From arteries to venous diseases...Do you know vascular surgery?
Jan 12, 2025
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Kang Ji-hee, head of the vascular surgery department at Bucheon Sejong Hospital, said, "Many patients know surgery, but vascular surgery is unfamiliar. Vascular surgery is a sub-division of surgery that studies, diagnoses, and treats diseases, trauma, and congenital abnormalities in all arteries and veins of the human body except for blood vessels in the chest and skull."
◇ It is also called 'transplant vascular surgery'…In charge of medication and procedures, etc
The main diseases treated by vascular surgery include ▲ arterial disease (abdominal aortic aneurysm, peripheral artery disease, aortic iliac artery occlusion, Berger's disease, vasculitis, carotid artery stenosis, etc.) ▲ venous disease (lower varicose veins, deep vein thrombosis, visceral vein thrombosis, etc.) ▲ Issues related to arteriovenous fistula for hemodialysis ▲ Other vascular malformations, vascular trauma, and vascular tumors.
"Vascular surgery is also in charge of organ transplantation, especially kidney transplantation, and sometimes referred to as 'transplant vascular surgery' depending on the hospital," Kang said. "Vascular surgery is a branch of surgery and is recognized as a field only in charge of surgical treatment, and it is appropriate to view it as a field in charge of treating all vascular diseases such as drug treatment and surgical treatment."
In addition, "Usually, arterial diseases are at high risk for cardiovascular and cerebrovascular diseases or often have comorbid diseases already. When planning the treatment of a single disease, it is often necessary to pre-assess various risk factors. "In some cases, while being treated for a related disease, he discovers a vascular disease and visits an vascular surgery, and in such cases, consultations with medical departments such as cardiology, thoracic surgery, neurology, and neurosurgery may be required. If tissue necrosis and infection due to ischemia are accompanied, cooperation between orthopedics and infectious medicine departments is also important."
◇ Representative diseases and treatments covered by vascular surgery
Abdominal aortic aneurysm is often diagnosed by accident in tests conducted for other purposes. It is generally characterized by no symptoms until just before rupture. If you feel a lump in your abdomen that is beating your pulse, you should visit the hospital to check it out.
Depending on the patient's underlying disease, general condition, age (life expectancy), and anatomical structure of blood vessels, intravascular stent graft insertion or artificial vascular reconstruction surgery is used.
Peripheral artery disease is a state in which the peripheral artery is narrowed or closed, and clinical features vary from asymptomatic to claudication when walking (lower extremity pain when walking for a certain distance, improvement when resting), delayed wound healing, and terminal tissue necrosis. Here, the peripheral artery refers to all other arteries except cardiovascular (corrhizal artery), cerebrovascular, and aorta, and is usually recognized as an artery for limbs.
Percutaneous angioplasty and vascular bypass surgery using autologous and artificial blood vessels are also performed in consideration of the degree of progression of vascular lesions and the patient's systemic condition. In some cases, the best treatment results are obtained with a hybrid method combining interventional procedures and surgery.
Carotid artery stenosis refers to cases in which arteriosclerotic lesions and cholesterol accumulate in the main blood vessels (carotid arteries) that supply blood from the heart to the neck and the lumen is narrowed or completely blocked. Crumbs fall off the narrowed blood vessel wall and enter the cerebral artery via the bloodstream, which can cause cerebral infarction.
The treatment target for carotid stenosis has different criteria for stenosis when symptomatic and asymptomatic, and it can be treated with appropriate methods among carotid stent implantation and carotid endometriomy.
Manager Kang said, "Most arterial diseases must be treated in addition to physical treatment methods, lifestyle improvements including smoking cessation, diet, exercise, and medication (hyperlipidemia treatment, antiplatelet drugs, etc.)"In general, these patients are at high risk of other cardiovascular diseases and often already have comorbidities. Above all, vascular disease itself is a progressive disease, requiring periodic follow-up rather than an end with a single vascular treatment.
As for venous diseases, varicose veins are typical. Inside the vein, there is a structure called a valve that always keeps blood flow toward the heart, and when these valve structures fail to function for various reasons, blood flows back, increasing venous pressure, and thus increasing the vein and making it visible.
Symptoms may include easily tired legs, heavy feet and legs, or soreness, especially in the afternoon. Although ambiguous, many patients commonly complain of discomfort with numbness in their legs and cramps during night sleep. On the outside, it may be fine, or it may extend serpentinely from the spider web-shaped thread veins and show protruding blood vessels. In severe cases, skin pigmentation near the front of the ankle or shin bones, and furthermore, venous skin ulcers may occur.
If varicose veins are not severe, no special treatment is required. When active treatment is performed according to the severity of illness and symptoms, various methods can be considered, such as surgical vein extraction, intravenous laser and high-frequency obstruction, and drug sclerotherapy to close the reflux superficial vein.
Patients with chronic renal failure need kidney transplantation or continuous renal replacement therapy such as hemodialysis and peritoneal dialysis in the long term. When hemodialysis is planned, surgery is performed to create blood vessels to be used for dialysis using autologous veins or artificial blood vessels depending on the patient's blood vessel condition, which is called arteriovenous fistula.
The arteriovenous fistula can cause numerous problems repeatedly, including vascular stenosis, arteriovenous fistula obstruction, and pseudoaneurysm for its own hemodynamic and physiological reasons. Due to the nature of patients who have to continue hemodialysis, it is important to select the best treatment method to use it for as long as possible with minimal procedures and surgeries.
The most common treatment for vascular stenosis is percutaneous vasoconstriction. In addition, various surgical correction may be necessary depending on the type of problem and blood vessel condition that has occurred.
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This article was translated by Naver AI translator.