Vascular Surgery

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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.

Carotid stenosis.

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.

Varicose veins.

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.

A surgical intervention is often required in case of severe damage of the blood vessels. Vascular surgery is aimed to normalize the blood supply.

The most common type of vascular surgery is a bypass surgery, its purpose is to exclude the affected parts of the blood vessels from the circulatory circle. Another common type of surgery is the removal of the aneurysm of the carotid artery, which is responsible for the blood supply to the human brain. This surgery helps to prevent stroke. Some of the most common types of vascular operations are described below.

Vessel surgeries in general stenosis

The most frequently used method of elimination of stenosis or the problem of vascular constriction is the installation of special balloons and catheters that forms a structure that widens the arteries. In order to normalize the blood circulation for a longer period of time, it is recommended to install special stents that prevent the formation of a new narrowing.

Surgical treatment of vessels in aortic aneurysms

Some problems with the obstruction of the aorta imply the use of conservative therapy with the appropriate drugs. If such therapy does not bring the desired results, doctors offer a surgery. All the necessary manipulations are performed through an incision that penetrates the affected area of the aorta. Then a catheter is inserted and the vessel is widened using a special balloon.

Vascular surgery in acute arterial obstruction

First, the patient is given a special medicine that contributes to the resorption of blood clot. However, in some cases this measure can be useless, then a surgical removal of the clot using a catheter prescribed. This operation has a similar principle to the aortic surgery.

Aneurysm surgery

An aneurysm is an expansion of an artery caused by lifting of weights or a trauma. Most often the aneurysm affects the abdominal aorta. This disease is extremely dangerous, as there is a high risk of aneurysm rupture, which severely disturbs the blood flow. Therefore, an aneurysm requires urgent surgical intervention.

The operation is performed to remove the affected area of the artery, to do so a small incision is made. Later the artery is restored with a special prosthesis.

In some cases, the implant is placed using a catheter. However, this type of operation is not always suitable. Everything depends on the passability of the patient's vessels.

Carotid artery stenosis surgery

The progress of clogged vessel disease can sometimes reach even such crucial arteries as, for example, carotid artery. Such consequences of the disease can cause the formation of a blood clot preventing blood supply of the human brain. The most dangerous outcome is the blot clot detachment that can lead to a stroke. In order to normalize the performance of the carotid artery, the classical surgical method of a balloon catheterization is used.

Surgery of lower limb thrombosis

When thrombosis of the lower limbs is treated using medication therapy, the situation is often aggravated even further. The blood flow is disturbed leading to blood stagnation in the lower limbs and accumulation of fluid in the tissues.

The surgery of the lower limbs thrombosis is aimed to restore the blood circulation and remove the affected parts of the vessels. One should note that such operations are carried out only in a few specialized clinics because of their complexity. The operation requires the highest accuracy and special knowledge.

Varicose veins surgery

The earlier the patient detects the first signs of varicosity, the easier it will be to perform a surgical intervention. If the damage to the veins is small, the operation is carried out fairly quickly and using minimally invasive techniques.

As a rule, a cryoprobe, which attracts vein using liquid nitrogen, is used to remove the damaged parts of the veins.

Modern treatment methods also utilize radio waves, laser and special chemical substances to normalize veins performance.

Occlusion of the lower leg arteries

Occlusion of the lower leg arteries is very dangerous because the disease it is not often noticeable at the initial stage. And only at a critical moment the patient begins to suffer from excruciating pain.

In this case, a classical operation to expand vessels with a balloon catheter is often used. This measure restores the normal blood circulation for a long period. If several lower leg vessels are affected, it can be necessary to perform a transplantation of those veins, replacing them with healthy, or to exclude the affected veins from blood circulation through a special shunt.

Reconstruction of damaged blood vessels

As a result of an injury or other accidents, vessels can be damaged which is not noticeable at first sight. One should prevent the development of vascular disorders, as in an extreme case this may result in amputation.

In order to reconstruct the vessels small incisions are made, through which the affected areas are stitched. If the damage is too extensive, the vessels are replaced by healthy veins.

Vascular surgery in blood vessel infections

Patients who have already had a vascular surgery or have implants in the vascular system are particularly susceptible to infection of blood vessels. It is very important to pay attention to your health condition, because the infection of blood vessels is a serious disease, which can result in amputation or even death.

In case of a blood vessels infection, the affected vessels are often replaced with healthy ones, taken, for example, from the lower limbs, or by synthetic vessels made of high-quality materials.

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.

