Whenever I mention vascular surgery to friends outside the medical field, the natural response is often: “Vascular surgery? Do you mean heart surgery?” This provides a good opportunity to explain what vascular surgery is.

Cardiac surgery is usually managed by cardiothoracic surgeons or cardiologists. By contrast, the body’s blood vessels include both arteries and veins, and apart from those involving the brain and heart, the remaining vessels are generally referred to as peripheral blood vessels. When these peripheral vessels require surgery or treatment, care is usually provided by doctors with experience in vascular surgery, commonly described in practice as vascular surgeons, even though their specialist registration may still fall under general surgery.

Common peripheral vascular conditions include varicose veins, deep vein thrombosis, arterial narrowing or blockage, and abdominal aortic aneurysm, as well as many other less common disorders. For many members of the public, however, these remain unfamiliar medical terms.

With the development of modern medicine, vascular surgery today can be seen as a combination of technical skill and medical technology. Surgeons no longer rely only on traditional open operations. They also use newer instruments, imaging support, and lower-trauma treatment approaches to improve results. Advances in guidewires, catheters, and vascular stents have all contributed to better outcomes in vascular procedures. These minimally invasive vascular procedures are now commonly referred to as endovascular surgery.

Varicose vein treatment provides one example. Endovenous ablation is a minimally invasive treatment option that is less traumatic than traditional great saphenous vein stripping. The basic principle is to deliver radiofrequency or laser energy inside the diseased vein in order to damage the abnormal vessel. The procedure may be carried out in a clinic while the patient remains awake, and the doctor uses ultrasound to monitor the vein during treatment. Local anaesthetic is first given in the thigh, and a very small opening, only slightly larger than a needle puncture, is made. A catheter is then passed into the vein, and as it travels through the diseased segment, energy is delivered to heat the vein wall so that it shrinks and closes. This treats the varicose vein, and after a short rest the patient can usually walk again.

Author: Honorary Clinical Associate Professor, Department of Surgery, The University of Hong Kong; President, Vascular Health Foundation