Vascular surgeons are a small group of surgeons (approximately 3,000 in the U.S.) who are specially trained to care for abnormalities of the arteries and veins other than those inside the skull or in the heart.  The diseases most commonly cared for by vascular surgeons include those of the veins and arteries of the leg and of the large blood vessels in the abdomen which become enlarged (aneurysms). 

Stroke prevention is a major focus for vascular surgeons. That’s because disease of the arteries in the neck (carotid arteries) is a common cause of stroke. Many people with diabetes suffer problems with their legs and feet that require vascular surgery. 

Smoking damages arteries anywhere in the human body, so many smokers require treatment by a vascular surgeon. Most commonly, smokers develop blockages in the arteries of their legs making it difficult for them to walk any distance. Other problems commonly treated by vascular surgeons include venous problems such as blood clots and venous ulcers.

When a patient sees a vascular surgeon, he or she may look for signs that are indicative of peripheral artery disease, including weak or absent artery pulses in the extremities, changes in blood pressure in the limbs at rest and/or during exercise (treadmill test), and skin color and nail changes due to lack of blood flow.

In addition to the history of symptoms and the physical signs of peripheral artery disease described above, physicians can use imaging tests in the diagnosis of peripheral artery disease. These imaging tests include:

  • Doppler ultrasound (measurement of high-frequency sound waves that are reflected off of tissues) — This form of ultrasound can detect and measure blood flow.
  • Angiography — An angiography is an imaging procedure to study the blood vessels of the extremities, similar to the way a coronary angiogram provides an image of the blood vessels supplying the heart. It is the most accurate test to detect the location(s) and severity of artery blockage.

Because angiography is invasive and includes potential side effects (such as injury to blood vessels and contrast dye reactions), it is not used for initial diagnosis of peripheral artery disease. It is only used when a patient with severe peripheral artery disease symptoms is considered for treatment. A number of different imaging methods have been used in angiography examinations, including X-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans.

The work of vascular surgeons continues to be based on operative arterial and venous surgery. But since the early 1990s it has evolved greatly. There is now considerable emphasis on minimally invasive alternatives to traditional open surgery using wires and stents rather than the scalpel. This area of vascular surgery is called endovascular surgery. Endovascular and endovenous procedures now form the bulk of most vascular surgeons’ practices. 

Arterial and venous disease treatment by angiography, stenting, and non-operative varicose vein treatment, sclerotherapy, and endovenous laser treatment are rapidly replacing major surgery in many first world countries. These newer procedures provide outcomes that are comparable to surgery with the advantages of short hospital stays (day or overnight for most cases) and lower morbidity and mortality rates. The cost savings from shorter hospital stays and reduced morbidity are considerable but are balanced somewhat by the high cost of imaging equipment, construction and staffing of dedicated procedural suites, and of the implant devices themselves.

The development of endovascular surgery has been accompanied by a gradual separation of vascular surgery from its origin in general surgery. Previously considered a field within general surgery, it is now considered a specialty in its own right. As a result, there are two pathways for training in the United States. Traditionally, a five-year general surgery residency is followed by a 1-2 year (typically 2 years) vascular surgery fellowship. An alternative path is to perform a five-or-six-year vascular surgery residency. 

Most vascular surgeons would now confine their practice to vascular surgery and, similarly, general surgeons would not be trained or practice the larger vascular surgery operations or most endovascular procedures. More recently, professional vascular surgery societies and their training programs have formally separated “Vascular Surgery” into a separate specialty with its own training program, meetings, and accreditation.