Vascular surgery is the surgical speciality dedicated to all the vessels in the human body, except for the intracranial vessels and heart vessels (coronary arteries), which come under cardiac surgery.
Cardiovascular diseases are the leading cause of mortality and disability in industrialized countries. The cardiovascular system is complex, with multiple roles concerning the heart, arteries, veins, and lymphatics. It carries blood and, therefore, oxygen to different organs. It is also involved in immunity, thermoregulation and hormone diffusion and allows for waste removal.
As chronic and progressive diseases, regular monitoring is essential.
As the name suggests, it treats arterial lesions. In more than 90% of cases, they are lesions of atheromatous origin and usually occur in bifurcations.
As well to age, sex and genetics, the four major risk factors of atherosclerosis are smoking, diabetes, hypercholesterolemia and arterial hypertension.
These lesions may be narrowing (stenoses), slowing the blood flow; occlusions (thromboses), responsible for acute ischaemia in an arterial territory (sudden lack of oxygenation); dilations known as aneurysms; or even dissections. After an anamnesis and a full clinical examination, in the first instance, the assessment is based on a Doppler ultrasound with the calculation of the ABI (ankle-brachial) index in particular.
Depending on the pathology (type and location of lesions), but also on the patient (age, history, etc.), the surgeon may proceed with:
In all cases, surgical treatment is combined with medical treatment and control of risk factors. In particular, this includes stopping smoking, making lifestyle improvements and more specific antiplatelet medication.
Depending on the location of lesions, symptoms may be very varied. Carotid stenosis (of arteries vascularised the brain) may be responsible for:
If the narrowing is more significant than 70%, surgery is required. Here, the gold standard is endarterectomy, which consists of ablation of atheromatous plaque best performed under local/regional anaesthesia.
This mainly concerns problems relating to chronic superficial venous insufficiency causing varicose veins and the related complications. It is the most common chronic disease as it affects three quarters of the population over the age of 65.
The vascular surgeon is called upon in the treatment of stenoses of the renal and digestive arteries, deep vein thrombosis, or for the embolisation of pelvic varicose veins. The surgeon creates arteriovenous fistulas for dialysis.
The surgeon may also deal with thoracic outlet syndrome, arcuate ligament syndrome and trophic disorders, specifically, diabetic foot. Finally, they may be involved in surgical procedures or injuries where vessels are concerned. Lymphatic surgery occurs in exceptional circumstances.
The variety of pathologies encountered and their diffusion mean that this speciality requires much expertise and experience in all conventional and endovascular techniques. It requires a complete medical environment with an angiologist, a radiologist, a cardiologist, an endocrinologist, a pulmonologist and, of course, an anaesthetist. It also needs high-performance technical facilities, complete with angio-CT, angio-MRI, cath lab, amplifier and state-of-the-art carbon table.