Medical science is constantly progressing and new techniques for treating disorders or diseases of the blood vessels are under development. The vascular surgery procedures in operating rooms used by cardiovascular surgeons, as of 2010, vary depending upon the particular problem. Possibly, by the time you read this article, new, more effective techniques may be used, should you require vascular surgery.
Doctors would describe all surgical procedures as invasive, however, as technology and our understanding of the human body progresses, minimally-invasive procedures have replaced many of the surgical techniques that were used during the mid-twentieth century. Many of the most common types of surgery pertaining to the cardiovascular system fall into this category, but for certain conditions, highly-invasive surgical procedures are still the norm.
One of the common vascular surgery procedures in operating rooms is an endarterectomy. This procedure is performed on patients suffering with diminished blood flow in an artery due to atherosclerotic plaques. Often this procedure is used on the carotid artery in the neck in order to prevent the occurrence of a stroke.
In a carotid endarterectomy (CEA), the surgeon makes an incision in the neck at the site of the blockage, then makes a lengthwise incision in the artery. The physician removes the plaque and sutures the incisions. Blood is rerouted to the brain during this procedure. CEAs have a very high national success rate.
Angioplasty and Stenting
A common minimally-invasive technique is angioplasty and stenting. Technically, these are two separate procedures, but they are often performed in tandem. Research has shown a higher success rate when both are used, as opposed to one or the other. Patients with arterial stenosis, or narrowing, undergo this procedure, which is often performed under local anesthesia, rather than general.
This procedure utilizes a thin tube, called a catheter, which is inserted into a small incision in the groin. The surgeon navigates the tube through the patient’s arteries to the narrowed portion. A balloon at the end of the catheter mechanically expands the walls of the artery to improve blood flow. A “wire-mesh tubular scaffolding”, or stent, is placed at the site of stenosis to prevent the artery from becoming narrow again.
Another minimally-invasive procedure used is atherectomy. Patients with high levels of occlusion due to atherosclerosis are candidates for this procedure, which is usually performed under local anesthesia with the addition of a light sedative. .
When performing atherectomy, the surgeon guides a catheter through the artery until it reaches the diseased portion. The catheter is equipped with a sharp blade that is used to cut away the plaque from the wall of the artery. A small reserve in the tip of the catheter collects the plaque returning normal blood flow to the artery.
Patients suffering from varicose and spider veins have a number of outpatient treatments that do not require a surgical setting. The process of ablation has taken the place of the former standard, surgical vein stripping. The far less invasive ablation uses a catheter to scar and close the varicosity with heat. Depending upon where the treatment is being performed, the attending surgeon may use laser or radiofrequency waves as the preferred source of heat.
Ablation is also a therapy option for certain cardiac arrhythmias. Due to the electric nature of cardiac contraction, surgeons use electricity to kill cells that are causing arrhythmia.
The use of bypass surgery is for extreme cases, particularly in extremities, in which an artery has developed such a large percentage of blockage that the tissues are not being supplied with the proper amount of oxygenated blood or ulcers on the skin are forming. Usually, this surgery takes place under general anesthesia.
In bypass surgery, a surgeon will isolate the artery above and below the blockage. He or she will make a small incision at each site and connect the two with either a section of the patient’s blood vessel or a synthetic tube. This bypasses the site of the blockage, and normal blood flow resumes.
At most hospitals, certain conditions, such as aortic aneurysm, must be treated by traditional open surgery methods. However, research and more advanced hospitals are developing less invasive, endovascular techniques for the disorders that still require open surgery. Open surgeries occur most often under general anesthesia, unless there is a concern that there may be complications with general anesthesia.
In aortic aneurysm surgery, the surgeon uses a long incision of the chest or abdomen. A synthetic tubing is inserted into the diseased portion of the aorta acting as a replaced and repaired aorta.
It is important to reiterate that surgical techniques are continuing to evolve as technology provides more options for surgeons. There are undoubtedly more procedures used by surgeons than are listed here, and these may be outdated in the next decade. If you are expecting to have any type of vascular surgery, discuss your options and the most up-to-date procedures with your doctor.
Cleveland Clinic Department of Vascular Surgery: Vascular Surgery Services
Mayo Clinic: Vascular and Endovascular Surgery in Minnesota
Stanford University of Medicine Vascular Surgery Clinic: Vascular and Endovascular Surgery
Robert Wood Johnson University Hospital: Carotid Artery Surgery Interventions for Stroke Prevention
Peripheral Vascular Surgery Society: Endovascular Surgery
The Lancet: Success with Coronary Angioplasty as Seen at Demonstrations of Procedure by P. Chatelain MD et al
Journal of Vascular Surgery: Carotid Angioplasty and Stenting, Success Relies on Appropriate Patient Selection by Sadek M et al
NYU Langone Medical Center Cardiac and Vascular Institute: Vein Ablation Surgery