Vascular surgery - information and specialists

Areas of application for vascular surgery

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

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

Frequently treated diseases are:

• Narrowing of the carotid arteries to prevent a stroke
• Narrowing of the aorta and the iliac and leg arteries
• Intermittent claudication
• Non-healing wounds on the lower leg and foot
• Sudden occlusion of arteries in the arms and legs
• Protrusions of theaorta (aortic aneurysm), some of which cause back or abdominal pain and can lead to death from bleeding if they burst
• Creation of vascular accesses for blood washing (so-called hemodialysis shunts)
• Removal and sclerotherapy of varicose veins

The importance of vascular surgery

Vascular surgery has developed rapidly since the middle to end of the last century. One reason for this is the blood-thinning medication that has been available since around 1960.

Another reason for this development is the ever-increasing demand, as vascular diseases are on the rise.

This is also a reason why more and more clinics are setting up and expanding independent departments for vascular surgery. In some clinics, however, vascular surgery is integrated into other surgical departments. Usually in general or cardiac surgery.

Patients who require vascular therapy often have pre-existing conditions such as heart attacks or strokes. They often suffer from diabetes or cardiac insufficiency.

The therapy methods

Put simply, there are three treatment methods to choose from:

• Conservative therapy:

Here, doctors try to get the disease and symptoms under control with medication.

• Endovascular surgery:

This is where the blood vessels are supplied from the inside. This method is also known as the "buttonhole technique". With this procedure, doctors only need small incisions in the groin to treat the vessels from the inside. It is also possible to make a puncture in the groin vessel.

• Open (surgical) vascular surgery:

This is the classic and oldest method. A wide variety of options are available to widen narrowed or blocked vessels.

The open surgical treatment methods in detail

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

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

• Peeling away deposits from the vessel wall and inserting widening strips (thrombendarterectomy and patchplasty)
• The bridging of constrictions and occlusions through newly created bypasses. These bypass circuits can consist of the body's own superficial leg veins or plastic tubes.
• Removal of vascular outpouchings of the aorta or other blood vessels (e.g. knee joint artery).
• Sewing in plastic tubes
• The creation of a connection between the artery and vein in order to create an access for hemodialysis(shunt surgery). If possible, this connection is made on the left arm for right-handed patients (right for left-handed patients).
• The removal of blood clots directly or with special catheters(thrombectomy).
• Removal of varicose veins (varicose vein surgery)

Open surgical treatment is carried out through incisions in the groin and lower leg. Doctors insert a wire through the opened vein to knot the vein at the opening and pull it out. The opening sites are usually in the groin, on the lower leg or at the level of the inner ankle.

The endovascular therapy procedures in detail

The special feature of endovascular surgery is the use of wires and catheters. This allows doctors to reach all vessels via small access points.

The following methods and procedures are available:

• Expanding constrictions with balloon catheters

This can also be done during the operation together with the stripping of the blood vessel or the bypass.

In most cases, however, it is a stand-alone measure. This means that no operation is necessary. The catheter is inserted via the inguinal artery because this vessel is superficial and easily accessible.

The procedure is performed under local anesthesia. The prerequisite is that the patient lies still for 1-2 hours.

A balloon expandsthe constricted area of the vessel @ Matthieu /AdobeStock

• The internal splinting of vascular aneurysms

This is usually carried out in the area of the large thoracic or abdominal aorta. Here too, doctors pierce (puncture) the inguinal artery and insert a prosthesis.

These prostheses are in a pen-thick sheath so that doctors can push them forward in the vessel. Once the prosthesis has bridged the dissection, the doctor can pull back the sheath.

The prosthesis can then expand and anchor itself in the sac due to the tension.

• Creating vascular accesses for dialysis

Here, doctors pull the artery and the vein together internally and connect them using heat.

• Sclerotherapy of varicose veins using special catheters

Doctors also insert a catheter into the vein. The application of heat then causes the vein wall to stick together.

Endovascular "buttonhole" procedures versus open surgery

There is no general answer as to which procedure is better. What is certain is that endovascular surgery has a number of advantages and disadvantages.

The advantages of endovascular procedures are

• Smaller access routes, in some cases not even a skin incision is necessary
• Procedures can be performed under local anesthesia without general anesthesia
• Usually shorter operation times
• Usually shorter hospital stay

The disadvantages:

• More frequent follow-up checks necessary
• Follow-up examinations are usually associated with exposure to radiation and contrast media
• More frequent repair procedures required over the course of months and years
• Procedures cannot be used for all vascular diseases