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
  • Infection
  • 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.

focus 2018

Vascular disorders, both chronic and acute, are fairly common throughout the world. The biggest proportion of vascular patients is traditionally registered in the USA, Great Britain and Canada. In the past four years the vascular surgery clinics in Germany have witnessed a significant increase in patients who need the highly sophisticated vascular surgery.

With the view to this fact, the German weekly magazine FOCUS in close cooperation with the German Cardiovascular Society has recently published the list of the “Top vascular surgeons” in Germany.

The major parameter, which have been paid attention to during the comprehensive comparative survey were the following:

  • Treatment success rate and complication rates
  • “patient volume”, i.e. the number of treated patients (a year)
  • practical experience of the vascular surgeon
  • scientific excellence
  • recommendations

The rate of the best German vascular surgeons addresses the international patients who are planning to come to Germany for vascular surgery and are looking for the top medical services and the best angiology specialists.

Top score: The best vascular surgeons in Germany

You suffer from arteriosclerosis, thrombosis, vascular occlusion or diabetic foot or other vascular disease and are in search of an experienced vascular surgeon who specializes in vascular bypass or stenting? Please find some selected specialists for vascular surgery in Germany in the table below. All the surgeons on this list are certified specialists of the highest level and have been selected, according to the strictest criteria of an independent GMG Team.

Univ.-Prof. MD Hans Scholz

Univ.-Prof. MD Hans Scholz

Evangelical Hospital in Berlin (Vascular department)

Scienti-fic contrib.:

Technological advance:

Minimally invasive surgery/ reconstructive procedures:

Recommended by other specialists:

Recommended by patients:

Prof. Scholz and his team perform around 3120 surgical interventions a year. The state-of-the- art hybrid operating theatre, launched in 2009, contributes to higher precision of the therapeutic procedures.

Special Treatment Areas

  • Treatment of aorta diseases;
  • Aortic dissection;
  • Treatment of narrowing of the carotid artery;
  • Surgery and interventions in aneurysms patients;
  • Peripheral revascularization;
  • Treatment of malignant tumors of the vascular system;
  • Minimally invasive reconstructive venous surgery;
  • Carotid endarterectomy (CEA).
Prof. Dr. Heiner Wenk

Prof. Dr. Heiner Wenk

Clinical Community “Gesundheit Nord” in Bremen

Scienti-fic contrib.:

Technological advance:

Minimally invasive surgery/ reconstructive procedures:

Recommended by other specialists:

Recommended by patients:

Special Treatment Areas

In the year 2013 the “Vascular Surgery Center”, headed by Prof. Heiner Wenk, has successfully undergone the certification of the German Society for Vascular Surgery and is ranked as the fifth center in the Federal Republic of Germany.

Special qualifications:

  • Bypass or endovascular treatment
  • The acute vessel closure - preclinical and clinical management
  • Aneurism surgery;
  • Peripheral “Bypass-surgery”
  • Varicose vein treatments

Prof. Wenk is a world known scientist and the author of numerous contributions and publications. He and his team perform around 800 aneurysm treatment a year. More than 1000 reconstructive vein surgery are carried out at the Vascular surgery center in Bremen. Close interdisciplinary collaboration with the Department for tumors in the abdomen as well as with the Bremen Cancer Society and the Cancer Center of the Cancer Society.

Dr. Thomas K. Weiler

Dr. Thomas K. Weiler

The Phlebology center in Pforzheim

Scienti-fic contrib.:

Technological advance:

Minimally invasive surgery/ reconstructive procedures:

Recommended by other specialists:

Recommended by patients:

(Since January 2005 Head of the Iterdisciplinary Phlebology Center in Pforzheim) Jameda Note: 1,2. 20 years of experience in the field of vascular surgery and phlebology. Training authorization in the field of Phlebology. National and international lectures

Memberships:

  • Professional Association of German Surgeons (BDC)
  • German Society for Vascular Surgery (DGG)
  • Professional Association of phlebotomists (BVP)

The major focus is the cosmetic-aesthetic aspect, both in surgery and in the non-surgical procedures. The special focus is gentle endovascular therapy in the treatment of varicose veins. The catheter treatment method CELON / RFITT, Laser (Elves Radial) and Venefit (VNUS Closure ™) are applied under the guidance of Dr. Weiler.

Prof. MD Christiane Bruns

Prof. MD Christiane Bruns

The Cardiovascular center in Kassel

Scienti-fic contrib.:

Technological advance:

Minimally invasive surgery/ reconstructive procedures:

Recommended by other specialists:

Recommended by patients:

Specialist for surgery, vascular surgery and phlebology at the Diakonie Hospital in Kassel Chief physician of the vascular surgery department

Qualifications: The endovascular specialist and endovascular surgeon (DGG) Full training authorization for vascular surgery Training authorization Phlebology.

