Division of Vascular Surgery
Overview
Diseases treated in the field of vascular surgery
Vascular surgery is defined as "a field of surgery that deals with surgical treatment of vascular lesions"according to the Heibonsha World Encyclopedia, second edition. Stroke, a disease of the blood vessels of the brain, is mainly treated by departments of neurology and neurosurgery, while diseases of the coronary arteries such as angina pectoris and myocardial infarction are treated mainly by departments of cardiovascular medicine and cardiac surgery.
The Division of Vascular Surgery at NCVC treats diseases of the following blood vessels: 1) aorta, which sends the blood pumped from the heart to the entire body; 2) arteries branching out from the aorta, which send blood to peripheral areas such as the upper limbs, abdominal organs, and lower limbs; 3) veins including cava through which blood flows from the peripheral areas back to the heart; and 4) pulmonary arteries, which send blood from the heart to the lung.
Diseases of the blood vessels are divided into ectatic diseases in which blood vessels are enlarged and eventually rupture and occlusive diseases in which blood vessels are narrowed and eventually become occluded.
Diseases of the aorta are mostly ectatic. They mainly consist of aneurysm and aortic dissection. Rupture of an aneurysm and aortic dissection are immediately life-threatening.
Among arterial diseases, occlusive diseases of the arteries of the hands or feet are most common. Diseases of the arteries are relatively rare in abdominal organs; a high percentage consists of aneurysm. In the renal arteries, stenosis and occlusion are frequently observed. Sudden occlusion of any artery would lead to severe symptoms that require emergency surgery. When gradual occlusion of arteries occurs, symptoms also appear gradually.
Varicose veins in the lower extremity constitute the most common venous disease. Varicose veins are almost never life-threatening. By contrast, venous occlusion caused by thrombosis may lead to life-threatening acute pulmonary embolism, which is commonly known as economy class syndrome.
The most common disease of the pulmonary arteries is pulmonary hypertension. Among different types of pulmonary hypertension, pulmonary thromboembolic pulmonary hypertension can be treated with surgery, albeit a very difficult procedure.
Diseases in the field of vascular surgery may require extremely urgent treatment. Because understanding of these diseases among emergency physicians and ambulance crews has improved and medical devices have become more advanced, more patients are now brought to hospitals before it is too late to treat. However, the urgency of treatment for ruptured aneurysm and aortic dissection, which may cause sudden death, is extremely high. Prompt action is required to bring patients to hospitals or operation rooms while they still have a pulse.
Aortic dissection and acute pulmonary embolism occur without warning. Therefore, there is no choice other than responding as soon as either condition occurs.
By contrast, aneurysms enlarge gradually, usually without symptoms. It is common that aneurysms are discovered at rupture. In most cases, it is detected incidentally when testing for other diseases or during health checkups. In arteriosclerosis obliterans, a condition in which arteries gradually become occluded, symptoms progress in stages. For both diseases, it is safe to consult specialists promptly after the diagnosis.
Surgeries performed by the division
Since its inception, NCVC has performed more than 3,500 surgeries of the thoracic aorta and more than 3,000 surgeries of the abdominal aorta. More than 230 surgeries of the pulmonary arteries have been performed. The number of surgeries in the past 10 years is presented below.
The percentage of emergency surgeries of the aorta is growing yearly. In particular, among the surgeries of the thoracic aorta, surgeries for acute aortic dissection were common. One-third of all surgeries for the thoracic aorta were emergency surgeries. More than 10% of all surgeries of the abdominal aortae were emergency surgeries.
In order to perform emergency surgery, hospitals have to be ready for immediate computed tomography, blood testing, transfusions, and other procedures. Not only vascular surgeons, but also a large team of professionals including emergency physicians, nurses, clinical laboratory technologists, and X-ray technologists are needed for accepting critical care patients. In addition, anesthesiologists, nurses, and clinical engineers are needed for performing surgeries and nurses are needed for providing postoperative intensive care. NCVC is always ready for multiple simultaneous aortic surgeries.
To implant prostheses in blood vessels, which is a standard technique for treating diseases of the aorta, blood flow in the aorta has to be temporarily blocked in addition to thoracotomy or laparotomy. During surgery of the thoracic aorta, an extracorporeal circulation apparatus is necessary, as is the case for cardiac surgery. It is common that special supplementary procedures such as therapeutic hypothermia, circulatory arrest, and cerebral perfusion become necessary. These surgeries are invasive, placing a heavy burden on the patient's body. However, many patients for whom aortic surgery is indicated are elderly or have other diseases, making them unlikely to be able to tolerate such invasive surgeries. Stent-grafting via catheterization was developed to treat these patients. At NCVC, this method was fully introduced in 2007.
The proportion of stent-grafting procedures involving the thoracic aorta is close to 30%. Recently, stent-grafting has been used for the treatment of aortic dissection and outcomes have been improving. For the abdominal aorta, more than half of the surgeries are performed with stent-grafting. It has been 10 years since the introduction of stent-grafting; its benefits and areas for improvement are being identified continuously. We compare stent-grafting with blood vessel prosthesis implantation and select the most suitable therapeutic method for each patient.
For peripheral arteries, bypass surgery used to be the standard. Recently, catheterization has advanced such that in some cases, it is now selected as the first-line therapy. We select the therapeutic method with a lasting effect in collaboration with Department of Vascular Medicine and Department of Radiology.
Among diseases of the pulmonary arteries requiring surgery, the most common is pulmonary thromboembolic pulmonary hypertension. This condition has a long clinical course and its treatment is rarely started by surgical departments. Catheterization has recently been introduced for this disease. We select the therapeutic method based on disease severity and occlusion location in collaboration with the Department of Cardiovascular Medicine (Division of Pulmonary Circulation) and the Department of Radiology.
For the treatment of varicose veins in the lower extremities, varicose vein removal surgery (stripping) used to be performed before. In the spring of 2018, catheter-based laser treatment was fully introduced in our division.
Certifications
- Training facility certified by the Japanese Board of Cardiovascular Surgery and the Japanese Society for Cardiovascular Surgery
- Training facility for the surgery specialist system certified by the Japan Surgical Society
- Facility certified for stent-grafting by the Japanese Committee for Stentgraft Management
last updated : 2021/10/01