Vascular Surgery — Find Specialists & Top Hospitals Worldwide | MyMedicPlus

Vascular surgery is the surgical specialty focused on the diagnosis and treatment of diseases affecting the blood vessels — arteries, veins, and lymphatics — throughout the body, excluding the heart and intracranial vessels (which are managed by cardiac surgeons and neurosurgeons respectively). The vascular system is responsible for delivering oxygenated blood to every organ and tissue and returning deoxygenated blood to the heart and lungs. Disease of these vessels causes conditions ranging from limb-threatening arterial occlusion and life-threatening aortic rupture to disabling claudication and chronic venous ulceration.

Vascular surgeons are trained in both open surgical reconstruction — using bypass grafts, endarterectomy, and patch angioplasty — and endovascular techniques — using catheters, balloons, stents, and stent grafts delivered through small punctures in the groin or arm. This dual skill set, unique among surgical specialties, allows vascular surgeons to select the least invasive effective treatment for each patient based on anatomy, comorbidities, and surgical risk.

The specialty encompasses several clinical domains. Aortic surgery manages aneurysms and dissections of the abdominal and thoracic aorta using both open and endovascular approaches. Peripheral arterial disease (PAD) specialists treat atherosclerotic occlusion of leg arteries causing claudication and critical limb ischaemia. Cerebrovascular surgery addresses carotid artery stenosis causing stroke risk. Venous surgery treats deep vein thrombosis, chronic venous insufficiency, varicose veins, and venous leg ulcers. Dialysis access surgery creates and maintains arteriovenous fistulae and grafts for haemodialysis patients. Vascular trauma surgeons repair vessel injuries from penetrating and blunt trauma. Lymphatic surgery addresses lymphoedema through microsurgical lymphovenous anastomosis and vascularised lymph node transfer.

Vascular surgeons diagnose and manage the full spectrum of arterial, venous, and lymphatic vascular disease:

• Abdominal aortic aneurysm (AAA): Pathological dilation of the abdominal aorta to more than 3 cm, with rupture risk increasing significantly above 5.5 cm; managed with surveillance for smaller aneurysms and elective repair (EVAR or open) for those meeting size or growth rate thresholds.
• Peripheral artery disease (PAD): Atherosclerotic narrowing of the iliac, femoral, popliteal, or tibial arteries causing intermittent claudication (calf pain with walking relieved by rest) and in advanced cases critical limb-threatening ischaemia (rest pain, non-healing ulcers, gangrene).
• Carotid artery stenosis: Atherosclerotic plaque build-up at the carotid bifurcation causing stroke and TIA risk; managed with carotid endarterectomy or carotid artery stenting in symptomatic patients with greater than 50% stenosis.
• Thoracic aortic aneurysm and dissection: Dilation or tear of the thoracic aorta, managed with thoracic endovascular aortic repair (TEVAR) or open surgery for complex anatomy.
• Deep vein thrombosis (DVT): Clot formation in the deep veins of the leg or pelvis causing leg swelling and pulmonary embolism risk, managed with anticoagulation and in selected cases catheter-directed thrombolysis.
• Chronic venous insufficiency and venous leg ulcers: Valve incompetence causing venous hypertension, chronic leg oedema, skin changes, and ulceration, managed with compression therapy, endovenous ablation, and wound care.
• Varicose veins: Dilated, tortuous superficial veins caused by venous valve failure, causing aching, swelling, and cosmetic concern, managed with endovenous laser ablation, radiofrequency ablation, or foam sclerotherapy.
• Mesenteric ischaemia: Acute or chronic inadequate blood flow to the intestines from thrombosis or embolism of the mesenteric arteries, causing severe abdominal pain and bowel infarction in acute presentations requiring emergency surgery.
• Renovascular disease: Renal artery stenosis causing secondary hypertension and ischaemic nephropathy, managed with angioplasty, stenting, or surgical bypass in selected cases.
• Dialysis access: Surgical creation and maintenance of arteriovenous fistulae and synthetic grafts for haemodialysis patients, including management of access thrombosis, stenosis, and infection.

Vascular surgeons perform a combination of open surgical and minimally invasive endovascular procedures:

• Endovascular aortic aneurysm repair (EVAR): Deploying a stent graft inside the aorta through small bilateral groin incisions under fluoroscopic guidance to exclude the aneurysm sac from the circulation, preventing rupture — the most common treatment for AAA in suitable anatomical candidates.
• Open AAA repair: Surgical replacement of the diseased aortic segment with a prosthetic Dacron graft through an abdominal or retroperitoneal incision; preferred for complex anatomy or young fit patients where durability is paramount.
• Carotid endarterectomy (CEA): Open surgical removal of atherosclerotic plaque from the carotid bifurcation under general or regional anaesthesia, the gold-standard treatment for symptomatic carotid stenosis above 50% and asymptomatic stenosis above 60–70%.
• Peripheral angioplasty and stenting: Balloon dilation of stenotic or occluded peripheral arteries with or without stent placement through a catheter introduced at the groin, effective for iliac and femoropopliteal disease.
• Femoral-popliteal bypass grafting: Surgical bypass of the occluded femoral artery using the patient's own saphenous vein (preferred) or a synthetic PTFE graft to restore blood flow to the lower leg.
• Aorto-bifemoral bypass: Open surgical bypass from the aorta to both femoral arteries using a bifurcated Dacron graft, used for extensive aorto-iliac occlusive disease causing bilateral claudication or critical ischaemia.
• Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA): Minimally invasive closure of the incompetent great saphenous vein using laser or radiofrequency energy delivered via a catheter inserted under ultrasound guidance, performed under local anaesthesia as an outpatient procedure.
• Arteriovenous fistula creation: Surgically joining an artery and vein in the forearm or upper arm to create a high-flow access site for haemodialysis, the preferred access type for its longevity and low infection risk.
• Catheter-directed thrombolysis: Infusing clot-dissolving drugs directly into occluded arteries or veins through a catheter positioned at the thrombus for acute limb ischaemia or extensive DVT.
• Thoracic endovascular aortic repair (TEVAR): Stent graft deployment in the thoracic aorta for descending thoracic aneurysms, complicated type B dissections, and traumatic aortic injuries.

