Aneurysm surgery, also called traditional open surgery, is a treatment for aortic aneurysms. An aortic aneurysm damages your aorta and causes life-threatening complications. The main purpose of open surgery is to prevent an aneurysm rupture or dissection. It can also repair damage after such an event happens. A surgeon removes the damaged part of your aorta and replaces it with a synthetic fabric tube. This tube is called a graft. It functions as a new lining for your artery so blood can safely pass through. A thoracic or vascular surgeon performs this procedure in a hospital surgical suite. This procedure is considered major surgery. Your surgeon needs to make a large incision in your chest or belly to access the aneurysm. The aneurysm might be located in your chest (thoracic aortic aneurysm) or a bit further down in your belly (abdominal aortic aneurysm). Aneurysm surgery is often necessary to prevent serious complications or death. Like any major surgery, it carries risks. But the benefits usually outweigh the risks. Your provider will discuss your options with you and determine if you need surgery. People who have a ruptured or dissected aortic aneurysm need this surgery. It’s an emergency surgery that can save your life. Other people might need this surgery if they have an aneurysm that’s at risk of rupturing but hasn’t yet. This risk increases if your aneurysm is getting bigger or causing symptoms. Aneurysm surgery can save your life. It can prevent an aneurysm rupture or dissection. It can also be performed in an emergency to repair damage from an aneurysm rupture or dissection. Open surgery is a good option for people who can’t have endovascular aneurysm repair (EVAR). For example, the stent graft used in EVAR doesn’t always fit the shape of a person’s aorta. So, that person would need open surgery. Aneurysm surgery is very serious if performed after an aneurysm rupture. The chance of survival after surgery for a ruptured aortic aneurysm is 50% to 70%. The greatest threat comes from complications of the rupture, including kidney failure. But with no treatment at all, the rupture will certainly be deadly. So, surgery offers the best chance of survival after a rupture. The chance of survival is much better when you have surgery before a rupture. In that case, the chance of surviving aneurysm surgery is 95% to 98%.

A carotid endarterectomy removes plaque (fat and cholesterol) buildup from inside your carotid artery, improving blood flow to your brain. This can help prevent another stroke in someone who’s already had one. Even with treatment, you’ll still need to improve your diet, start exercising and reduce your stress level to prevent future plaque buildup. A carotid endarterectomy is the surgical removal of plaque (fat and cholesterol buildup) from inside your carotid artery, which supplies blood to your brain and your face. There’s one carotid artery on either side of your neck. Blood flow inside your carotid arteries can slow down or stop when plaque collects in your artery walls. If enough blood can’t reach your brain, you can have a stroke. If you have a stroke, it’s important to get to an emergency room to get prompt medical treatment within three to six hours. Your doctor may recommend a carotid endarterectomy if the patients have a transient ischemic attack (TIA) or a mild stroke due to significant carotid artery disease, and have severe narrowing or blockage (usually at least 80%) in your carotid artery but have not had symptoms related to this disease. If a carotid endarterectomy surgery isn’t the right treatment for you, your provider may want to check your carotid artery once a year. You may need to improve your diet to bring your cholesterol level down and start taking blood thinners like aspirin or clopidogrel to prevent a stroke. Your provider could also perform an angioplasty (which pushes plaque against your carotid artery walls for better blood flow) and put in a stent (mesh tube) to keep your carotid artery open. A carotid endarterectomy clears plaque from your carotid artery so you can get better blood flow to your brain. Carotid endarterectomy is the most commonly performed surgical treatment for carotid artery disease. In many instances now, however, your healthcare provider may get this information from either a CT angiography or MR angiography. These are noninvasive methods to obtain information about your carotid arteries and your brain, and these can be performed without risk of stroke. A carotid endarterectomy normally takes approximately two hours. Your healthcare provider will give you general anesthesia (like being asleep) or regional anesthesia, which means you’re awake but the area to be operated on is numbed. If you get regional anesthesia, you’ll also receive medicine to help you relax. Most people stay overnight in the hospital to watch for problems after their procedure. You may have a temporary drain in your neck to remove fluid where your provider made an incision. This drain will usually only stay in for one day.

