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A vascular surgeon is a doctor who diagnoses, treats and prevents vascular diseases (veins and arteries).
Vascular surgery is a branch of medicine aimed at diagnosing, treating and preventing diseases of the large main vessels and the lymphatic system.
A vascular surgeon (or angiosurgeon) uses minimally invasive therapies to treat vascular disease. Minimally invasive methods are called in which the size of incisions is minimized during surgical treatment, which makes the operation less traumatic for the patient, facilitating the rehabilitation period, while achieving maximum treatment efficiency.
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What does a vascular surgeon treat?
Vascular diseases are congenital and acquired, can develop against the background of other systemic diseases, hormonal imbalance, or occur after traumatic damage to blood vessels. The field of activity of the vascular surgeon also includes oncological formations located near large main vessels, which can create pathological communications between veins and arteries. The consequences of such diseases include both cosmetic defects and functional disorders in the organs, for the blood supply of which the affected vessels are responsible.
Microsurgery is a branch of vascular surgery that uses optical magnification systems, special instruments and suture material, which makes it possible to perform operations even on vessels with a diameter of less than 2 mm. Microsurgical methods make it possible to perform the replantation of parts of the limbs (hands and fingers, toes) after traumatic amputation with partial or complete restoration of their function. During the microsurgical operation, it is possible to stitch veins and arteries of small diameter, nerves and lymphatic vessels.
The most common problem with which an angiologist is consulted is atherosclerosis and its complications. It was previously believed that this disease occurs mainly among the elderly, but in the modern world, young patients also suffer from atherosclerosis. Atherosclerotic lesions of blood vessels, the formation of cholesterol plaques leads to a narrowing of their lumen, which makes it difficult for blood flow. In this case, there are violations of the blood supply to the organ whose vessels are affected by the disease, which can lead to loss of functionality and tissue necrosis.
In most cases, atherosclerosis is asymptomatic, since the presence of atherosclerotic plaques can only be judged by the negative consequences of vascular lesions. So, if when a vessel is blocked by an atherosclerotic plaque, the blood supply is disturbed, and destructive changes occur in the tissues, a vascular disease can be assumed from the pathology of this organ. This situation is very dangerous, since atherosclerosis is often detected at a stage when irreversible pathological processes occur. For some patients, the first symptom of atherosclerosis is also the last – in the case of a heart attack or stroke, that is, damage to the vessels of the heart or brain.
The main activities of an angiosurgeon:
Diagnosis of vascular diseases, violations of the functionality of the main vessels;
Replantology – microsurgical operations for sewing limbs after traumatic amputation;
Prosthetics of blood vessels after an injury resulting from mechanical impact or surgery;
Treatment of vessels damaged as a result of traumatic impact;
Treatment of oncological neoplasms growing into large vessels;
Conservative treatment of damaged vessels, as well as preventive measures that prevent the occurrence of vascular diseases;
Treatment of congenital vascular pathologies – hemangiomas and arteriovenous malformations.
Diseases treated and diagnosed by a vascular surgeon:
Atherosclerotic vascular lesions – atherosclerosis of the lower extremities, thrombosis of the renal arteries, atherosclerosis of the cerebral vessels;
Coronary heart disease;
aortic aneurysm;
Arteriovenous malformations;
Myocardial infarction;
Congenital or traumatic arteriovenous fistula;
Damage to the vessels that provide cerebral circulation;
Trophic ulcerative lesions of the skin;
Stenosis of the carotid arteries;
Diabetic angiopathy;
Cinga;
Phlebitis, thrombosis and thrombophlebitis;
Stroke
Varicocele;
Venous embolism;
Arterial gas embolism;
Phlebeurysm;
Encephalopathy;
Inflammatory thrombosis of small arteries and superficial veins;
Violation of the outflow of lymph – lymphostasis;
Aneurysm rupture and subarachnoid hemorrhage;
Chronic ischemia of the brain, insufficiency of cerebral circulation;
Inflammation of the aorta and its branches – Takayasu’s syndrome;
Violation of the venous outflow in the liver – Budd-Chiari syndrome;
Autoimmune syndrome characterized by alveolar pulmonary hemorrhage and glomerulonephritis – Goodpasture’s syndrome or systemic capillaritis;
Transposition of the great vessels;
Aortic dissection in Marfan syndrome;
Raynaud’s disease – damage to the vessels of the distal extremities, fingers and toes.
When should I see a vascular surgeon (angiosurgeon)?
For preventive purposes, it is recommended to undergo an annual examination by a vascular surgeon, this allows you to detect vascular diseases at an early stage and prevent the occurrence of atherosclerosis.
