Vascular Surgeon
Occupation
Names	Doctor, Medical Specialist
Type	Specialty
Activity sectors	Medicine
Description
Education required	Degree in Medicine
Fields of employment	Hospitals, Clinics
Average salary	▲ USD $380,000

Vascular surgery is a specialty of surgery in which diseases of the vascular system, or arteries and veins, are managed by medical therapy, minimally-invasive catheter procedures, and surgical reconstruction. The specialty evolved from general and cardiac surgery. Early pioneers of the field include Russian surgeon Nikolai Korotkov, noted for developing early surgical techniques, and Robert Paton, one of the first Australian vascular surgeons and often credited with helping the field achieve recognition as a speciality. Edwin Wylie of San Francisco was one of the early American pioneers who developed and fostered advanced training in vascular surgery and pushed for its recognition as a specialty in the United States in the 1970s. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system except that of the heart and brain. Cardiothoracic surgeons manage surgical disease of the heart and its vessels. Neurosurgeons manage surgical disease of the vessels in the brain (eg intracranial aneurysms).

Contents 1 Breadth of discipline 2 Training 3 Surgical procedures 4 Major Trials in Vascular Surgery 5 References 6 External links

[edit] Breadth of discipline

• Arterial diseases ( especially in Diabetics )
  • Aneurysms
  • Ischemia
    • Limb ischemia
      • Acute limb ischemia
        • Thrombectomies
        • Embolectomies
        • Anti-coagulation and Thrombolysis
      • Chronic limb ischemia
        • see intermittent claudication and peripheral artery occlusive disease
        • Diabetic foot ulcers
    • Mesenteric ischemia
    • Renal ischemia
  • Extracranial cerebrovascular disease
    • Carotid Endarterectomy and other carotid surgery
    • Surgery of the vertebral system
• Venous disease
  • Deep Vein Thrombosis
  • Thrombophlebitis
  • Varicose Veins and Varicosities
  • Venous malformations
• Lymphatic disease
  • Lymphoedema

• Vascular Medicine
  • Medical disorders with a significant vascular components, for example:
    • Raynaud's syndrome
    • Scleroderma

[edit] Training

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.

Programs of training are slightly different depending on the region of the world one is in.

Country	Standards body	Professional representation	Minimum Length of training (post intern)
Australia and New Zealand	Royal Australasian College of Surgeons	Australian & New Zealand Society of Vascular Surgery (ANZSVS)	6 years
United Kingdom	Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh	Vascular Society of Great Britain and Ireland http://www.vascularsociety.org.uk/	8 years
USA	Accreditation Council for Graduate Medical Education (ACGME), American Board of Surgery	American College of Surgeons Multiple vascular societies	5 years ( 4 via 5-year integrated Vascular Surgery Residency)[1]

[edit] Surgical procedures

By no means exhaustive, but below are a number of common procedures and indications for vascular surgeons.

Indication/disease	Procedure
Abdominal aortic aneurysm	Open AAA repair Endoluminal AAA repair (EVAR)
Carotid stenosis	Carotid endarterectomy Carotid stenting
Varicose veins	Vein stripping Sclerotherapy and Foam sclerotherapy or Laser and radiofrequency vein ablation Ambulatory phlebectomy
Peripheral arterial occlusive disease	Angioplasty with/out Stenting Bypass surgery Endarterectomy Atherectomy
Acute limb ischaemia	Balloon embolectomy Thrombectomy Bypass surgery
Aortic dissection	Open repair Thoracic stent graft

[edit] Major Trials in Vascular Surgery

- Edinburgh Artery Study. *Highwire results for Edinburgh Artery Study

- Netherland Vascular Study.^[2]

- Framingham heart study. Highwire results for Framingham heart Study

- MASS Trial. – the Multicentre Aneurysm Screening Study (MASS) trial. Four centres (about 7000 men); screening (and treatment) vs. control group. AAA-related mortality in the screening arm reduced by about 40%; emergency ruptured AAA reducted by about 70%; disruption to elective work was reduced; and better management of risk factors and ITU/HDU beds. The overall survival benefits remain difficult to estimate, nevertheless, screening for AAA is recommended [level of recommendation: B].^[3][4][5]

- UK Small Aneurysm Trial: 1090 patients; AAA 4-5.5 cm; Immediate surgery vs. ultrasound surveillence (and treatment for rapid expansion or AAA >5.5); 30-day mortality after elective AAA repair is 5.8%. No difference in survival.^[6]

- ADAM VA Cooperative Group Trial. 32697 patients screened; Age 50-79; AAA 4.0-5.4 cm; similar conclusion to Uk Small Aneurysm Trial.^[7]

- Joint Vascular Research Group Trial. 284 patients; Study the relationship between intraoperative intravenous heparinisation, blood loss during surgery and thrombotic complications. Conclusion: Intraoperative heparin, given before aortic cross clamping, is an important prophylaxic against perioperative MI in aortic aneurysm surgery.^[8]

- HOPE (Heart Outcomes Prevention Evaluation) study - 4046 patients with PAD. In this subgroup, there was a 22% risk reduction in patients randomized to ramipril compared with placebo,which was independent of lowering of blood pressure.^[9]

[edit] References

[edit] External links

• University of Illinois at Chicago, Division of Vascular Surgery
• Society for Vascular Surgery (U.S.)
• European Journal of Vascular and Endovascular Surgery: the official journal of the European Society for Vascular Surgery.
• Division of Vascular Surgery and Endovascular Therapy at the Baylor College of Medicine

v • d • e Health science – Medicine · Surgery · Vascular surgery and other vascular procedures (ICD-9-CM V3 38-39) Aortic aneurysm / dissection Open AAA repair · Endoluminal AAA repair (EVAR) Carotid stenosis Carotid endarterectomy · Carotid stenting Varicose veins Ambulatory phlebectomy · Laser ablation · Sclerotherapy · Vein stripping Peripheral arterial occlusive disease Angioplasty with/out Stenting · Balloon embolectomy · Peripheral arterial bypass surgery · Thrombectomy Portal hypertension Transjugular intrahepatic portosystemic shunt (TIPS) · Distal splenorenal shunt procedure Other vascular procedures Venous cutdown · Cardiopulmonary bypass · Cardioplegia · Hemodialysis/Hemofiltration · Revascularization Imaging Angiography (Digital subtraction angiography, Cerebral angiography, Aortography, Fluorescein angiography, Radionuclide angiography, Magnetic resonance angiography) Venography (Portography) vascular navs: anat/physio/dev, noncongen/systemic vasculitis/congen/neoplasia, symptoms+signs/eponymous, proc