Coronary artery bypass grafting is a surgery that restores blood flow to areas of your heart that aren’t getting enough blood while you are having an heart attack or coronary heart disease with and without symptoms.This surgery can improve your heart function and how you feel, especially when you’ve just had a heart attack or there’s an increased risk for you to have one in the near future. The condition that’s most likely to lead to CABG is coronary heart disease, a group of conditions that includes heart attack and coronary artery disease. Other conditions under coronary heart disease include angina pectoris, which is chest pain caused by ischemia in your heart, and silent myocardial ischemia, which is heart ischemia without any symptoms. Conditions that fall under coronary heart disease usually involve a narrowing of the arteries in your heart because of a buildup of a fatty, wax-like residue called plaque. As plaque builds up on the inside of your heart's arteries, the arteries become stiffer and narrower. If an area of plaque breaks open, blood clots can form there and create blockages in those arteries. Those blockages cause ischemia in parts of your heart, which can lead to a heart attack. The average age for people who have CABG surgery is around 64 years old, and most of  the people (70%) who undergo it are men. CABG involves creating a bypass for blood to use to reach blocked areas of your heart. A bypass is like a detour for your blood to use to get around an obstacle. Creating that bypass involves taking a blood vessel from somewhere else in your body, such as your leg, arm or chest, and using it to craft the detour around the blockage. In cases where there’s more than one blocked artery, multiple bypasses may be necessary. To reach your heart to perform the surgery, a cardiothoracic surgeon will make an incision in the center of your chest. They’ll also split your breastbone (sternum) down the middle, then spread and lift your rib cage to make it easier to access your heart. Once they reach your heart, the surgeon will take the harvested blood vessel and craft the bypass. The upper end (beginning) of the bypass attaches to your aorta, the large artery that carries blood out of your heart and to the rest of your body, just after it exits your heart. The lower end (ending) of the bypass will attach to the blocked artery just past the blockage. Once the bypass is in place, the surgeon can restart your heart (if they stopped it) and get your blood flowing again. They’ll then lower your rib cage back into place and wire it together so it can heal. They’ll then close the incision in your chest with staples and sutures (stitches). While CABG tends to use the same techniques in most people, there are instances where different techniques are better for your particular needs. The variations of this surgery include: Off-pump CABG doesn’t use a heart-lung bypass machine. That means the surgeon doesn’t stop your heart during this procedure and does all the work while your heart is still beating. This type of surgery is not for every patient, and it is more challenging for the surgeon. However, some surgeons have special training and experience in performing CABG surgery this way. Minimally invasive CABG doesn’t use a large incision and splitting/lifting of your sternum and rib cage. Instead, the surgeon uses much smaller incisions and accesses your heart through the gaps between some of your ribs. This version of the procedure may also use the off-pump technique. Hybrid procedure mixes CABG with other techniques or approaches. This usually involves robot-assisted CABG on at least one artery, but non-CABG techniques like stenting for the remaining diseased blood vessels. Stenting is the placement of a stent, a device with a frame-like structure, into an artery. Inserting a stent helps hold the artery open because the stent acts as a skeleton inside the artery. After surgery, people who undergo CABG go to the hospital’s intensive care unit Staying in the intensive care unit (ICU) is necessary because ICU staff have specialized training and experience that is better suited for people with specialized needs like those who’ve just undergone CABG. Once a person is stable and a doctor feels they’re ready, they can transfer to a regular medical-surgical room in the hospital for the remainder of their stay. The average hospital stay for CABG is between 5 and 7 days. CABG has several advantages that make it a useful and common part of treating heart problems. It is a safe procedure because it has a long history of use. Surgeons performed the first CABG procedures in the early 1960s. In the decades that followed, additional studies and advancements helped make this procedure a key and reliable technique for treating ischemia of the heart. CABG is better for multiple blockages or blockages in certain arteries. It’s also a superior procedure for blockages in certain places. Many studies have linked CABG with improved long-term outcomes, including better survival odds. This advantage often grows when used alongside advanced bypass techniques with durable results. CABG is a durable and needs less follow-up procedures, when compared to the main alternative to CABG is percutaneous coronary intervention (PCI), often known as coronary angioplasty.

