What is a certified vascular center?
A medical facility that specializes in the diagnosis and treatment of vascular diseases and has demonstrated its high level of professional expertise and quality in this field through a certification process may call itself a certified vascular center. The certification of vascular centers is jointly administered by
- the German Society for Angiology – Society for Vascular Medicine e.V. (DGA),
- the German Society for Vascular Surgery and Vascular Medicine – Society for Surgical, Endovascular, and Preventive Vascular Medicine e.V. (DGG), and
- the German Radiological Society – Society for Medical Radiology e.V. (DRG)
. The evaluation and certification process for vascular centers is carried out by the Private Academy of the German Society for Vascular Surgery gGmbH on behalf of these three professional societies.
Only those medical facilities that meet the quality criteria and requirements defined by the DGA, the DGG, and the DRG and have successfully completed the certification process receive certification as a vascular center. The list of requirements for certified vascular centers comprises a total of 22 criteria groups, focusing on staffing, equipment, and therapeutic standards. Key certification criteria for vascular centers include, among other things, minimum case volumes, effective interdisciplinary collaboration among the participating departments, participation in quality assurance measures, the availability of training authorizations, and membership in the respective professional societies. In addition, vascular centers must have a sufficient number of specialists from the relevant medical disciplines on staff.
Which medical specialties are involved in a vascular center?
Interdisciplinarity is another important criterion for certification as a vascular center. The various medical specialties involved in the diagnosis and treatment of vascular diseases must therefore collaborate constructively and interdisciplinarily within a certified vascular center. The medical departments that must always be represented in a vascular center include vascular surgery, radiology, and angiology. In addition, vascular centers must maintain structured collaboration with other medical disciplines, including, for example, cardiology, neurology, anesthesiology, nephrology, phlebology, and diabetology.
Background Information on Vascular Diseases
The term “vascular diseases” encompasses all diseases of the blood vessels—that is, the arteries and veins—as well as the lymphatic vessels. Common arterial vascular diseases include atherosclerosis, peripheral arterial disease (PAD), and diabetic foot syndrome. Venous diseases frequently treated in vascular centers include thrombosis, chronic venous insufficiency, and varicose veins (varicosis). The most common disease of the lymphatic vessels is lymphedema. Numerous imaging techniques and interventional treatment methods are available for the diagnosis and treatment of vascular diseases, and these have continued to evolve in recent years.
Since it is expected that the diagnosis and treatment of vascular diseases will become increasingly important in the coming years and decades, and since an ever-growing number of patients with multiple comorbidities will require treatment, interdisciplinary treatment approaches are becoming increasingly important. Interdisciplinary diagnostic and therapeutic concepts for vascular diseases—such as collaboration between diagnostic and interventional radiology and the specialties of vascular surgery and angiology—can best be implemented in vascular centers.
Objectives of Certified Vascular Centers
The primary goal of the certification of vascular centers by the DGA, the DGG, and the DRG is to bring together the various participating disciplines for the joint diagnosis and treatment of vascular diseases within an interdisciplinary center. This improves and ensures the quality of care for patients with vascular diseases. This is because treatment processes in a vascular center can be holistically tailored to patients’ needs. The connections between outpatient and inpatient care are strengthened, processes are structured even more clearly, and responsibilities are clearly assigned.
Another goal of certified vascular centers is to form a regional network with other clinical and contract-based units, utilizing a uniform quality management system. This improves communication, consultation, and patient care while preventing duplicate tests and multiple hospital admissions.
In addition, the certification as a vascular center can also serve as a communication tool for engaging the medical community and the general public. The certification as a vascular center allows referring physicians, as well as patients and their families, to recognize that the facility has been proven to be among the specialists in the field of diagnosing and treating vascular diseases. They can therefore be confident that patients will receive high-quality care at a vascular center.
