Open vascular surgery

Vascular surgery is a medical specialty concerned with the surgical treatment of disorders affecting the blood vessels and lymphatic system (vascular diseases) of the body, excluding the blood vessels of the heart. Vascular surgery is usually recommended when nonsurgical treatments fail to treat the diseases of the vascular system. Vascular surgery is often performed to improve blood circulation to an area of the body where the blood vessels have been damaged, following injury, disease or other conditions.

Vascular surgery can be performed as an open surgery and as endovascular procedures. Open vascular surgery requires several days in the hospital and an extended recovery period.

Open vascular surgery involves a variety of procedures, which include:

Carotid endarterectomy - Carotid endarterectomy is a surgical procedure performed to remove plaque (deposits of fat) from the carotid arteries of the neck; the main blood vessels that supply blood to the brain.

A carotid endarterectomy often takes about 1 ½ to 2 hours and is usually performed by a vascular surgeon. The procedure is performed in a hospital under general or local anaesthesia with intravenous sedation. During the surgery, an incision is made over the neck to expose the narrowed carotid artery. A plastic tube is placed into the blood vessel, above and below the narrowing or blockage, to re-route the blood flow around the narrowed or blocked area. The artery is then opened and the plaque is removed. The plastic tube is then removed and the artery and skin incisions are closed.

As with any type of surgery, there are some risks associated with a carotid endarterectomy which include infection, bleeding, blood clot formation, brain damage, and heart attack or stroke.

Surgical bypass - Surgical bypass is usually performed in patients who are not good candidates for angioplasty or who have found angioplasty to be ineffective. It is a good treatment option for atherosclerosis.

During bypass surgery, you will receive anaesthesia so that you do not feel any pain. Your surgeon will make an incision over the artery that is blocked. The clamps will be placed at each end of the blocked section of artery. The graft is then sutured in place. The doctor will make sure that the alignment is correct without any leakage, blood flows properly and the graft is working fine. Your surgeon then stitches the incision firmly. After surgery, you might have to stay for 3-10 days in the hospital for monitoring. You should contact your physician immediately if you develop a fever, a cold painful arm or leg, or if the incision area becomes red or swollen. You may have to follow a strict diet and take prescribed medications regularly. You can resume your physical activities only as per your doctor’s advice. You will be asked to meet your doctor for follow-up visits.

As with any surgical procedure, surgical bypass carries some minor risks such as swelling, bleeding at the incision site, wound healing problems and infection.