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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:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 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.
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.
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:
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.
More and more patients benefit from innovations in vascular medicine. In Germany alone, a toe, a foot, a lower leg or even a leg has to be amputated around 50,000 times a year due to tissue damage due to blood circulation. Advances in research and development in the field of minimally invasive procedures offer these patients new perspectives, can help avoid amputations and improve the quality of life of those affected. These and many other affected people can be better helped in the future.
The femoral artery ensures blood supply to the entire leg. Constrictions and occlusions should therefore be remedied in good time with the help of catheter treatment in order to prevent the consequences of insufficient blood circulation, such as pain, wounds that do not heal and ultimately amputations. In the worst case, calcium deposits stiffen and narrow the artery like a pipe. Expanding with a balloon alone is often not enough. Medical devices that mill calcified tissue from the inside of the vessel (atherectomy) or break the lime with shock waves (lithoplasty) are able to prepare the artery for the actual therapy without significantly injuring it.
Vascular supports, so-called stents, which hold a narrowed carotid artery wide to ensure adequate blood flow to the brain, usually consist of a coarse-mesh, metallic grid. With the help of an additional, close-meshed covering, the “Micromesh”, it is now possible to prevent the smallest particles of blood, tissue or lime, which are deposited on the inflamed artery wall, from penetrating through the meshes of the stent during or after a stent implantation Blood flow.
Over half of all men with erectile dysfunction do not respond adequately to medication or suffer from side effects. In many cases, the disease is based on an atherosclerotic circulatory disorder. Arteries of the pelvis and penis are narrowed or closed so that an erection cannot be achieved. Catheter treatment with or without stent implantation can help here.
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.
Smoking leg is a slang term for peripheral arterial occlusive disease (PAD) in the legs. Because smoking is the most important risk factor for PAD. In PAD, constriction in the arteries forms due to arteriosclerosis. These hinder blood flow and thus lead to a lack of oxygen in the tissue. If people manage to quit smoking, this significantly improves the prognosis. Read all important information about smoking leg here.
The smoker's leg accounts for about 90 percent of all PAD cases. The constriction is then in about a third of the patients in the pelvic arteries, 50 percent in the femoral arteries and about 15 percent in the lower leg arteries. In about ten percent of PAD patients, the upper half of the body (upper arm, forearm, hand) is affected.
Type or name of the therapy in case of smoker's leg: treatment of the smoker's leg. Specifically here: balloon expansion (PTA), possibly with the insertion of a stent into the leg artery. The technical term for smoker's leg is called peripheral arterial occlusive disease (PAD) in the legs.
These examinations are necessary: interrogation, physical examination, various imaging methods such as duplex sonography, closure pressure measurement, magnetic resonance angiography (MR angiography).
The typical complaints: pain when walking in the leg muscles, poorly healing wounds in the foot area, toe death or blackening.
The area of application: narrowing or complete occlusion of the leg arteries.
How it works: The procedure is minimally invasive - this means in this case: A catheter - a thin, flexible plastic tube - is inserted into the vessel via the inguinal artery. The constriction or closure is shown with the aid of X-ray fluoroscopy. A balloon is transported to the constriction with the catheter and inflated on site. It expands the narrowing. In some cases, a stent (vascular support) is used for splinting - the lattice tube can also be transported to the constriction with the help of the catheter.
The treatment process of smoker leg: intervention under local anesthesia. Duration approx. 1 to 2 hours, depending on the extent of the restriction or closure. 12 hours after surgery, then walking and light physical exertion possible, sport possible after 5 days. Blood thinning medication for 1 to 3 months.
Opportunities and risks of smoker leg treatment : Very well-tried process with constantly refined technology. Success rate in removing a restriction greater than 90 percent. Complications are rare: for example, a bruise in the groin artery, vascular occlusion requiring treatment.
Notes, explanations: Patients are strongly advised to stop smoking to stop the disease from progressing. Furthermore, lifelong drug therapy is necessary for vascular constrictions. If the risk of a heart attack is increased, further examinations of the heart should be carried out.
As all of the minimally invasive techniques endovascular treatment has the following benefits:
When installing the graft a number of complications could happen, among them are following:
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.
At the annual conference of the German Society for Angiology (DGA) from September 12th to 15th in Münster, vascular specialists from all over Germany presented the latest therapies for vascular diseases. There is good news for patients, particularly in the areas of peripheral arterial disease (PAD) and venous occlusive diseases such as deep vein thrombosis (DVT).
Millions of people in Germany suffer from vascular diseases, around five million alone from the "window shopper's disease", medically peripheral arterial occlusive disease or abbreviated PAD. The quality of life of those affected is often severely restricted: pain and swelling in the legs are part of everyday life. "Patients with vascular diseases could be helped much better if standard therapies and new therapies were used more," says Prof. Dr. Holger Reinecke, vascular specialist of the German Society for Angiology (DGA), who chaired the annual conference. Too often vascular diseases are recognized too late. With serious consequences: narrowing in the blood vessels can lead to a stroke, heart attack or even an amputation of the legs.
It doesn't have to be! Prof. Reinecke: “Those affected should immediately contact a vascular specialist (angiologist). Because he can best initiate the necessary treatments and is also familiar with the latest therapies. ”
There are several good new therapies, especially in the area of "window disease". The cause of the symptoms is a circulatory disorder in the legs. Pain occurs in the calf or buttocks area because the blood vessels have narrowed. The muscles no longer receive enough nutrients and oxygen. If the circulatory disorder becomes more pronounced or if an artery closes completely, the pain occurs even at rest. The blood vessels can be damaged by numerous risk factors, but above all by long-term smoking. For this reason, the legs affected by pAD are often called "smoking legs". Other risk factors: diabetes, high blood pressure, a fat metabolism disorder, lack of exercise, gout, overweight and stress.
The treatment is always multi-track. In the first place is to turn off the risk factors. This means: quit smoking and treat any underlying conditions such as high blood pressure. Once this has been done, structured walking training with guidance should be used to try to improve the blood supply to the remaining vessels. Active movement therapy may open and expand small blood vessels around the vascular occlusion. This is called the bypass circuit. If exercise training does not help, other measures must be taken.
New therapies for "window shopper's disease":
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:
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.
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
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
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:
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
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:
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
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
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:
Special techniques, applied at the department of Dr. Gerbig:
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
“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:
Memberships:
Scientific and public activities
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.
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