Clinical Review

Recent developments in vascular surgery

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7420.911 (Published 16 October 2003) Cite this as: BMJ 2003;327:911
  1. Jeremy Crane, clinical research fellow (j.crane@imperial.ac.uk)1,
  2. Nick Cheshire, consultant vascular surgeon1
  1. 1Regional Vascular Unit, St Mary's Hospital, London W2 1NY
  1. Correspondence to: J Crane

    The authors of this review discuss the changing role of vascular surgery and the impactof developments such as endovascular interventions and new techniques for treating varicose veins

    Introduction

    Vascular surgery has come of age over the past two decades. The specialty has increasingly separated from general surgery as evidence accrues that outcomes for patients are better when arterialoperations are done by a specialist.1 In the United Kingdom,this has meant an increasing number of consultant posts for purely vascular surgery being advertised. As a result of the expanding ageing population and historical under-provision of vascular intervention in the United Kingdom, vascular workload is expected to rise and the need for specialistswill grow.2

    Recognition of the multisystem nature of vascular disease has increased integration of vascularsurgery into multidisciplinary teams of allied specialties. Surgical decisions are now often made jointly with the input of the renal physician, diabetologist, radiologist, cardiologist, neurologist, and specialist nurse. As a result, the role of the vascular surgeon as a sole player within hospital medicine is changing.

    Sources and selection criteria

    To identify emerging trends in vascular surgery, we searched Medline and the Cochrane database and discussed developments with surgical colleagues. We also reviewed published abstracts of presentations from the Vascular Surgical Society of Great Britain and Ireland, the European Society of Vascular and Endovascular Surgery, and the Society for Vascular Surgery (USA) in the past two years.

    Abdominal aortic aneurysm

    Endovascular aortic repair

    Endovascular repair of abdominal aortic aneurysms was introduced a decade ago. This operation involves radiographically guided intraluminal placement of a prosthetic graft on a wire mesh into the abdominal aorta. This is done via a small groin incision, thus avoiding the morbidity and mortality associated with major open abdominal surgery. As with conventional repair, the goal of endovascular treatment is to prevent further expansion by excluding flow within the aneurysm, thus reducing the …

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