Vascular surgery consultation is warranted in the following situations, some of which are time-critical emergencies:

• Suspected ruptured aortic aneurysm: Sudden severe abdominal or back pain with cardiovascular collapse, hypotension, or a pulsatile abdominal mass in an older patient is a surgical emergency requiring immediate transfer to a vascular surgery centre — the perioperative mortality of ruptured AAA is 40–50% even with emergency surgery.
• Critical limb-threatening ischaemia: Rest pain, non-healing ulcers, or digital gangrene in a patient with known or suspected PAD requires urgent vascular surgery evaluation — untreated critical limb ischaemia leads to amputation within weeks.
• Symptomatic carotid stenosis: After a TIA or minor stroke with confirmed carotid stenosis above 50%, carotid endarterectomy should be performed within 48 hours to two weeks to maximise stroke prevention benefit — delay substantially reduces efficacy.
• Abdominal aortic aneurysm above threshold: Asymptomatic AAA reaching 5.5 cm in men or 5.0 cm in women, or growing more than 1 cm per year, should be referred for elective repair before rupture risk becomes prohibitive.
• Claudication limiting lifestyle: Leg pain with walking that limits daily activities despite three to six months of supervised exercise therapy and cardiovascular risk factor optimisation warrants vascular assessment for revascularisation options.
• Pulsatile or expansile peripheral mass: Any pulsatile mass in the groin, popliteal fossa, or elsewhere may indicate a peripheral aneurysm at risk of thrombosis or embolism, requiring vascular evaluation.
• DVT with haemodynamic compromise: Extensive iliofemoral DVT causing phlegmasia or pulmonary embolism with haemodynamic instability may require catheter-directed thrombolysis or surgical thrombectomy.

Vascular surgery training in the United States is available through two pathways. The integrated vascular surgery residency is a five-year programme that trains directly in vascular surgery from the start, including two years of general surgery foundation training. The traditional pathway involves completing a five-year general surgery residency followed by a two-year vascular surgery fellowship. Both pathways provide comprehensive training in open surgery and endovascular techniques.

During training, vascular surgeons develop expertise in preoperative vascular assessment (including duplex ultrasound, CT angiography, MR angiography, and catheter angiography), open surgical reconstruction (bypass grafting, endarterectomy, patch angioplasty), endovascular procedures (angioplasty, stenting, EVAR, TEVAR), wound management, and the medical management of atherosclerotic risk factors. Operative volume in both open and endovascular procedures is carefully tracked, as competency in both modalities is expected of all graduating vascular surgeons.

Board certification is awarded by the American Board of Surgery in vascular surgery (ABS-VS) upon passing written qualifying and oral certifying examinations. In the UK, vascular surgeons hold FRCS (Vasc). The specialty has evolved dramatically with the shift toward endovascular approaches — vascular surgeons now perform the majority of aortic aneurysm repairs using EVAR rather than open surgery, and ongoing procedural training with advanced endovascular simulation is essential. Many vascular surgeons participate in multidisciplinary vascular and limb salvage teams alongside interventional radiologists, diabetologists, podiatrists, and wound care nurses.

Referrals to a vascular surgeon typically come from cardiologists, neurologists, nephrologists, diabetologists, vascular medicine physicians, and GPs based on clinical findings or imaging. For urgent conditions such as ruptured AAA, acute limb ischaemia, or symptomatic carotid stenosis after TIA, proceed directly to the emergency department or request urgent hospital referral — these conditions cannot wait for routine outpatient appointments.

For elective referrals such as stable claudication, varicose veins, or AAA surveillance, vascular surgery clinics with dedicated vascular labs (duplex ultrasound capability), multidisciplinary wound care teams, and high EVAR/open surgery volumes provide the best outcomes. When attending your appointment, bring all prior vascular imaging (duplex ultrasound, CT angiogram, MRI), blood pressure readings, a list of all cardiovascular medications (including antiplatelet agents and anticoagulants), and details of your cardiovascular risk factors including smoking history, cholesterol levels, diabetes status, and prior cardiac events. Optimising medical therapy — antiplatelet medication, statins, blood pressure control, smoking cessation, and supervised exercise — before any elective vascular intervention significantly reduces perioperative risk and improves long-term outcomes.