratio. File:Angioplasty-scheme.svg,
Angioplasty Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty, is a minimally invasive procedure, minimally invasive endovascular surgery, endovascular Medical procedure, procedure used to widen narrowed or obstructe ...
(pictured) and stenting are two endovascular treatments employed by the vascular surgeon.


Management of venous diseases


Chronic venous disease

Chronic venous insufficiency Chronic venous insufficiency (CVI) is a medical condition characterized by blood pooling in the veins, leading to increased pressure and strain on the vein walls. The most common cause of CVI is superficial venous reflux, which often results in ...
is the abnormal pooling of blood in the lower extremity venous system which can lead to reticular veins, varicose veins, chronic edema and inflammation among other things. Population data suggests that chronic venous insufficiency affects up to 40% of females and 17% of males. When chronic insufficiency leads to pain, swelling and skin changes it is referred to as chronic venous disease. Chronic venous insufficiency (CVI) is distinguished from
post-thrombotic syndrome Post-thrombotic syndrome (PTS), also called postphlebitic syndrome and venous stress disorder is a medical condition that may occur as a long-term complication of deep vein thrombosis (DVT). Signs and symptoms Signs and symptoms of PTS in the le ...
(PTS) in that CVI is primarily an issue of valvular incompetence of the
superficial Superficial may refer to: *Superficial anatomy, is the study of the external features of the body *Superficiality, the discourses in philosophy regarding social relation * Superficial charm, the tendency to be smooth, engaging, charming, slick and ...
or
deep vein A deep vein is a vein that is deep in the body. This contrasts with superficial veins that are close to the body's surface. Deep veins are almost always beside an artery with the same name (e.g. the femoral vein is beside the femoral artery). ...
s whereas PTS may occur as a long-term complication of
deep venous thrombosis Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and e ...
. The vascular surgeon has several modalities to treat lower extremity venous disease which including medical, interventional and surgical procedures. For instance, venous ulceration may be treated with Unna's boots, superficial venous reflux with
radiofrequency Radio frequency (RF) is the oscillation rate of an alternating electric current or voltage or of a magnetic, electric or electromagnetic field or mechanical system in the frequency range from around to around . This is roughly between the upper ...
,
laser ablation Laser ablation or photoablation (also called laser blasting) is the process of removing material from a solid (or occasionally liquid) surface by irradiating it with a laser beam. At low laser flux, the material is heated by the absorbed laser ...
or
vein stripping A phlebectomy, or vein stripping, is a surgical procedure done under general or local anaesthetic to aid in the treatment of varicose veins and other manifestations of chronic venous disease. The vein "stripped" (pulled out from under the skin ...
if indicated. When indicated, insufficiency in the deep veins may be treated with reconstruction of the venous valves with internal or external valvuloplasty.


Varicose veins

Lower extremity
varicose veins Varicose veins, also known as varicoses, are a medical condition in which superficial veins become enlarged and twisted. Although usually just a cosmetic ailment, in some cases they cause fatigue, pain, itch, itching, and cramp, nighttime leg cram ...
is the condition in which the superficial veins become tortuous (snakelike) and dilated (enlarged) to greater than in the upright position. Incompetent or faulty valves are often present in these veins when investigated with
duplex ultrasonography Doppler ultrasonography is medical ultrasonography that employs the Doppler effect to perform medical imaging, imaging of the movement of tissue (biology), tissues and body fluids (usually blood), and their relative velocity to the ultrasound pro ...
. Vascular treatments can include
compression stockings Compression stockings (Flight Socks, Support Bandage) are a specialized hosiery designed to help prevent the occurrence of, and guard against further progression of, venous disorders such as edema, phlebitis and thrombosis. Compression stockings ...
, venous ablation or
vein stripping A phlebectomy, or vein stripping, is a surgical procedure done under general or local anaesthetic to aid in the treatment of varicose veins and other manifestations of chronic venous disease. The vein "stripped" (pulled out from under the skin ...
, depending on specific patient presentation, severity of disease, among other things.