Heart valve surgery repairs or replaces a valve with stenoses, insufficiency or both.  Heart valves are like doors that supposed to open fully or close tightly to store blood in heart chambers and direct blood flow to lungs and body. Mitral and tricuspid valves close when heart contracted, and open while heart relaxed at diastole, aortic and pulmonary valves react vice versa. Left heart  valves are: Mitral valce lets oxygen-rich blood coming back from your lungs move from your left atrium (upper chamber) to your left ventricle (lower chamber). Aortic valve lets oxygen-rich blood move from your left ventricle (lower chamber) to your aorta, which sends blood to your entire body. Right heart valves: Tricuspid valve  Lets oxygen-poor blood flow from your right atrium (upper chamber) to your right ventricle (lower chamber). Pulmonary valce lets oxygen-poor blood move from your right ventricle (lower chamber) to your pulmonary artery, which takes blood to your lungs to get oxygen. Valve repair surgery to fix the damaged or faulty valve, while preserving much of the person’s own tissue. Most commonly, mitral and tricucpid valves can be repaired succesfully.  Prosthetic heart valve rings are used while repairing mitral and tricuspid valves. Valve replacement surgery to remove the faulty valve and replace it with a biological (pig, cow or human tissue) or mechanical (metal or carbon) valve. All valve replacements are biocompatible, which means your immune system won’t reject your new valve. Timing and type of  heart valve surgery is decided by the patients cardiologists and heart surgeons. Heart valve surgery options include: Traditional sternotomy incision:  15 to 20 cm  through the breastbone. Right mini thoracotomy incision: 8 cm through the right axillary and chest Minimally invasive heart valve surgery: 5 to 8 cm inciision through right chest and groin. Techniques include endoscopic or keyhole approaches (also called port access, thoracoscopic or video-assisted surgery) and robotic-assisted surgery. Transcatheter methods : Your doctorwill put a catheter into a larger artery, such as your femoral artery in your groin, and do the work without making a cut in your chest. It takes about four to eight weeks to recover from heart valve surgery. But your recovery may be shorter if you had minimally invasive surgery or surgery through a vein. People who were more physically active in the year after surgery had a lower risk of death than those who didn’t exercise much. The death rate ranges from 0.1% to 10% depending on the operation and the person's overall health. The need for anticoagulant medication (blood thinners) after surgery depends on the type of surgery patients have. The medication prevents blood clots from forming and causing problems with your heart valve. Currently, warfarin is the only approved blood thinner for mechanical heart valves. Mechanical heart valved patients need to take this medication for the rest of their lives. In valve repair or a biological valve replacement, patients may need to take this medication for several weeks after surgery, or maybe not at all.

An abdominal aortic aneurysm (AAA) is widening of this vessel, especially to a balloon-like shape. This is a potentially life-threatening condition, because it has  risk for rupturing (breaking open) and causing a hemorrhage (severe bleeding). Abdominal aorta is located below diaphragm and it ends up  before splitting to  iliac arteries. Smoker male patients who are  over 65 with hypercholesterolemia, hypertension and positive family history are at risk for AAA. Patients having vascuşitis and some congenital disease like Marfan and Ehlers Danlos type 4 have more commonly AAA. AAA is often asymptomatic and found accidentally in physical examinations. Others have pulsatile sensation in abdomen and  sometimes pain in back and stomach. Abdominal ultrasound and  computed tomography angiography (CTA) are the radiological diagnosisi methods for AAA. There is no known medication of AAA. Surgery must be applied to patients: Open surgery: A surgeon makes an incision in your belly to gain access to your abdominal aorta. They interpose the anuerysm with a graft (tube made of a strong, synthetic material. Endovascular aneurysm repair (EVAR): is a minimally invasive aneurysm repair surgery. Small incisions are made in the groins and inserts an expandable textile graft into aneurysmatic segment of abdominal aorta via femoral arteries. Hospital stay for EVAR patients are less comparing to open surgery.  

Peripheral arterial disease (PAD), also known as peripheral vascular disease or peripheral artery disease, is  plaque (made of fat, cholesterol and other substances) that forms gradually inside your artery walls slowly narrows your extremity arteries. This plaque is also known as atherosclerosis. Blood clots can form around the plaque, making your artery even narrower. If your arteries become narrowed or blocked with plaque or a blood clot, blood can’t get through to nourish organs and other tissues. This causes damage to your toes and feet and eventually death (gangrene) of tissues and extremities. Smoking is the most important risk factor for PAD. In fact, 80% of people with PAD are people who currently or were former smokers. Regardless of your sex, you’re at risk of developing peripheral arterial disease when you have one or more of these risk factors: Smoking, diabetes, Age > 50 personal or family history of heart or blood vessel disease, hypertension, hyperlipidemia, obesity, blood clotting disorder. The typical symptom of PAD is called “claudication,” a medical term that refers to pain in your leg that comes on with walking or exercise and goes away with rest, and also called leg angina. Numb, heavy, tired, weak, pale, and cold  extremities can be other symptoms. Untreated people can undergo to extremity amputation.   Ankle/brachial index (ABI) (measurement of the blood pressure in your lower legs compared to the blood pressure in your arms), arterial ultrasound, computurized tomography angiography and conventional arterial angiography are the diagnostic tests for PAD.   The two main goals in the treatment of PAD include: Reducing the risk of heart attack and stroke. Improving quality of life by easing the pain that occurs with walking. With early diagnosis, lifestyle changes and treatment, you can stop PAD from getting worse. In fact, some studies have shown that you can reverse peripheral vascular disease symptoms with exercise combined with careful control of cholesterol and blood pressure. If you think you’re at risk for PAD or may already have the disease, talk to your primary care doctor, vascular medicine specialist or cardiologist so you can get started on a prevention or treatment program as soon as possible. Lifestyle changes;  medications and interventional procedures can treat your PAD. Lifestyle changes: 1-quit smoking, 2- balanced diet, 3-control diabetes, cholesterol levels, and hypertension 4-exercise and meditation Medication; antiaggregants, antiplatelets, statins, antidiabetics and antihypertensives Peripheric angioplasty with drug eluted balloons and peripheric stents. Peripheric arterial surgery with autogeneous or fabric grafts,

