Vascular Surgery

Vascular Surgery

Vascular Surgery involves either minimally invasive surgery or open surgery to correct circulation problems. Some people may simply have pain in their legs when they walk, which is called “claudication,” or they might have sores or ulcers on the legs that refuse to heal. Others may need surgery to correct problems in the carotid arteries of the neck, which can help prevent strokes.

At Midland Surgical Associates, we treat vascular surgical disease, as well as evaluate how vascular medicine overall may be of benefit to you. We provide a number of diagnostic studies to determine if you need vascular treatment or vascular surgery.

Vascular Disease Symptoms


Claudication is pain or tiredness in a muscle group with activity, like walking, that improves with rest. Some might develop claudication in their calf muscles at two blocks. This is how claudication is evaluated.

Claudication is the early and classic finding that indicates the potential of peripheral arterial disease (PAD).

Rest Pain

This symptom is pain in a muscle group that occurs while resting and usually worsens when you put your legs up on the bed. Sitting in a chair usually relieves the pain.

This symptom is considered end stage peripheral arterial disease (PAD), which indicates that you should see a vascular specialist quickly.


A stroke is a permanent neurologic defect (weakness or speech difficulty) that does not reverse itself. People can recover from stroke, however.

Symptoms of stroke include a sudden numb or weak feeling in a particular part or side of the body; sudden loss of vision, speech, or coordination; sudden loss of balance, especially if accompanied by nausea; sudden severe headache and dizziness.

Transient Ischemic Attack (TIA)

A TIA consists of stroke-like symptoms that quickly revert to normal after several minutes to an hour or two. This is often a risk factor or notification that a stroke may occur soon.

Varicose Veins

Varicose veins are dilated, often twisted, veins that occur under the skin. They can cause pain, swelling, and skin problems, and they are usually large, unsightly, and bulge on the skin.

Various treatments are available to treat varicose veins, including some minimally invasive techniques, although open surgery may be necessary. Potential treatments include sclerotherapy, which involves injecting a solution in the vein to close it. In ambulatory phlebectomy, the surgeon removes the veins by making a series of very small punctures in the skin.

In catheter-assisted procedures, a tube called a catheter is inserted into the vein, and the catheter is heated in order to destroy the vein. Endoscopic vein surgery requires small incisions, in which a camera is inserted that allows the surgeon to see inside and close the veins. Vein stripping is the traditional technique that involves removing the vein through small incisions.

Note that destroying or closing varicose veins does not affect blood circulation.

Minimally Invasive Endovascular Procedures

These procedures are performed under a local anesthetic and involve a small needle stick in the skin, followed by placement of a sheath (straw) into the artery. This sheath provides access to the arterial system for diagnostic angiograms and possible interventions.

Most of these procedures are done on an outpatient basis in our in-office Angio Suite so that you can return to the comfort of your own home afterwards. Here are some examples:

Balloon Angioplasty

In this procedure, the surgeon inflates a balloon in a narrow point of an artery (stenosis) to make it wider and allow more blood to flow through.


This procedure uses a device to clean out the plaque inside an artery. A balloon angioplasty or stent may be required afterward to promote more blood flow.

Stent Placement

A stent is a special metal tube used to help keep a narrowed artery open so that sufficient blood can flow through it. The stent remains permanently in the artery.

Stent Graft

A stent graft is a stent that is wrapped around a thin plastic or Teflon tube to direct blood flow directly through it. It is often used in the repair of an artery that has suffered an aneurysm.

Aneurysm Repair

An aneurysm is an abnormal weakness in an artery wall that allows the artery to expand abnormally like a bubble on an inner tube. Any artery of the body can have an aneurysm, but they most commonly occur in the Chest (Thoracic) or Abdomen (Abdominal Aortic).

Repair of an aneurysm most often involves a minimally invasive technique using a stent graft. Open surgery is occasionally necessary, however, which involves an incision to repair the artery.

Deep Venous Thrombosis (DVT) Treatment

DVT is when a blood clot forms in a deep vein in the body, commonly in the legs or pelvis. These clots are potentially dangerous because they can break off and float (embolize) to the lungs.

DVT can be treated with a minimally invasive technique of thrombolysis, which breaks up the clot. This involves the use of pharmaceuticals, such as injections directly to the area of blockage. This diagnosis also usually requires at least six months on anticoagulant therapy (blood thinners).

Open Vascular Surgery

These procedures are more invasive and require larger incisions so that the surgeon can repair the affected veins or arteries.

Bypass Surgery

In bypass surgery, a conduit – either an existing vein or a plastic tube – is used to bring blood flow from one area to another. This is done when a vein is blocked.

Bypass operations are named for whichever arteries are bypassed. For example, if the femoral artery in the thigh is blocked, and blood flow needs to be bypassed to the popliteal artery in the knee, the surgery is called a femoral to popliteal bypass or “fem-pop” for short.


This procedure involves using specialized tools to clean the plaque out of a blocked or narrowed artery and then closing it. It is most often used on the carotid artery to prevent stroke, but it can be used on any other narrow artery.

This surgery is done with the patient under either general anesthesia or local anesthesia. In some cases, a hospital stay of only one day is required, while other cases will require up to a week in the hospital.

AV (Arterialvenous) Fistula

This is a procedure done to provide access for hemodialysis, which is a process that removes waste, fluid, and salt from the blood. It involves connecting an artery and a vein together to create a high flow circuit.

It is usually accomplished using an existing artery or vein, but sometimes requires the use of a plastic tube inserted to connect the artery and vein.