Our entire body is criss-crossed by blood vessels in a vast network of veins and arteries. Every minute, thanks to the power of our heart, all the blood in the body is pumped through the vessels. If all the vessels were laid end to end, they would stretch for around a thousand kilometres, which is more than twice the circumference of the Earth. Without our vascular system, our blood circulation, our organs, bones and skin could not function. However, as soon as disturbances occur within this system in the form of wear and tear or calcification, this vital supply is jeopardised. The risk of heart attack and stroke increases. However, deposits or calcifications in the blood vessels can also be repaired. That is when it is time to consult a specialist who is familiar with all areas and has mastered the art of operating inside the vessels themselves. A specialist such as Wail Al Ahmad from the Kitzinger Land Clinic.
Panta Rhei – everything flows! Vascular surgery under the microscope
Vascular and endovascular surgeon Wail Al Ahmad has been the new Head of Department and Senior Consultant for Vascular Surgery at the renowned Klinikum Kitzinger Land near the historic university city of Würzburg – in the Lower Franconia region, where he also grew up. The editorial team of the Leading Medicine Guide had the opportunity to speak with the vascular specialist about the intricate system of our blood vessels. True to the motto ‘everything flows’ …
Fundamentally, blood vessels differ in the direction in which they flow. Veins carry oxygen-poor blood from organs, muscles and tissues toward the heart, while arteries transport oxygen-rich blood away from the heart. Veins have valves to ensure that the blood reaches the heart and does not flow back in the opposite direction. The more elastic arteries do not require valves, as the blood is already directed accordingly by the heart’s pumping action.
“Generally speaking, it is my personal aim to avoid any operation wherever possible,” explains Wail Al Ahmad right at the start of the conversation. “When a patient comes to me with symptoms, I first investigate exactly where the problem lies – whether in the arteries, veins or lymphatic system. Varicose veins or spider veins are, of course, visible signs of poor blood circulation. The clinical analysis is then carried out using diagnostic imaging such as ultrasound, often combined with vascular imaging via X-ray (angiography) or computed tomography (CT), as well as through physical examination,” explains Al Ahmad.
Contrary to the common belief that varicose veins – knotty, dilated veins on the legs – occur mainly in heavy smokers, it should be noted that varicose veins are purely hereditary and constitute an incurable condition. Wail Al Ahmad also removes varicose veins, and patients often enjoy a good ten years of relief afterward. He knows the best approach – because it is important that the side branches of the varicose veins are exposed; otherwise, the varicose veins will return more quickly. Wearing compression stockings regularly can also slow down the process somewhat.
Peripheral arterial disease (PAD)
One of the most common vascular diseases is peripheral arterial disease (PAD), also known as intermittent claudication. This involves blockages or aneurysms in one or more arteries, which can lead to severe pain, forcing those affected to stop frequently while walking. Out of embarrassment, many sufferers stop in front of shop windows to conceal their problem.
The blockages in the blood vessels are often caused by thrombi, or blood clots, in the vessels. “The aim here is to clear these pathways again,” says Al Ahmad. “Many procedures can be performed using minimally invasive techniques, meaning no open surgery, no lengthy rehabilitation period and no scarring. General anesthesia is also not required, of course, thanks to this gentle treatment method,” he reassures.
Vascular blockages can also be caused by atherosclerosis (calcium deposits in the blood vessels leading to narrowing), coronary heart disease (CHD), and following surgery or heart attacks. “High blood pressure is also a widespread problem in our society. It poses a high risk to normal blood flow and must be treated urgently,” recommends Wail Al Ahmad. This is because if the arteries are subjected to persistently high blood pressure, they can become damaged, leading to the formation of aneurysms – bulges in the artery wall. In practical terms, this means that the artery wall can no longer withstand the increased pressure.
With or without surgery – there are several options
However, Wail Al Ahmad always tries to avoid surgery in his treatments. “If blood vessels are already severely narrowed by calcium deposits, they can be treated with a catheter-based procedure involving dilation,” he explains, adding: “A major risk with calcium deposits is that they can lead to inflammation of the vessel wall, causing it to become inelastic and brittle. This promotes the formation of a blood clot, or thrombus.”
Surgery cannot always be avoided. “I am happy to perform combined procedures, known as hybrid procedures, which are a combination of open surgery and endovascular surgery. Endovascular means ‘from the inside’. This means that the affected vessel is punctured at an easily accessible site, such as the groin, and dilated from the inside using a balloon via a catheter,” reports Al Ahmad positively.
He recalls a particularly successful treatment: “A very young woman who had a long-segment occlusion in the pelvic region was a patient of mine. We aimed for a puncture, i.e. treatment without open surgery, which was a delicate undertaking in this case. But our persistence paid off. During the procedure, we were able to use wires with and without curvature, and we succeeded in reopening the vessel! The patient was able to go home the very next day. She was spared an incision in her lower abdomen as well as a difficult rehabilitation process,” Al Ahmad recounts enthusiastically.
The special gift
The specialist has developed a unique tradition for his patients, intended to give them food for thought: “After treatment, whether conservative or surgical, my patients receive a memento from me to take home. I give the patient the removed deposits in a tube filled with formalin after the treatment. Then the patient can consider whether, for example, not smoking might not be the better option to protect their blood vessels in future,” he says with a smile. “There have been many patients who have been even more motivated by this to change their lifestyle for the sake of their health!”
“Eliminate the risk factors!”
Unfortunately, vascular diseases are widespread; they are caused not only by genetic predisposition but also by an unhealthy lifestyle. “Of course, the best thing is to eliminate all risk factors,” warns Al Ahmad, referring naturally to the classics such as smoking, excessive alcohol consumption, a high-fat diet and a lack of exercise.
“A new study from Wiesbaden has shown that even a single cigarette a day can lead to changes in blood flow. Incidentally, women are at a disadvantage here compared to men and suffer more harm from cigarette consumption,” he explains. “Anyone who decides to give up smoking, for example, will return to the desired normal levels after just one year,” says the vascular specialist, who also encourages people to eat more healthily: “Cut out animal fats as much as possible! High cholesterol levels also have a negative effect on blood circulation. Deposits can form, and the blood can no longer flow freely,” Al Ahmad continues.
In principle, the same applies here: everything in moderation. The so-called Mediterranean diet, with plenty of cold-pressed and extra virgin olive oil, little meat, plenty of vegetables and the occasional fish and fruit, has proven to be the healthy middle ground. So: you don’t have to give up everything, but you shouldn’t eat meat every day either. Whole milk with a fat content of 3.5% also counts as an animal fat, and when it comes to eating eggs, it is generally the yolk that, if anything, has a negative impact on cholesterol levels. But opinions do indeed differ on this point.
Regular exercise, however, definitely supports blood circulation and keeps you fit. Go for regular walks or go swimming – the main thing is that you get some physical activity!
A wish for the future
If it were up to Wail Al Ahmad, whose career ambition has always been to become a doctor, technology should be researched further and integrated into everyday clinical practice. “I hope to see even more progress in robot-assisted surgery. Because with robotic technology, complex findings can also be calculated digitally, and vascular navigation would be possible,” says Al Ahmad, looking to the future. “But the human being remains at the forefront,” he concludes with satisfaction, and his patients are grateful to him. And we thank him for this interesting conversation!
If you would like to find out more about Wail Al Ahmad, please visit the profile of vascular surgery specialist Wail Al Ahmad and contact him with any questions regarding vascular surgery!
