Vascular surgery

Vascular surgeons are trained in the diagnosis and management of conditions affecting the circulation, including disease of the arteries, veins and lymphatic vessels. They treat all parts of the vascular system excluding the heart and the brain.

This page provides useful information on the nature of the work, the common procedures/interventions, sub-specialties and other roles that may interest you.

picture of theatre for surgery

Nature of the work

Vascular surgery became a surgical specialty in its own right in 2012, having previously been a subspecialty of general surgery. The first trainee vascular surgeons started training in 2013.

Vascular surgeons are trained to assess, diagnose and treat vascular conditions. Many vascular conditions can be treated without surgery, radiology or invasive procedures. The vascular surgeon often has a preventative role and may advise the patient to adopt a healthy lifestyle including a suitable diet and regular exercise. This, in combination with appropriate medication, will often minimise future risk of heart attack and stroke.

Where surgery is required, endovascular surgery is often performed utilising minimally invasive techniques. Vascular surgeons or interventional radiologists both provide these treatments such as angioplasty (widening narrowed or obstructed arteries) and inserting stents. For example, during angioplasty an empty and collapsed tiny balloon is inserted into narrowed areas of the vessel and inflated using water pressure to improve blood flow. A stent (a tiny metal cylinder) may also be inserted to ensure the vessel remains open. The aim of these techniques is to restore normal blood flow.

Endovascular surgery has some advantages over open surgery including shorter recovery periods both in and outside the hospital, less pain and scarring and lower mortality rates. Endovascular techniques may however be less durable when applied to more extensive disease, so a careful decision is required before treatment. Multidisciplinary working with interventional radiology is very important.

Open surgery is used to remove blockages from blood vessels or to bypass a blocked vessel.

Vascular surgeons treat a wide variety of conditions including:

Diabetes can affect vascular health adversely and may result in foot problems due to peripheral arterial disease. Vascular surgeons often provide the care for diabetics with foot problems.

Vascular surgeons also treat renal vascular disease – conditions that affect the circulation of the arteries and veins affecting the kidneys, such as renal artery aneurysms and thrombosis (a blood clot in the renal artery which may lead to kidney failure).

Vascular surgery is very varied and most operations have to be tailored to the individual patient. Some vascular surgeons develop experience of treating paediatric vascular conditions and vascular malformations, whilst others provide vascular input into trauma centres. Because this surgical specialty is new, there are no defined sub-specialties as yet.

Vascular surgeons work particularly closely with other specialist medical colleagues, for example in the control of vascular bleeding. They also work alongside vascular interventional radiologists and often carry out procedures jointly. Cardiac and vascular surgeons increasingly work together, particularly for complex aneurysms. Vascular surgeons also work closely with cardiologists to assess patients with cardiovascular disease.

About 40% of vascular patients present to hospitals as emergency cases. Urgent intervention is required for conditions such as ruptured aortic aneurysms and vascular trauma following road accidents, assaults and other accidents.

“I love working in vascular surgery as the outcomes are clearly related to the work you have done”. Marcus Brooks, Consultant Vascular Surgeon, North Bristol NHS Trust.

Read Marcus’s story

Common procedures

Procedures performed by vascular surgeons include:

Varicose veins surgery has been transformed in recent years following the introduction of endovenous vein treatment – minimally invasive surgery where the veins are repaired without major incisions in the leg. An ultrasound machine enables the surgeon to see the damaged vein under the skin. Tiny incisions are made and instruments are placed into the vein to perform the repair, under local rather than general anaesthetic. In the past this was a much bigger operation, where the veins had to be stripped from the leg and recovery times were much longer.

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