Who Should I Turn to for Vascular Surgery?

According to the Franklin Institute, a science museum in Philadelphia, the average human adult body contains more than 100,000 miles of blood vessels. This vast network of veins, arteries and capillaries reach every corner of the body, delivering oxygen to tissues and removing waste. In addition to blood vessels, the lymphatic system also runs throughout the body, similarly moving elements of the immune system and pushing waste products toward exit points via a network of lymph nodes, glands and channels. Together, the vessels that carry blood and lymph through the body is called the vascular system.

As with any complicated network in the body, sometimes things go wrong with the vascular system, and when this happens, the doctor who can help you is the vascular surgeon.

Although vascular surgeons are, as the name implies, well versed in surgical techniques, Dr. William P. Shutze, a vascular surgeon at Baylor Scott and White The Heart Hospital — Plano in Texas, says that often the care patients receive is not surgical in nature. “The majority of our clinic day is actually not operatively taking care of patients. It’s either making the diagnosis or making recommendations for continued care or following up” with patients. Vascular diseases are considered chronic, and as such, the vascular surgeon can care for virtually any problem that arises in this complicated part of the body.

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“Vascular surgery is a little bit of a misnomer,” Shutze says, “because the surgery part is only a fraction of what we do. A vascular surgeon is trained to take care of people with vascular problems whether they require surgery or not. We take care of people with problems with their arteries, their veins and their lymphatics.” Some common conditions vascular surgeons care for include:

Aneurysms — enlargement of an artery caused by a weakened arterial wall

Peripheral artery disease — hardening or blockage of an artery that’s not in the heart

Deep vein thrombosis — blood clots in a deep vein, often in the leg

Carotid artery disease — a clot or blockage in the artery in the neck that leads to the brain

Pulmonary embolism — a blood clot in an artery in the lungs

This list is not exhaustive, and there are many other conditions vascular surgeons treat. “As vascular surgeons, we’re able to treat blood vessels all over the body with the exception of the heart and the brain,” says Dr. Grace Wang, director of the vascular laboratory and assistant professor of surgery at the Hospital of the University of Pennsylvania. “What distinguishes us from other subspecialties is that we have to have a good grasp of anatomy everywhere in the body.”

Because vascular surgeons have a mastery of the entire system, the approach is often nonsurgical, and the relationship between patient and doctor frequently becomes a long-term one. “We kind of look at ourselves as the primary care physician for the blood vessels,” Shutze says. “It’s an area that’s under-recognized and physicians are under-trained and less comfortable with it.” Vascular surgeons are highly trained — often completing 8 to 10 years or more in medicine and their specialty field to learn how to treat this wide range of conditions.

Wang says that “many people don’t truly understand what the specialty entails. They know that cardiac surgeons do heart surgery. They know neurosurgeons treat the brain. But it is very hard to describe in a nutshell what vascular surgeons do. What’s unique about our specialty is that we offer both the open and the endovascular [minimally-invasive] options, and while there are other specialties that may perform the endovascular procedures in isolation, we’re really the only specialists who are able to treat the entire spectrum of disease,” she says. That means that “when stents [small wire mesh tubes that are inserted into veins and arteries to improve blood flow] fail, or we’re going in too often to treat restenosis of those stents, we’re able to say, ‘you know, you’d be better served with an open bypass.'”

Dr. Timur P. Sarac, director of vascular surgery at The Ohio State University Wexner Medical Center, says, “our specialty really truly became a specialty over 40 years ago. There’s a lot of other people dabbling into the field, but really we’re the one group that can offer open surgery and endovascular surgery. We have the opportunity to give patients such a wide breadth of treatments our specialty is very unique in that way.”

This can mean your own preferences are taken into account, depending on the situation. “Every patient gets their care tailored to their own physiology and anatomy, but also if you have somebody with both [endovascular and open surgical] options we like to take the patient’s preference into account,” Sarac says. “Certainly, we recommend what is best based upon our expertise of being able to offer them both, taking into account risk factors and comorbidities.”