Publications 302 presentations at the international scientific conferences Author and co-author of 87 national and international publications.

Memberships: Member of the German Society of Surgery, the German Society of Vascular and Endovascular Surgery, the German Society of Visceral Surgery, Member of the International Society of Endovascular Specialists

MD. Malte Gerbig

MD. Malte Gerbig

Head of the Center for vascular surgery at the Clinic of Friedrichshafen

Scienti-fic contrib.:

Technological advance:

Minimally invasive surgery/ reconstructive procedures:

Recommended by other specialists:

Recommended by patients:

More than 5000 interventions (vascular surgery) are performed at the clinic.

2009 the Clinic has been certified as the Vascular Surgery Center with the special Qualification in minimally-invasive surgery.

Special qualifications:

  • Treatment of closures / restrictions of
  • Cerebral arteries
  • Clavicle arteries (subclavian-steal-syndrome)
  • Visceral arteries
  • Pelvic arteries.
  • Groin and leg arteries

Special techniques, applied at the department of Dr. Gerbig:

  • Enucleation (endarterectomy, desobliteration), surgical removal of the blood clot (embolectomy)
  • Minimally invasive treatment of aneurysms
  • Prosthetic replacement or stent (inner stents) management
  • Vascular access for dialysis (renal replacement therapy)
  • Special arterial reconstructions
  • Revascularization (improving blood flow to undersupplied tissue by vascular surgery) in case of erectile dysfunction
  • Removal or reduction of arteriovenous malformations ("hemangiomas")
  • Management of complicated varicosity (varicose veins)
  • Acute vascular occlusion (embolism, thrombosis)
  • Vascular injuries (cuts, injuries, pseudoaneurysm)
  • Aneurysm rupture
Prof. MD. Werner Jung

Prof. MD. Werner Jung

(Medical Director of the Heart Center in Schwarzwald-Baar Klinikum). Heart surgeon/ angiology surgeon.

Scienti-fic contrib.:

Technological advance:

Minimally invasive surgery/ reconstructive procedures:

Recommended by other specialists:

Recommended by patients:

Special focus: Operation of the pelvic and femoral arteries Vascular constrictions management (Dilations) on vascular punctures or small incisions Besides the classical surgical procedure for the treatment of vascular problems, modern minimally invasive methods are implemented at the clinic, headed by Prof. Jung.

Special Awards: “TOP heart and vascular surgeon”, according to Jameda and Sanego survey 2015. Annually about 4000 patients with cardiovascular disorders are treated at the department of vascular surgery in Schwarzwald-Baar Klinikum.

Dr. Stefan Schulte

Dr. Stefan Schulte

“Am Neumark” — A private center for vascular surgery in Cologne

Scienti-fic contrib.:

Technological advance:

Minimally invasive surgery/ reconstructive procedures:

Recommended by other specialists:

Recommended by patients:

Focus Areas:

  • Vascular diagnosis
  • Thrombosis management
  • Minimally Invasive Varicose (laser method, radio wave therapy);
  • Arterial vascular Surgery of the cervical, abdominal and leg arteries;
  • Minimally invasive catheter procedures of the arteries (balloon dilatation, stents, stent grafts)

Memberships:

  • German Society of Surgery (DGCH);
  • German Society for Vascular Surgery (DGG);
  • European Society for Vascular Surgery (ESVS);
  • International Society for Vascular Surgery (ISVs);
  • International Society of Endovascular Specialists (ISES);
  • International Neuromodulation Society (INS);

Scientific and public activities

  • Numerous publications and scientific lectures;
  • Orientation and organization of vascular surgery workshops;
  • Congress secretary and organization of vascular surgery congresses;
  • Supporting international, clinical trials;
  • Co-author of technical books in vascular surgery;
  • Participation in the preparation of medical guidelines

Special signs:

Scientific contributions: -many contributions; - regular contributing to medical journals and participation in scientific conferences.

Technological advance: -well-equipped; - highly-equipped center.

Minimally invasive surgery/ reconstructive procedures: -highly efficient -state of the art technologies.

Specialists recommendation: -very recommended; -highly recommended;.

Patient recommendation: –very recommended; -extraodinary recommended.

Author: PD MD Tobias Traeger on Jameda.

GermanMedicalGroup + 49 (7221) 39-65-785 Flugstrasse 8a 76532 Baden-Baden Germany Vascular Surgery Vascular Surgery 2017-10-13 Vascular Surgery

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