Vascular Surgeons
Vascular Surgeons |
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Vascular surgeons are physicians who care for patients with diseases that affect the arteries and veins throughout the body. This medical specialty first emerged in the early 1950s as a hybrid between general and cardiac surgery. However, unlike most other surgical specialties, no parallel medical discipline evolved to treat these patients and vascular surgeons were left to manage the full spectrum of vascular disease.
Over the next three decades, pioneers in this specialty expanded our knowledge of the disease processes that affect blood vessels and helped to develop many of the diagnostic modalities and treatments that we use today. Most vascular surgeons spend five years completing their training as general surgeons and then pursue an additional 1-2 years of training to acquire the special skills they will need to recognize and treat the full spectrum of vascular conditions they may encounter.
In 1982, the American Board of Surgery established Board Certification in Vascular Surgery to recognize individuals who had satisfactorily completed such a course of study. Surgeons who qualify for this certification must sit for a comprehensive written and oral examination covering all aspects of vascular disease.
If successful, the certificate must be renewed every ten years by passing an examination which tests their familiarity with the latest advances in the specialty.
Although there are a number of diseases that can affect arteries and veins throughout the body, the most common problem that vascular surgeons treat is atherosclerosis, or hardening of the arteries, as it is more commonly known. This condition affects virtually every artery within the body. However, its preference for several specific locations results in a limited number of disease patterns. Blockage or narrowing of the arteries in the neck can predispose patients to suffer a stroke which occurs when a portion of the brain receives inadequate blood flow and dies.
Since it is very difficult to reverse the damage once it has occurred, successful management of this condition requires early recognition of the disease, often even before symptoms occur, and prompt, safe treatment. The aorta which is the main artery carrying blood from the heart to every part of the body can develop a focal weakness of its wall due to atherosclerosis. This results in the formation of a dilated segment, or aneurysm, which if left untreated, will continue to enlarge until it ruptures resulting often in the death of the patient.
Other arteries, usually in the legs, can also become aneurysmal. However, leg aneurysms rarely rupture. In fact, they are more likely to become filled with blood clot which can break off and go to other parts of the body. These clots, or emboli as they are called, can lead to complete obstruction of that artery and abrupt loss of circulation to the body part it supplies. When the arteries to the legs are narrowed by atherosclerosis, a characteristic recurrent muscle pain occurs in the legs following exercise. This symptom, which is called intermittent claudication, usually is promptly relieved by rest alone and does not get progressively worse. In a small number of advanced cases, the pain may become constant and keep the patient from sleeping. If this "rest" pain is ignored, approximately one patient in ten will develop gangrene and may require amputation of part, or all, of their leg. However, few patients with intermittent claudication ever develop this disastrous complication.
Several of the main arteries within the abdomen can become narrowed by atherosclerosis. When this affects the arteries to the kidneys, the patient can develop severe hypertension, or high blood pressure, and ultimately kidney failure. Although this problem occurs in less than 10% of people with high blood pressure, it is important to recognize because the patient's high blood pressure can be completely cured, or dramatically improved, by restoring circulation to the kidneys.
Rarely, the main arteries to the intestines can become blocked by atherosclerosis or by a blood clot from another part of the body resulting in severe abdominal pain after meals and weight loss. If not recognized, this condition can result in gangrene of the intestines and death.
Although problems with the veins are not as dramatic as those that follow arterial obstruction, they are a source of pain, suffering and economic loss to patients. The superficial leg veins can become very dilated and tortuous. If left untreated, these varicose veins will continue to enlarge and may be complicated by the development of blood clots or in advanced cases, by leg ulcers. The veins deep within the legs are prone to develop blood clots, especially in patients who are bedridden or following surgery. This results in a common, and serious, condition known as deep venous thrombosis, or DVT. Although this problem usually improves dramatically following the administration of anticoagulants, or "blood thinners", these blood clots can break loose and go to the patient's lungs. Five to 10 years later, the patients can develop disabling leg swelling and ulceration.
Quite the contrary! Many problems seen by vascular surgeons, such as intermittent claudication and DVT, are usually treated medically. Others such as small, asymptomatic, abdominal aortic aneurysms or moderate narrowing of the neck arteries are followed with noninvasive tests. As long as there is no evidence of progression, these problems are also left alone.
For those conditions in which some form of intervention is necessary, a number of new, innovative techniques are available. Manipulation within the arteries using specially designed balloons and catheters, can often restore circulation or the integrity of the vessel wall without the need for an open surgical procedure or extended hospital stay. Because vascular surgeons are trained in all forms of treatment, from medical to catheter-guided procedures to open surgery, they are uniquely qualified to offer their patients a variety of therapeutic options while exposing them to the least risk.