Sclerotherapy is a treatment method used for spider veins and varicose veins that appear superficially, usually in the legs. Before the treatment starts, a local anaesthetic cream can be used to minimize the needle entry and the burning that may occur during the injection. The medicines that are sold ready-made in the market are taken into fine needle-tipped injectors and given into the veins, and the veins are closed with this irritant substance. In this way, the visually disturbing image is eliminated. However, every patient is not suitable for this treatment. It is not appropriate to apply this treatment during active venous occlusion, pregnancy and lactation. The treatment lasts for 30-45 minutes and a few days after the treatment, elastic bandages or varicose stockings are used both to increase the effectiveness of the treatment and to prevent swelling, pain or burning that may develop. It is necessary not to be exposed to direct sunlight or to enter the tanning device for 4 weeks after the treatment to prevent possible colour changes. Most patients pass through this period with no problem. In sclerotherapy performed on large vessels, the patient may feel swelling and stiffness in that area. Slight redness may be seen in the treated area. Brown discolouration in the procedure area disappears in a few weeks but may be permanent in a small group of patients.

Venous insufficiency is a condition that progresses clinically from superficial vascular enlargement to swelling and wound opening in the leg with the enlargement that occurs due to the deterioration of the valve structures in the vessels carrying blood to the heart, and the resulting increase in blood pressure in these vessels. The basic examination in the diagnosis is Venous Doppler Ultrasonography. If you have the above-mentioned signs, you will become a candidate for treatment by confirming the diagnosis with an ultrasonography procedure that takes 15 minutes. Compression stockings, drug therapy and surgical methods  (ligation, ablation, mini-phlebectomy, etc.) are at the forefront of the treatment.   SURGICAL METHODS HIGH LIGATION It is a procedure that is mostly applied in two regions on the legs. These regions are in the groin and behind the knee, and the reason for this is to prevent the blood from pooling in the superficial system by cutting the connection of the vessels developing here with the deeper main venous system. Sometimes the entire leg, or partly, of this superficial vascular structure can be removed.   STRIPPING It is a 30-45 minute procedure performed with local anaesthesia, and the patient is discharged on the same day after being followed up for a few hours.   Mini-phlebectomy, which is the process of removing varicose veins with superficial vasodilation, by entering through 1 mm holes, is applied to the procedure. The process after the operation must pass with no problem for the patient and the incision site must be taken care of for a few days. The patient can return to her/his normal business life after 1-2 weeks.   ABLATION Thermal ablation methods are mostly performed with technology-assisted catheters such as laser and radiofrequency. The main purpose of these methods is to insert the vessel sheath by entering the great saphenous vein and the small saphenous vein, where venous insufficiency is most common, with a needle accompanied by ultrasonography, and to close a partial segment of the vessel by placing a special laser or radiofrequency catheter through this sheath.  The advantage of this technique is that no incision is made and a short time to return to normal life. However, although local anaesthesia called tumescent anaesthesia is applied during the procedure, patients mostly need sedation, regional anaesthesia or general anaesthesia. This may prolong the patient's post-operative stay. The basic method used in non-thermal ablation methods is the adhesive ablation method. In this method, a large or small saphenous vein is entered under ultrasound guidance with a special catheter, and a partial segment of these vessels is closed with an adhesive (N-byte- cyanoacrylate) compatible with human tissue, and the pressure and insufficiency in the superficial veins are eliminated, and the patient's signs are eliminated. Again, mini phlebectomy or perforating vein ligation can be added to this method, making the treatment holistic.