Certification of Vascular Centers
A medical facility wishing to be certified as a vascular center must first submit a written application to the Private Academy of the German Society for Vascular Surgery (DGA) gGmbH. This academy has been commissioned by the DGA, the DGG, and the DRG to coordinate the applications in order to ensure consistent processing of all applications. The vascular center seeking certification can choose whether it wishes to be certified by all three professional societies, by two professional societies, or by only one professional society—that is, whether it seeks “triple certification,” “double certification,” or “single-society certification.”
Upon receipt of the written application, the application documents are reviewed by the private academy Deutsche Gesellschaft für Gefäßchirurgie gGmbH and then forwarded to the responsible certification commission. In the next step, members of the certification commission conduct an on-site audit at the vascular center to be certified, during which they verify compliance with the quality criteria. Upon successful completion of the audit and the certification process, the Private Academy of the DGG will send the facility its certificate as a vascular center. This initial certification as a vascular center is valid for three years. Recertification takes place after three years.
Criteria for Certification as a Vascular Center
The criteria for “triple certification” as a vascular center by all three professional societies include the number of treatment cases, the number of therapies for arterial and venous diseases, the number of surgeries and interventions, invasive and non-invasive diagnostic procedures, quality assurance, the availability of training authorization, the presence of qualified specialists, and membership in the respective professional societies.
Number of treatment cases that certified vascular centers must demonstrate:
- Treatment (outpatient and inpatient) of more than 800 patients with vascular diseases annually; of these, more than 600 must be cases of arterial vascular disease
- Treatment of more than 150 patients per year with peripheral arterial occlusive disease or diabetic foot syndrome; of these, more than 50 must be treated for critical limb ischemia
- Treatment of more than 75 patients per year with phlebothrombosis, chronic venous insufficiency, or lymphedema
- Treatment of more than 5 patients per year with inflammatory vascular diseases
- Structured management of cardiovascular risk factors and rehabilitation for vascular diseases
Invasive and non-invasive diagnostic procedures that certified vascular centers must offer:
- CT
- MRI
- Intra-arterial angiography (DSA)
- Phlebography
- Peripheral Doppler ultrasound
- Duplex sonography of the extracranial, abdominal, and peripheral arteries and veins
- Treadmill ergometry
- Functional vascular diagnostics (e.g., capillary microscopy, oscillography, TCPO2)
Number of surgical procedures and interventions that certified vascular centers must perform:
- Performing more than 200 open arterial reconstructions per year; more than 30 of these surgeries must be performed on the carotid artery, more than 20 of these surgeries must be for the exclusion of aortic aneurysms, and more than 20 of these surgeries must involve cruciate reconstructions
- Performing more than 100 venous surgeries per year
- Performing more than 100 PTAs and/or stent implantations per year
- Performing more than 10 local thrombolysis procedures and/or mechanical thrombectomies per year
- Capability to perform percutaneous vascular occlusion procedures on arteries
Quality assurance measures that certified vascular centers must demonstrate:
- Participation in the quality assurance program of the DeGIR (German Society for Interventional Radiology and Minimally Invasive Therapy)
- Participation in the quality assurance modules mandated by state authorities
- Participation in the quality assurance projects of the DGG and the DGA
- Regular holding of mortality and morbidity conferences
- Written guidelines for the most common vascular diseases
- Systematic assessment of treatment outcomes at the end of the hospital stay
- Systematic collection and evaluation of medical radiation exposure data for vascular patients
Training authorizations that certified vascular centers must hold:
(Partial or) full training authorization for vascular surgery, radiology, and angiology (with possible exceptions in cases where there is no specialist certification in angiology)
Organizational characteristics that certified vascular centers must demonstrate:
- Ensuring seamless “round-the-clock care” for all vascular patients through on-call and/or standby services
- Offering prevention programs
- Use of a common documentation system
- Conducting interdisciplinary vascular conferences at least once a week, attended by specialists with decision-making authority
- Conducting structured internal and external continuing education programs
Number of specialists required to work in certified vascular centers:
- At least 3 specialists in vascular surgery
- At least 3 specialists in radiology
- At least 2 specialists in angiology
- At least 3 specialists with interventional expertise
Membership in professional societies:
The physicians in charge at certified vascular centers must be members of their respective professional societies.
