The vascular system consists of the heart and arterial tree, the veins and
the microvascular elements: the capillaries and lymphatics. Age dependent, degenerative
diseases that affect the vascular tree are by far the commonest causes of death
and impaired quality of life in Western societies.
General vascular surgery is concerned with diseases of the larger arteries
and veins in the neck, abdomen and limbs. Intracranial vascular disease is managed
by neurosurgeons and cardiac and intrathoracic vascular disease by the cardiothoracic
Arterial disease can be broadly classified into occlusive and aneurysmal.
Occlusive Arterial Disease
Occlusive arterial disease is where the lumen of the artery becomes progressively
narrowed up to the point of complete occlusion. The primary cause is the process
of atherogenesis that affects the inner layers of large and medium sized arteries.
Atherogeneis starts early in life and progresses at a rate that depends on
a number of inherited and environmental factors such as smoking, high blood
lipids (hyperlipidaemia), high blood pressure (hypertension) and diabetes mellitus.
Atherogenesis is a systemic disease that affects all large and medium sized
arteries to some degree, although it has a predilection for certain anatomical
sites such as the heart (coronary arteries), the neck (carotid arteries) and
the lower half of the body (aorta and lower limb arteries).
All occlusive arterial disease, has an incidence that increases progressively
with age and the prevalence at any site is greater in patients with co-existing
symptomatic occlusive arterial disease elsewhere. Occlusive arterial disease
causes symptoms due to lack of adequate arterial blood supply (ischaemia) which
results in limited function or tissue death (infarction). Occlusive arterial
disease is the single commonest cause of death and disability through ischaemic
heart disease (angina, myocardial infarction, heart failure), cerebrovascular
disease (stroke) and lower limb arterial disease (intermittent claudication,
critical limb ischaemia and amputation).
Aneurysmal Arterial Disease
Aneuysmal arterial disease is where the lumen of the artery becomes progressively
dilated. Arterial aneurysms are classified into two types: true aneurysms
that represent a progressive weakness of all three layers of the arterial wall
(intima, media and adventitia) and false aneurysms which are contained
arterial leaks and which only have an adventitial layer. The abdominal aorta
is the commonest site for a true aneurysm.
The incidence of aortic aneurysm is greater in men and increases progressively
with age. Aneurysms are a life threatening condition because a large aneurysm
may rupture suddenly and without warning. There are an estimated 6000 deaths
per year in the UK from ruptured aortic aneurysms, i.e. about that same number
of people who die annually in road traffic accidents.
Venous disease can be broadly classified into venous insufficiency and venous
Venous insufficiency is very common and mainly affects the lower limb, primarily
because of the upright human posture. Venous insufficiency covers a broad spectrum
of severity from minor cosmetic varicose veins through functionally significant
varicose veins to venous leg ulcers.
Venous insufficiency is a progressive, degenerative process and it is estimated
that 30% of the adult population have a significant degree of venous insufficiency.
In the UK alone 50,000 varicose veins operations per year are performed, mainly
for mild disease. Venous leg ulcers affect around 1% of the adult population,