Vascular Surgery

Limb amputation is considered a last resort when other treatments have not been successful. It involves the surgical removal of part of the body, such as an arm or leg. 

Doctors may perform a vascular-related amputation when a person has an advanced case of peripheral artery disease. PAD causes plaque to build up in the artery walls, blocking blood flow to the limb. People who have both PAD and diabetes face an even greater risk of needing an amputation. This procedure may become necessary when sores fail to heal or progress to gangrene, where tissue turns black and dies. If infection is also present, it becomes a medical emergency. In some cases, amputation is the only way to relieve severe, intractable pain caused by poor blood flow when all other attempts to restore circulation have failed. 

Doctors typically perform limb amputations using either general or spinal anesthesia. They make an incision that ensures enough healthy tissue is available to cover and protect the amputation stump. The affected limb or part of the limb is then removed and the stump is closed with stitches. An internal drain may be placed to collect blood or fluid and is later removed as healing progresses. 

Recovery varies based on the type of amputation and a person’s overall health. Full recovery, which involves undergoing physical rehabilitation and fitting a prosthetic limb when needed, can take time. However, surgical incisions generally heal within 4–8 weeks.

Endovascular repair is a minimally invasive procedure used to treat an aortic aneurysm, which is a large bulge in the aorta, the major artery that carries blood from the heart through the chest and torso. This approach allows doctors to repair the aneurysm from inside the blood vessel and may be performed under either general or local anesthesia. 

Doctors typically perform endovascular repair when an aortic aneurysm is at risk of rupturing. Large aneurysms that cause symptoms or grow quickly have a higher likelihood of bursting, making timely treatment essential. 

During the procedure, the doctor makes one or two small incisions in the groin and inserts catheters into the arteries. Dye is added to make the aorta visible on X-ray imaging. Using the catheters, the doctor guides a stent graft (a tube-like device) through the arteries to the aneurysm. Once positioned, the graft is expanded and attached to the blood vessel. After the stent graft is in place, the catheters are removed and the incisions are closed. This creates a new channel for blood to flow through the aorta, thereby reducing pressure on the aneurysm. 

Recovery typically involves a hospital stay of 1–5 days, depending on the individual's condition and response to the procedure. 

Lower limb revascularization is a procedure doctors use to treat peripheral artery disease (PAD), a condition that affects more than 200 million people. PAD occurs when plaque buildup blocks or narrows the arteries, reducing blood flow to the legs and feet. Revascularization helps restore circulation, reduce pain and prevent tissue decay caused by restricted blood flow. 

There are two primary approaches to lower limb revascularization. Traditionally, surgeons make incisions in the leg and use one of the patient's own veins or an artificial vein to create a new pathway for blood to flow. This bypasses the blocked artery, restoring circulation. Increasingly, doctors use less invasive endovascular techniques to avoid long incisions. These may include balloons, stents made of metallic mesh to keep vessels open or atherectomy devices that remove plaque through small tubes. In some cases, a combination of these techniques is used to improve results. 

Doctors perform this procedure to treat blood flow occlusion, a blockage or closing of the artery. By restoring circulation to the legs and feet, the procedure helps relieve pain and prevents tissue from dying due to a lack of blood supply. 

During the procedure, the doctor performs a bypass to reroute blood around the blockage. This may involve using the person’s own vein or an artificial graft to restore adequate blood flow. 

Recovery typically involves a hospital stay of 3–5 days, followed by 2–4 weeks of complete healing. If long incisions were required, recovery may take longer.

Also known as carotid endarterectomy, is a procedure doctors use to treat carotid artery disease. The carotid arteries, located on each side of the neck, supply blood to the face and brain. When plaque, composed of fatty material or calcium, builds up inside these arteries, blood flow can become partially or completely blocked. This blockage can lead to a stroke by reducing blood flow to the brain or by allowing plaque to break loose and travel to brain tissue. Carotid artery surgery helps restore healthy blood flow and reduce the risk of stroke. 

Doctors perform this surgery when a person has symptoms of reduced blood flow or when testing shows a significant blockage that could cause a future stroke. It is typically recommended when the narrowing exceeds 70%, and less commonly when symptoms occur with more than 50% stenosis. While the procedure aims to prevent stroke, it also carries risks, so doctors must carefully weigh surgical benefits against non-operative management. A thorough preoperative assessment, particularly of heart function, is crucial because many patients have underlying health conditions that may impact outcomes. The surgery does not cure the underlying cause of plaque buildup and arteries may become blocked again if conditions such as high cholesterol are not well managed. 

During a carotid endarterectomy, patients typically receive general anesthesia, though some hospitals use local anesthesia with sedation. The patient lies on their back with their head turned to expose the blocked artery. The surgeon makes an incision in the neck, may insert a shunt to allow blood to flow around the blockage, opens the artery, removes the plaque and closes the artery with stitches, oftentimes with a patch. 

Recovery typically involves a 1–to 2–day hospital stay, followed by several weeks of recovery and healing. Patients may experience neck pain and difficulty swallowing for a few days and may need to take medication to help prevent blood clots during recovery.