Symptoms that should be seen by a specialist:
Heaviness in the legs and feet, swelling and burning sensation in the legs;
Tingling and numbness of the distal extremities and any other parts of the body;
Dizziness, tinnitus, impaired coordination and consciousness;
Darkening of the fingertips, they may turn black and acquire a bluish tint;
Ulcerative lesions on the skin, long-term healing lesions;
Headaches not associated with other diseases; (Read also: causes, signs and symptoms of headaches, consequences)
Spots and dark spots before the eyes;
Pulsating sensations in the abdomen;
Bleeding in any area of the body;
The occurrence of seizures even at rest, aggravated by physical exertion;
Dilated veins in the legs, pain in the feet when walking;
The occurrence of varicose veins or telangiectasias;
Seals localized in the lower extremities, their redness and soreness, or, conversely, loss of sensitivity;
Pain in the side, chest, and lumbar region, which may extend down the buttocks and through the groin to the legs.
Tests to be taken by a vascular surgeon
To diagnose the state of the vascular system and identify functional disorders of blood flow, it is necessary to undergo a series of examinations.
Blood chemistry analysis allows you to determine the functional state of the liver, pancreas, kidneys, gallbladder and other organs, to identify metabolic disorders and blood diseases. This is the basic analysis needed to diagnose most diseases. The indicators of the level of glucose, bilirubin, liver and pancreatic enzymes, proteins and blood lipids are examined. In the diagnosis of vascular diseases, an important role is played by indicators of lipid metabolism – the level of cholesterol, triglycerides, low-density lipoproteins. According to these data, it is possible to identify a predisposition to atherosclerosis and prevent vascular lesions. Blood is examined for the level of homocysteine (an amino acid that contributes to the depletion of the vascular walls, which provokes the deposition of cholesterol plaques), the level of creatine kinase, phosphatase and C-reactive protein.
General blood analysis – a blood test for hemoglobin levels, erythrocyte sedimentation rate, platelet index and the level of other blood cells – leukocytes and erythrocytes. These data make it possible to determine the quality of blood and timely detect its diseases, which can provoke damage to blood vessels, thinning of their walls.
Other tests to determine the clinical picture:
Urinalysis – prescribed for the diagnosis of most diseases, urine is examined for the level of glucose, bilirubin, ketone bodies, its pH is determined, the presence of blood cells, salts, parasitic organisms, bacteria and fungi;
Hemostasiogram – determines the level of fibrinogen, prothrombin time and prothrombin index;
Serological blood test – allows you to determine the infectious cause of vascular diseases, the blood serum is examined for the presence of antibodies.
In the process of diagnosis, an angiosurgeon may need additional studies for an accurate diagnosis, a referral for tests is given by a doctor.
Basic methods of diagnosis of a vascular surgeon
Diagnosis of vascular diseases is carried out on the basis of examination data and analyzes of the patient, carried out using instrumental methods.
Basic diagnostic methods:
MRI-angiography or ultrasonic duplex scanning – gives a two-dimensional image of the vessels, on which you can assess the state of their walls, structure and patency, determine the features of blood flow in the vascular bed;
X-ray angiography – using this method, the place of blockage of the vessel and the reduction of its lumen are determined;
Doppler ultrasound – a method for evaluating peripheral and main arteries, with its help determine the functional state of blood flow in the lower extremities, its speed and places of narrowing or blockage of blood vessels;
Cerebral angiography – a method for studying vessels that provide cerebral circulation (cerebral vessels);
Coronal angiography – assessment of the state of the vessels that provide blood supply to the heart – the coronary arteries, as well as the study of the heart chambers;
Ultrasound of internal organs – first of all, the organs of the endocrine system are examined, which are responsible for maintaining hormonal balance. These include the thyroid gland, kidneys and adrenal glands.
Electrocardiogram – the work of the heart muscle is assessed in daily dynamics;
Endoscopic methods for studying vessels or angioscopy allows you to assess the state of their inner surface, determine the tendency to develop atherosclerosis; (Read also: causes, symptoms, diagnosis and treatment of atherosclerosis)
Ultrasound of the liver vessels;
Echocardiogram– ultrasound examination of the work of the heart muscle;
Anthropometry – calculate the body mass index, measure the body length on the stadiometer, determine the circumference of the chest and abdomen to assess the general condition of the body based on anthropometric indicators;
Doppler sonography of the veins of the lower extremities – allows you to assess the state of blood flow in real time with sound and graphical display of indicators. This method is used to examine the great and small saphenous veins, deep veins of the lower leg, femoral, inferior vena cava and iliac veins. The state of the vessels, the presence of an anomaly in their structure, kinks and aneurysms, inflammatory processes and compression are determined.
Basic principles of treatment of a vascular surgeon
After assessing all the external and internal factors that provoked the vascular disease, the angiologist prescribes a course of treatment, which may include medication and compression therapy, surgery, and sclerotherapy.
Sclerotherapy is used in the treatment of varicose veins and vascular neoplasms, a special substance is injected into the vessel, which causes its walls to stick together and prevents the spread of the pathological process.
Other methods of treating vascular diseases are magnetic therapy, pneumomassage, cryotherapy, electrical nerve stimulation, as well as physical therapy exercises. If surgical intervention is necessary, the angiologist prescribes venectomy, miniphlebectomy or laser coagulation of the vessel, depending on the type of pathology.