Nonthrombotic iliac vein lesions

Nonthrombotic iliac vein lesions (NIVL) include May-Thurner Syndrome (MTS) whereby there is compression of the left iliac venous outflow usually by the right iliac artery leading to left leg discomfort, pain, swelling and varicose veins. NIVL encompasses compression of the iliac veins on either the right or left side. Vascular surgeons may offer different treatment modalities depending on the patient presentation. Minimally invasive diagnostic and therapeutic options might include
intravascular ultrasound Intravascular ultrasound (IVUS) or intravascular echocardiography is a medical imaging methodology using a specially designed catheter with a miniaturized ultrasound probe attached to the distal end of the catheter. The proximal end of the cathe ...
, venography and iliac vein stenting whereas surgical management may be offered in refractory cases. Surgical management strategies involve reconstruction or bypass of the affected segment such as cross-pubic venous bypass, also known as the Palma procedure.


Deep vein thrombosis

Deep vein thrombosis Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and enl ...
(DVT) is the formation of thrombus in a
deep vein A deep vein is a vein that is deep in the body. This contrasts with superficial veins that are close to the body's surface. Deep veins are almost always beside an artery with the same name (e.g. the femoral vein is beside the femoral artery). ...
. DVT is more likely to occur in the lower extremity than the upper extremity or
jugular vein The jugular veins () are veins that take blood from the head back to the heart via the superior vena cava. The internal jugular vein descends next to the internal carotid artery and continues posteriorly to the sternocleidomastoid muscle. Struc ...
. When a DVT involves the pelvic and lower extremity veins it can sometimes be classified as an
iliofemoral DVT Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and enl ...
. Some evidence to suggests that performing an intervention in these cases may be beneficial whereas other evidence does not. Overall, the data shows that there may be a reduction in the incidence in
post-thrombotic syndrome Post-thrombotic syndrome (PTS), also called postphlebitic syndrome and venous stress disorder is a medical condition that may occur as a long-term complication of deep vein thrombosis (DVT). Signs and symptoms Signs and symptoms of PTS in the le ...
in patients who undergo certain procedures for iliofemoral DVT but it is not without risks. A vascular surgeon may offer venogram, endovascular suction or mechanical thrombectomy and in some cases pharmacomechanical thrombectomy. Some lower extremity DVT can be severe enough to cause a condition called
phlegmasia cerulea dolens Phlegmasia cerulea dolens (PCD) (literally: 'painful blue inflammation'), not to be confused with preceding phlegmasia alba dolens, is an uncommon severe form of lower extremity deep venous thrombosis (DVT) that obstructs blood outflow from a vein ...
or
phlegmasia alba dolens Phlegmasia alba dolens (also colloquially known as milk leg or white leg; not to be confused with phlegmasia cerulea dolens) is part of a spectrum of diseases related to deep vein thrombosis. Historically, it was commonly seen during pregnancy and ...
and can be limb-threatening events. When phlegmasia is present, intervention is often warranted and may include venous thrombectomy.


Post-thrombotic syndrome

Post-thrombotic syndrome Post-thrombotic syndrome (PTS), also called postphlebitic syndrome and venous stress disorder is a medical condition that may occur as a long-term complication of deep vein thrombosis (DVT). Signs and symptoms Signs and symptoms of PTS in the le ...
(PTS) is a medical condition that sometimes occurs as a long-term complication of DVT and is characterized by long term
edema Edema (American English), also spelled oedema (British English), and also known as fluid retention, swelling, dropsy and hydropsy, is the build-up of fluid in the body's tissue (biology), tissue. Most commonly, the legs or arms are affected. S ...
and skin changes following DVT. Presenting symptoms may include itchiness, pain, cramps and paresthesia. It is estimated that between 20% and 50% of patients will experience some degree of PTS. A treatment strategy for PTS may involve the use of compression stockings.


Pulmonary embolism

Surgical management of an acute
pulmonary embolism Pulmonary embolism (PE) is a blockage of an pulmonary artery, artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Symptoms of a PE may include dyspnea, shortness of breath, chest pain ...
(
pulmonary thrombectomy A pulmonary thrombectomy is an emergency surgical procedure used to remove blood clots from the pulmonary arteries. Mechanical thrombectomies can be surgical (surgical thrombectomy) or percutaneous (percutaneous thrombectomy). Surgical thrombecto ...
) is uncommon and has largely been abandoned because of poor long-term outcomes. However, recently, it has gone through a resurgence with the revision of the surgical technique and is thought to benefit certain people. Chronic pulmonary embolism leading to
pulmonary hypertension Pulmonary hypertension (PH or PHTN) is a condition of increased blood pressure in the pulmonary artery, arteries of the lungs. Symptoms include dypsnea, shortness of breath, Syncope (medicine), fainting, tiredness, chest pain, pedal edema, swell ...
(known as ''chronic thromboembolic hypertension'') is treated with a surgical procedure known as a
pulmonary thromboendarterectomy In thoracic surgery, a pulmonary thromboendarterectomy (PTE), also referred to as pulmonary endarterectomy (PEA), is an operation that removes organized clotted blood (thrombus) from the pulmonary arteries, which supply blood to the lungs. Indi ...
.


