Vascular Surgery: Modern Treatment at the Vascular and Endovascular Center

Diagnostics in modern vascular surgery and endovascular surgery are based on high-resolution imaging techniques and close collaboration between vascular surgery, interventional radiology, and neuroradiology.
At the Vascular Center, we use ultrasound, CT, MRI, and angiographic examinations, among other techniques, to accurately assess arterial and venous vascular diseases.
These include narrowing of blood vessels, dilations, aneurysms, thromboses, and complex diseases of the arteries, including the aorta.
Many hospitals follow the guidelines of the German Society for Vascular Surgery (DGG) and have specialized physicians as well as a clinically coordinated diagnostic approach.
Such a structured diagnostic process is crucial for selecting the appropriate treatment option and reducing risks associated with acute and chronic arterial diseases.

Vascular surgery can treat all diseases of the blood vessels from head to toe. The only exceptions are the coronary arteries and the large artery that branches directly from the heart. These two areas fall within the specialty of cardiac surgeons.

Vascular surgery deals with the diagnosis and treatment of diseases of the vascular system @ Christoph Burgstedt /AdobeStock

Commonly treated conditions include:

• Narrowing of the carotid arteries to prevent a stroke
• Narrowing of the aorta and the pelvic and leg arteries
• Intermittent claudication
• Non-healing wounds on the lower leg and foot
• Sudden blockages of arteries in the arms and legs
• Aortic aneurysms, which can sometimes cause back or abdominal pain and, if they rupture, can lead to death from hemorrhage
• Creation of vascular access sites for dialysis (so-called hemodialysis shunts)
• Removal and sclerotherapy of varicose veins

In a clinic for vascular and endovascular surgery, specialists from various fields work closely together to provide comprehensive care for patients.
Vascular medicine, angiology, diabetology, anesthesiology, neurology, and interventional radiology form an interdisciplinary network that jointly manages diagnostics, treatment planning, and follow-up care.
This close collaboration is particularly important for complex conditions such as peripheral artery disease, aortic dissection, carotid artery disease, diabetic vascular problems, or venous disorders.
Many clinics are part of large hospital complexes or medical centers and offer a structured continuing education program that sustainably strengthens expertise in the fields of vascular surgery and endovascular surgery.
This ensures that patients receive optimal care through both minimally invasive and surgical procedures.

Vascular surgery has evolved rapidly since the mid- to late 20th century. This is due in part to blood-thinning medications, which have been available since around 1960.

Another reason for this development is the ever-increasing demand, as vascular diseases are becoming more prevalent.

This is also one reason why more and more hospitals are establishing and expanding dedicated departments for vascular surgery. In some hospitals, however, vascular surgery is integrated into other surgical departments—most often general or cardiac surgery.

Patients who require vascular treatment often have pre-existing conditions such as heart attacks or strokes. They frequently suffer from diabetes or heart failure.

Treatment Methods

Simply put, there are three treatment options to choose from:

• Conservative treatment:

Here, doctors attempt to manage the disease and its symptoms with medication.

• Endovascular surgery:

This involves treating the blood vessels from the inside. This method is also known as the “keyhole technique.” With this approach, doctors only need to make small incisions in the groin to treat the vessels from the inside. It is also possible to make an incision into the femoral artery.

• Open (surgical) vascular surgery:

This is the traditional and oldest method. It offers a wide variety of options for widening narrowed or blocked vessels.

The range of services offered by modern vascular centers encompasses the treatment of nearly all arterial and venous conditions—from conservative therapy to highly specialized combined procedures.
While arterial conditions such as intermittent claudication, aneurysms, peripheral arterial disease, or changes in the aorta are often treated with interventional or surgical procedures, minimally invasive techniques are the primary approach for venous conditions.
Conservative measures include medication, compression therapy, walking exercises, and the treatment of comorbid conditions such as diabetes mellitus, which play a central role in many vascular patients.
A vascular center is also equipped to provide comprehensive clinical care for patients with complex comorbidities—particularly those with high-risk conditions, neurological problems, or advanced vascular diseases.

In open (surgical) vascular surgery, doctors expose the affected blood vessels through skin incisions and then open them.

Depending on the situation, they can then use the following methods to repair the vessels:

• Scraping away deposits from the vessel wall and suturing in expansion strips (thrombendarterectomy and patch plasty)
• Bypassing narrowings and blockages using newly created bypass routes. These bypass circuits can consist of the patient’s own superficial leg veins or synthetic tubes.
• Removing aneurysms from the aorta or other blood vessels (for example, the femoral artery).
• Suturing of synthetic tubes
• Creating a connection between an artery and a vein to establish access for hemodialysis (shunt surgery). In right-handed patients, this connection is made on the left arm whenever possible (on the right arm for left-handed patients).
• Removal of blood clots directly or using special catheters (thrombectomy).
• Removal of varicose veins (varicose vein surgery)

Open surgery is performed through incisions in the groin and lower leg. Through the opened vein, doctors insert a wire to tie off the vein at its junctions and pull it out. These junctions are usually located in the groin, on the lower leg, or at the level of the inner ankle.

What sets endovascular surgery apart is the use of wires and catheters. This allows doctors to access all blood vessels through small incisions.

The following methods and procedures are available:

• Dilation of narrowings with balloon catheters

This can also be performed during surgery in conjunction with the scraping of the blood vessel or the placement of a bypass.

In most cases, however, it is a standalone procedure. This means surgery is not necessary. The catheter is inserted through the femoral artery, as this vessel is superficial and easily accessible.

The procedure is performed under local anesthesia. The patient must remain lying still for 1–2 hours.

A balloon dilates the narrowed section of the vessel @ Matthieu /AdobeStock

• Internal stenting of vascular aneurysms

This is most commonly performed in the area of the large thoracic or abdominal aorta. Here, too, doctors puncture the femoral artery and insert a stent.

These stents are housed in a sheath about the thickness of a ballpoint pen, allowing doctors to advance them through the blood vessel. Once the stent bridges the aneurysm, the doctor can withdraw the sheath.

The stent can then expand and anchor itself within the aneurysm due to the tension inside it.

• Creating vascular access for dialysis

Here, doctors bring the artery and vein together internally and fuse them together using heat.

• Sclerotherapy of varicose veins using special catheters

Here, doctors also insert a catheter into the vein. The application of heat then causes the vein wall to seal shut.

Endovascular procedures use modern catheter, guidewire, and stent technologies to treat blood vessels precisely from the inside.
These include minimally invasive techniques such as stent implantation, balloon procedures, the treatment of vascular dilations, the management of aortic diseases, and the treatment of carotid artery stenosis.
These procedures are often performed in collaboration with interventional radiology and allow for the treatment of hard-to-reach vascular segments without major surgical incisions.
Thanks to modern imaging techniques such as CT, MRI, or intraoperative angiography, many conditions can now be treated more quickly, gently, and precisely.
Endovascular procedures offer a significant advantage over traditional surgery, particularly for acute and chronic arterial diseases or for patients with significant comorbidities.

There is no one-size-fits-all answer as to which procedures are better. What is certain is that endovascular surgery has a number of advantages and disadvantages.

The advantages of endovascular procedures are:

• Smaller access points; in some cases, not even an incision is necessary
• Procedures can be performed under local anesthesia without the need for general anesthesia
• Shorter operating times in most cases
• Generally shorter hospital stays

The disadvantages:

• More frequent follow-up visits are necessary
• Follow-up examinations usually involve exposure to radiation and contrast agents
• Repair procedures are often necessary over the course of months and years
• These procedures are not applicable to all vascular diseases