Vascular surgery is a field of neurosurgery dealing with the vessels problems. There is a choice of methods that are aimed to prevention, treatment and emergency surgery of vascular diseases in modern medicine. Vascular surgery treats aortic, vessels and vein diseases of all the body exclude cerebral and coronary arteries which are related to the separate subspecialties in neurosurgery. Vascular surgery includes both traditional open surgery and ground-breaking minimally invasive techniques. There is a list of main issues of vascular medicine, that could be treated both with classical and endoscopic methods:
- Abdominal aortic aneurysm
- Carotid stenosis
- Peripheral arterial occlusive disease
- Varicose veins
- Aortic dissection
- Acute limb ischemia
The German clinics offer vascular therapy for all of above diseases. Qualified vascular specialists, first, suggest the best diagnostic method applicable to every personal situation and, than, make a decision on further treatment taking into consideration all related factors.
It is difficult to separate vascular and endovascular therapy into to independent branches as they often go together, could be interchangeable or go one after another.
Abdominal aortic aneurysm.
Conservative (non-surgical) treatment for this disease is applicable only when a high risk of mortality in patient during operation due to related health factors. When possible surgical intervention is preferable. The common name of surgical treatment for this disease is AAA surgery. It could be carried in the both techniques, open and endoscopic.
Nowadays, open surgery is used mostly as emergency measure for symptomatic, bleeding or big aortic aneurysm. It is preferable in young patients with stronger health. The goal of open surgery is to make everything fast and that is a reason for bigger incision. The recovery time after this operation is quite long.
Endoscopic surgery is growing popular and considered as alternative method for abdominal aorta aneurism, it is still not so widely used as it could be expected. Normally it is made in older patients with high risks of complications.
It is a constriction of the lumen of carotid artery. Carotic artery supply blood to the brain and the plaques in this artery could cause embolization of certain brain vessels that have a result in stroke. That is why important to treat carotid stenosis timely. For carotid stenosis are both open and endoscopic methods are used and there are no preferences to one of them.
Those are enlarged and twisted veins. In severe stage this disease causes significant discomfort. There are many kinds of therapy for varicose veins both surgical and non-surgical, and it mostly depends on degree which one to choose. The non-surgical treatments are sclerotherapy, exercises, leg elevation. Traditional surgical method is vein stripping removing diseased veins. There are also innovative methods as ultrasound sclerotherapy, radiofrequency ablation and endovenous laser treatment. Currently, the minimally invasive methods are more popular in this sphere.
Peripheral arterial occlusive disease.
It is a narrowing of the peripheral arteries. It could happen in the all arteries but mostly affects the legs. Both open surgery and endoscopy are possible. The treatment is significantly depends on degree. It varies from endoscopic angioplasty or atherectomy, and vascular bypass till amputation of the leg in case of gangrene.
Acute limb ischemia.
It is a result of thrombosis or embolism, and, rarely, trauma. For treatment are used embolectomy(emergency surgical removal of emboli) or vascular bypass.
For all of above diseases are equally possible open vessel reconstructive vascular surgery and newest endovascular treatments. Only a professional team of specialists in different fields as vascular doctors, neurosurgeons, neurologists, phlebotomists, radiologists, cardiologists and others could decide which treatment to use after evaluating all the factors. With modern diagnostics base and conditions for emergency surgery in German medical center it is possible to make your personal vascular therapy optimal and effective.
Aortic dissection is a condition when aorta is split and blood starts flowing between the layers. Treatment of this disease is a part of cardiovascular therapy as it closely related to the heart work. The various techniques are used for diagnostics, starting from ordinary chest X-Ray to transesophageal echocardiogram and aortography. Normally, aortic dissection is treated in cardiologic centers as there is a high risk of involving acute heart disorders. Among the methods used for aorta dissection are: open aortic surgery, Bentall procedure and David procedure (both are the replacement of aorta section with replacement/reimplantation of the valve), minimally invasive thoracic endovascular aortic repair (TEVAR) and some others.
Endovascular therapy is a complex of treatments aimed to correct the vessels problems with minimally invasive methods. It is a part of radiotherapy as it is based on using X-Rays. Initially endovascular surgery was used for diagnostics only but later it had been developed into independent field of vascular surgery.
Mostly femoral arteries are used for introduction of a catheter into the vascular system through a small incision using Seldinger wire technique. Once introduced catheter is filled up with special contract agent that could be seen while its travel in the veins by a doctor on fluoroscopy and it is possible both to make diagnosis and hold treatment during the procedure.
Today endovascular procedures are widely used to replace traditional invasive surgery. There some indication for the treatment:
- Peripheral artery disease;
- Different kinds of aortic aneurysms;
- Acute ischemia;
- Varicose veins;
- Deep vein thrombosis (DVT);
- Arteriovenous malformations (AVM);
- Pulmonary embolism.
A number of medical centers in Germany offer endovascular treatment of different vascular diseases. Being complex procedure endovascular surgery is carried out by a team of doctors including a vascular surgeon, neurosurgeon, neurologist, cardiologist, cardiothoracic surgeon, radiologists and, maybe, some other specialists, if needed.
Aortic aneurism is significant enlargement of aorta, which becomes more than 50% larger than normally. It is a dangerous condition as aneurism usually causes no symptom before it raptures. The most common types of the disease are abdominal aortic aneurism (AAA) and thoracic aortic aneurism (TAA). The both kinds could be treated with use of endovascular technique.
A patient is given a local or general anesthesia that depends on disease and other conditions. When a cut is made and a guide wire, which is used to bring a catheter to aneurysm, is inserted, a surgeon controlling a process on a monitor introduces the catheter into a vessel. The catheter is aimed to carry a graft (stent) to the aorta. When the graft arrives to destination, it replaces bad part of aorta and blood starts flowing through the graft that causes aneurism to shrink over time. Before finishing the procedure the doctor checks once again that blood is flowing through the newly installed graft and, then, removes the catheter and stitches the cut.
Peripheral Artery Disease is constriction of the arteries blocked with plaques. Peripheral arteries are all arteries beside those which supplying the heart and brain. The common symptoms of PAD are pain, ulcers and progressing gangrene. Stenting, angioplasty, and atherectomy performed by endovascular method are applicable for curing the disease.
The procedure of stents installing is the same as aneurism treatment above. When peripheral angioplasty is performed, balloons are used to open narrowed arteries. A balloon is delivered to a vessel in the same way as the graft to the aorta. Atherectomy is another minimally invasive method alternative to angioplasty. Whereas angioplasty and stenting push plaques to the vessels wall, atherecrtomy cuts them. Access often is carried out through a femoral artery, but it also possible to use radial artery, brachial artery, popliteal artery and others.
As all of the minimally invasive techniques endovascular treatment has the following benefits:
- Quick recovery;
- Less discomfort;
- Local anesthesia is possible instead of general anesthesia;
- Small incisions;
- Fewer load on the heart;
- It is possible to use minimally invasive method for those who have a risk of complications because of other health issues.
When installing the graft a number of complications could happen, among them are following:
- Occlusion of the graft
- Fever shortly after the surgery
- A temporary increasing in leucocytes
- Graft breaking
- Blood Leaking around the graft
- Displacement of the graft
To avoid further complications, it is very important to be under the control of the doctor after the surgery and do regular checkups. If you are interested in examination or need vascular surgery please contact any of specialized medical centers in Germany.