Compressive venopathies

Compression of large veins by adjacent structures or masses may lead to distinct clinical syndromes including
May–Thurner syndrome May–Thurner syndrome (MTS), also known as the iliac vein compression syndrome, is a condition in which compression of the common venous outflow tract of the left lower extremity may cause discomfort, swelling, pain or iliofemoral deep vein thro ...
(MTS),
nutcracker syndrome The nutcracker syndrome (NCS) results most commonly from the compression of the left renal vein (LRV) between the abdominal aorta (AA) and superior mesenteric artery (SMA), although other variants exist. The name derives from the fact that, in ...
and
superior vena cava syndrome Superior vena cava syndrome (SVCS), is a group of symptoms caused by obstruction of the superior vena cava ("SVC"), a short, wide vessel carrying circulating blood into the heart. The majority of cases are caused by malignant tumors within the me ...
to name a few. Treatment modalities include
venography Venography (also called phlebography or ascending phlebography) is a procedure in which an X-ray of the veins, a venogram, is taken after a special dye is injected into the bone marrow or veins. The dye has to be injected constantly via a cathete ...
,
intravascular ultrasound Intravascular ultrasound (IVUS) or intravascular echocardiography is a medical imaging methodology using a specially designed catheter with a miniaturized ultrasound probe attached to the distal end of the catheter. The proximal end of the cathe ...
and venous
stent In medicine, a stent is a tube usually constructed of a metallic alloy or a polymer. It is inserted into the Lumen (anatomy), lumen (hollow space) of an anatomic vessel or duct to keep the passageway open. Stenting refers to the placement of ...
ing as well as more invasive open venous reconstruction and bypass.


Management of hemodialysis access

Patients with
chronic kidney disease Chronic kidney disease (CKD) is a type of long-term kidney disease, defined by the sustained presence of abnormal kidney function and/or abnormal kidney structure. To meet criteria for CKD, the abnormalities must be present for at least three mo ...
may have progression of disease which requires
renal replacement therapy Renal replacement therapy (RRT) is therapy that replaces the normal blood-filtering function of the kidneys. It is used when the kidneys are not working well, which is called kidney failure and includes acute kidney injury and chronic kidney dis ...
to filter their blood. One strategy for this therapy is
hemodialysis Hemodialysis, American and British English spelling differences#ae and oe, also spelled haemodialysis, or simply ''"'dialysis'"'', is a process of filtering the blood of a person whose kidneys are not working normally. This type of Kidney dialys ...
, which is a procedure that involves filtering a patient's blood to remove waste products and returning their blood back to them. One method which avoids repeated arterial trauma is to create an
arteriovenous fistula An arteriovenous fistula is an abnormal connection or passageway between an artery and a vein. It may be congenital, surgically created for hemodialysis treatments, or acquired due to pathologic process, such as trauma or erosion of an arteri ...
(AVF). The first procedure described for this purpose is named the
Cimino fistula A Cimino fistula, also Cimino-Brescia fistula, surgically created arteriovenous fistula and (less precisely) arteriovenous fistula (often abbreviated AV fistula or AVF), is a type of vascular access for hemodialysis. It is typically a surgically c ...
, after one of the surgeons who first had success with it. Vascular surgeons may create an AVF for a patient as well as undertake minimally invasive procedures to ensure the fistula remains
patent A patent is a type of intellectual property that gives its owner the legal right to exclude others from making, using, or selling an invention for a limited period of time in exchange for publishing an sufficiency of disclosure, enabling discl ...
.