When you’re looking for the right surgeon for your situation, Sarac recommends looking for a surgeon who trained at a top institution. “Certainly, for complex cases or if a patient has increased risk factors, then you should look at where they trained and what institute they’re practicing at so they can provide the best possible care.” Surgeons located in larger academic or tertiary care facilities may have more expertise in certain procedures and they also have the benefit of quick access to most any other specialist or subspecialist to help out in case a complication develops.

Shutze agrees, saying that “vascular surgery is such a highly-specialized field, it’s important that if you’re doing complex vascular surgery that it’s practiced in a facility that is in significant metropolitan area. This is not small-town treatment — this needs to be done in a hospital that has the resources to help the vascular patients be successful, such as a good cardiac surgery program, a good dialysis program and support from all of the major subspecialists like nephrology and cardiology.” In addition to offering appropriate care in case of complications, working with a surgeon based in a large, multidisciplinary facility “demonstrates that the vascular surgeon is participating in an environment that gets the surgeon and the patient the resources necessary to provide high-quality care.” All that said, Shutze notes that many vascular surgeons can do some less complicated procedures in their office on an outpatient basis.

Sarac also recommends finding a surgeon who you’ll be comfortable with over the long term. “We’re one of the only surgical specialties that follows our patients longitudinally, so there is a component of primary care to what we do.” For example, “when we do an aneurysm repair on someone, they see us forever. When we do a lower extremity bypass or an angioplasty [using a balloon-like device to push a blood vessel open wider], they see us forever. That way they never lose continuity of care,” he says.

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Finding the best vascular surgeon for you can be challenging, in part because there’s a growing workforce shortage in this field, as the population ages and experiences more vascular problems that can often be related to aging. “The good news is that there are actually a lot of very good vascular surgeons out there,” he says.

So what defines a good vascular surgeon? Shutze says that often depends on what the patient values. “Many people say, ‘well I want a doctor who will sit down and explain things to me and take the time. He doesn’t have to be the best and brightest.’ Someone else wants a surgeon who’s on the cutting edge and knows the latest and greatest. Another patient says, ‘I don’t want an old doctor,’ while another doesn’t want a young doctor. So it kind of depends on what that person’s criteria is for a good doctor.” He recommends you make your own “checklist and have it thought out before” you go searching.

Once you know what’s important to you, you should use the same criteria for selecting a vascular surgeon as you would any other physician. “Look at reputation, where they practice, how long they’ve been in practice,” and Shutze says testimonials from other patients can also be useful.

Wang agrees that “word of mouth” is a good way to find a surgeon. “The best compliment I can receive is when a patient’s family member sends me additional family members, or when a friend refers a friend,” so ask around and be sure to ask other health care providers you know and trust. “I think if you know anyone who’s connected to a hospital or health care setting they can usually find out who the right person to approach may be.”

Shutze also recommends looking for a surgeon who’s a member of The Society of Vascular Surgery. “Membership in that organization is representative of a surgeon’s commitment to high-quality care.” You can use the search feature on its website to see if your doctor is a member. In addition, you should verify whether the doctor you’re considering is board-certified in vascular surgery. You can search for board-certified physicians on the American Board of Surgery’s website.

[See: HIPAA: Protecting Your Health Information.]

He also notes that if you’re taking pains to avoid a “bad surgeon,” check with your state’s licensing board to see whether any disciplinary actions have been taken against the physician you’re considering. These records are public and usually easily found via the state medical licensure board’s website.

Lastly, when you visit a vascular surgeon for the first time, it’s important to bring all your records and reports from any other doctors you’ve seen. “In vascular surgery, many times there are either imaging studies or other vascular laboratory studies done, which are basically ultrasound studies,” Wang says. “These are useful for the surgeon to interpret after a thorough history and physical exam. Many times, the patient will bring the report, but it’s actually very important that the surgeon actually looks at the images, which need to be burned on to a disc and brought to the office visit so we can review that imaging in detail.”

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Who Should I Turn to for Vascular Surgery? originally appeared on usnews.com