The Daily Schedule Of A Vascular Surgeon

A vascular surgeon is a surgical sub-specialist who trains in the diagnosis and management of diseases and conditions of the vascular system (veins and arteries). These issues are either managed conservatively, by medical treatment, or by surgical interventions such as surgical reconstruction or minimally-invasive catheter procedures.

Vascular surgery evolved from cardiac and general surgery, as well as from the minimally invasive procedures performed in interventional radiology. This specialist surgeon focuses on diseases that affect all the anatomy of the vascular system, except those of the brain and heart which are managed by neurosurgeons and cardiothoracic surgeons, respectively.

Vascular surgery includes conservative and surgical management of the carotid arteries, aorta and the tibial, femoral and iliac arteries of the lower extremities. Vascular surgery also involves surgery of veins, where the patient is diagnosed with varicose veins, as well as dialysis access surgery (fistulas for haemodialysis access) and transplant surgery.

Training

In order for a doctor to be allowed to specialise, they have to complete the 5-6 year medical and surgical undergraduate degree where one becomes a medical doctor. The doctor must then complete a mandatory 1-2 year internship phase where they are exposed to the numerous medical and surgical disciplines.

A doctor wanting to specialise in vascular surgery can do so via two routes. Depending on where they choose to study, the specialist candidate can decide to complete a 5-6 year residency programme in vascular surgery, or they will have to complete a 5 year residency programme in general surgery followed by a 2 year fellowship programme in vascular surgery. The latter seems to be the most common pathway available worldwide.

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Conditions managed and procedures performed by Vascular Surgeons

The conditions managed by vascular surgeons and the procedures performed for these issues include the following:

• Abdominal aortic aneurysm (AAA) - endovascular aneurysm repair (EVAR), open aortic surgery.
• Aortic dissection - open aortic surgery, thoracic endovascular aneurysm repair (TEVAR).
• Carotid stenosis - carotid stenting, carotid endarterectomy
• Acute limb ischaemia - thrombectomy, balloon embolectomy, vascular bypass grafting.
• Occlusive peripheral artery disease - vascular bypass, angioplasty with/without stenting, atherectomy, endarterectomy.
• Varicose veins - sclerotherapy, vein stripping, ambulatory phlebectomy, endovenous laser treatment.

Non-surgical management

No medical specialist counterpart exists for a vascular surgeon, as a cardiologist would manage medical cardiac conditions and a cardiothoracic surgeon would manage surgical issues, therefore the specialist would also be responsible for providing medical or non-surgical therapies.

These non-surgical therapies would include prescribing cholesterol lowering and clot preventing medications. Vascular surgeons would also suggest lifestyle changes to these patients such as stopping smoking, which is a major factor for the development of cardiovascular diseases, suggesting exercising and referring them to a dietician to adjust their eating habits.

Chronic conditions such as hypertension and diabetes, which increase the risk of developing vascular diseases, also need to be monitored and managed. The vascular surgeon could refer these patients to physicians to provide medical care for these issues.

The Daily Schedule Of A Vascular Surgeon

Vascular surgeons consult with their patients in hospital who have received surgery. This post-surgical care is provided to the patients until they are ready to be discharged home. The vascular surgeon will have patients referred to them by primary healthcare workers, but they will also be consulted by other specialists such as neurologists, cardiologists and their surgical counterparts, neurosurgeons and cardiothoracic surgeons. This will happen when the specialists are managing diseases relevant to their disciplines and they discover arterial or venous diseases that need the opinion of a vascular surgeon.

A vascular surgeon's office will be situated in the hospital where they can consult with their patients in the wards and the ICUs, but they will also be available to quickly respond to any assistance that may be needed in the emergency room. Vascular surgeons provide on call services during after hour and weekend periods for the hospital they work at, and they will be consulted to manage emergency cases such as acute limb ischaemia and a ruptured abdominal aortic aneurysm. These are conditions that can be life-threatening and the patients need to be managed surgically as soon as possible by these specialists.

Monday

Monday mornings are usually administrative days for most doctors and this will include dealing with clinical and non-clinical tasks pertaining to the specialist's office, as well as attending meetings with hospital management, staff and surgical representatives.

Once all these administrative issues have been dealt with, the vascular surgeon can then start consulting with their patients. The patients seen on this day are first time patients as well as surgical follow-up patients. The specialist will manage pathologies either conservatively or surgically, and surgical dates for elective procedures will be given to the patient to be performed at a later date. Patients needing urgent procedures done will be admitted to the hospital where they will be worked up so that they are optimally prepared for surgery.

It's also important to mention that these specialists will send patients for further investigations such as Doppler studies, ultrasound testing and CT scans to assess the affected vascular areas in the body. These investigations will be followed up by the surgeon and discussed further with the patient, as well as discussing what further management needs to be taken.

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Tuesday

The vascular surgeon will spend this day operating in theatre. The procedures would be elective ones, as mentioned above, or there could be emergency cases that would need to be performed urgently.

Wednesday

The specialist will consult with and manage patients accordingly during the morning, and the afternoon would be used for administrative tasks such as filling in of chronic patient prescriptions or providing medical insurance companies motivation for specific surgeries to be performed.

Thursday

The vascular surgeon could spend the morning either consulting with patients or operating in theatre.

The afternoon is used for training of undergraduate medical students and postgraduate general surgery residents and vascular surgery fellows.

Friday

The vascular surgeon will consult with patients in the morning and complete any unfinished administrative duties in the early afternoon.

The work week can then end when all of these aspects have been dealt with and the specialist's surgical lists for the following week have been confirmed.