Management of vascular trauma

One way that vascular trauma may be understood is by categorizing vascular injury by three criteria: mechanism of injury, anatomical site of injury and contextual circumstances. Mechanism of injury refers to etiology, e.g.
iatrogenic Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence." Iatrogenic", ''Merriam-Webster.com'', Merriam-Webster, Inc., accessed 27 ...
,
blunt Blunt may refer to: * Blunt (surname), a surname (and list of people with the name) * Blunt (cigar), a term used in the cigar industry to designate blunt-tipped, usually factory-rolled cigars * Blunt (cannabis), a slang term used in cannabis cult ...
, penetrating,
blast injury A blast injury is a complex type of physical trauma resulting from direct or indirect exposure to an explosion. Blast injuries occur with the detonation of high-order explosives as well as the deflagration of low order explosives. These injuri ...
, etc. Anatomical site functionally refers to whether there is compressible versus non-compressible hemorrhage, while contextual circumstances refers to injuries sustained in the civilian or military realm. Each context can be further broken down: military into combatant vs. noncombatant and civil into urban vs rural trauma. This categorization scheme is of both epidemiologic and clinical significance. For instance, arterial injury in military combatants currently occurs predominantly in males in their twenties who are exposed to improvised explosive devices or gunshot wounds; whereas in the civilian realm, one study conducted in the United States showed the most common mechanisms to include motor vehicle collisions, firearm injuries, stab wounds and falls from heights.


Blunt thoracic aortic injury

Advances in vascular surgery, specifically endovascular technologies, have led to a dramatic change in the operative approach to blunt thoracic aortic injury (BTAI). BTAI results from a high speed insult to the thorax such as a
motor vehicle collision A traffic collision, also known as a motor vehicle collision, or car crash, occurs when a vehicle collides with another vehicle, pedestrian, animal, road debris, or other moving or stationary obstruction, such as a tree, pole or building. Tra ...
or a fall from a height. One widely-used classification scheme is based on the extent of injury to the anatomic layers of the aorta as seen with
computed tomography angiography Computed tomography angiography (also called CT angiography or CTA) is a computed tomography technique used for angiography—the visualization of arteries and veins—throughout the human body. Using contrast injected into the blood vessels, im ...
or
intravascular ultrasound Intravascular ultrasound (IVUS) or intravascular echocardiography is a medical imaging methodology using a specially designed catheter with a miniaturized ultrasound probe attached to the distal end of the catheter. The proximal end of the cathe ...
. Grade 1 BTAI are those which tear the aortic intima; grade 2 injuries refer to intramural hematoma; grade 3 injuries are pseudoaneurysm and are only contained by adventitial tissue; and grade 4 refer to free rupture of blood into the chest and surrounding tissue. When indicated, first line intervention involves
TEVAR ''Tevar'' () is a 2015 Indian Hindi-language action film directed by debutante Amit Sharma and produced by Boney Kapoor, Sanjay Kapoor, Sunil Lulla, Naresh Agarwal and Sunil Manchanda, based on a script by Sharma and Shantanu Shrivastav. An o ...
.


Investigations


Major trials


Training

Previously considered a field within
general surgery General surgery is a Surgical specialties, surgical specialty that focuses on alimentary canal and Abdomen, abdominal contents including the esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, Appendix (anatomy ...
, 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. In many countries, Vascular surgeons can opt for additional training in cardiac surgery as well as post-residency. Programs of training vary slightly between different regions of the world.


See also

*
Society for Vascular Surgery A society () is a group of individuals involved in persistent social interaction or a large social group sharing the same spatial or social territory, typically subject to the same political authority and dominant cultural expectations. ...
, the major American professional society * Ischemia-reperfusion injury of the appendicular musculoskeletal system *
Kakish Ryskulova Kakish Ryskulova, (; 5 October 1918 – 26 August 2018) was a Kyrgyz medical doctor and politician, who was an Academician of the Kyrgyz Academy of Sciences. She was the first Central Asian and first Kyrgyz woman to become a surgeon. Biograph ...
*
Vein Veins () are blood vessels in the circulatory system of humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and feta ...
*
Phlebologist Phlebology is a medical speciality that is concerned with venous issues including the diagnosis and treatment of disorders of the veins. A medical specialist in this field is known as a phlebologist. The specialty of phlebology has developed to e ...
*
Cardiovascular disease Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina, heart attack), heart failure, hypertensive heart disease, rheumati ...
*
Cardiology Cardiology () is the study of the heart. Cardiology is a branch of medicine that deals with disorders of the heart and the cardiovascular system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery di ...


References


External links


Society for Vascular Surgery
(U.S.)
European Society for Vascular Surgery
{{DEFAULTSORT:Vascular Surgery Surgical specialties