In vascular surgery the useful question is rarely “which technique”, it is “when”, and often “should we intervene at all”. Below 5.5 cm an aneurysm is not treated. A symptomatic carotid operated within two weeks needs 5 patients treated to prevent one stroke, 125 at three months. And on varicose veins, no technique has demonstrated fewer recurrences at five years.
The questions we get asked
Which technique for varicose veins?
Only three things are solid: foam is technically inferior, laser causes fewer immediate complications, and endovenous techniques get people back to activity a few days sooner. On recurrence at five years there is no demonstrated winner, and open surgery is not disqualified.
At what size should an aortic aneurysm be repaired?
The 5.5 cm threshold does not come from a rupture rate measured above it, but from the absence of demonstrated benefit below it. Four trials pooled across 3,314 patients give a hazard ratio of 0.99, at high certainty.
Walk or revascularise for claudication?
Supervised walking gains 80 to 120 metres at high certainty. Revascularisation adds a gain at one year that is no longer measurable at five. Neither has demonstrated an effect on survival or amputation; the only treatment that has is a drug.
Should a narrowed carotid be operated on?
If it has caused symptoms, yes, and quickly: the whole benefit is decided in the first two weeks. If it has caused none, the answer has changed. Medical treatment has improved so much that the benefit of intervention, if it still exists, is of the order of 2 to 3 points over four years.
What the figures say
| Finding | Figure | Source |
|---|---|---|
| Symptomatic carotid, number needed to treat by delay | 5 at 2 weeks, 125 after 12 weeks | Rothwell et al., Lancet, 2004 |
| Aneurysm below 5.5 cm, early surgery | hazard ratio 0.99, high certainty | Cochrane, 2020 |
| Endovascular against open repair, 30-day mortality | 1.7 against 4.7 percent | EVAR-1, Lancet, 2004 |
| Supervised walking, pain-free distance | plus 82 metres, high certainty | Cochrane, 2017 |
| Foam, recanalisation at 5 years | 31.5 percent against 6 to 7 for the others | Rasmussen et al., Int Angiol, 2017 |
| Aneurysm screening, men to invite per death prevented | 216 | MASS trial, Br J Surg, 2012 |
A note on method. On three of this page’s four subjects, major trials contradict each other head-on: endovascular repair beyond eight years, bypass against endovascular in critical limb ischaemia, and asymptomatic carotid disease. We present those disagreements as they stand rather than picking the trial that suits.
What Noria Health does, and does not do
We organise a vascular surgery consultation with a specialist team near Brussels, duplex ultrasound and review of existing imaging included, and confirm feasibility within 24 to 48 hours. Follow-up is documented at D14, D30 and D90.
We do not handle any acute situation. A sudden neurological deficit, even transient, sudden abdominal or back pain in someone with a known aneurysm, leg pain at rest or a wound that will not heal all need immediate assessment, not remote organisation.
Who reviewed this page
Noria Health editorial team.
Our vascular surgery articles
- Varicose veins: no technique has shown fewer recurrences at 5 years
- Aortic aneurysm: below 5.5 cm, operating early gains nothing
- Claudication: walking gains 80 metres, surgery does not extend life
- Carotid stenosis: 5 patients to treat at two weeks, 125 at three months
Have your case reviewed. Noria Health arranges a specialist consultation near Brussels and confirms feasibility within 24 to 48 hours. Open a case.