Vascular surgery

The Vascular surgery eliminates disorders and diseases of the blood vessels, for example vascular stenoses or varices, through conservative (non-invasive) or surgical therapies. It is a branch of surgery. A frequently performed operation to eliminate vascular diseases is the placement of bypasses and vascular prostheses.

What is vascular surgery?

Specialists in vascular surgery (vascular surgeons) deal with the interventional (targeted interventions) and endovascular (within the blood vessel) treatment of diseases of the blood vessels. Therapy is either conservative (non-invasive) or surgical. The diseased blood vessels are hyperaemized (stimulates blood flow), reconstructed (restored), provided with prostheses or resected (removed). A risk assessment and prognostic assessment is carried out before treatment.

It is used for the prevention, detection and follow-up treatment of vascular injuries, diseases and malformations. The vascular surgeons also accompany their patients after the surgical intervention in the rehabilitation phase. This medical sub-area includes the instrumental examination methods including the blood flow measurement, the survey of the angiological findings, as well as the preparation for the operation and the follow-up care. Before the procedure, an intraoperative radiological control of the findings must be carried out in compliance with radiation protection.

Treatments & therapies

Vascular surgery deals with the conservative and surgical treatment of diseased blood vessels. A frequent procedure is the laying of vascular bypasses in the presence of arterial peripheral occlusive disease or circulatory disorders. Short-stretched constrictions are eliminated by expanding the affected vessels (balloon dilatation) and, if induced, by inserting a stent (metal tube).

Long constrictions or obstructions are treated either with drugs or surgically. This method exposes the diseased vessel and eliminates the calcification (thrombendarterectomy, TEA). Alternatively, a bypass from a body's own vein or a plastic prosthesis is implanted. This treatment bridges the vascular occlusion by diverting the blood flow path. Prosthetic inserts (vascular insoles) are placed in the presence of an aneurysm. This medical sub-discipline includes the treatment of all vessels that supply the brain with oxygen and blood.

The prophylaxis of a stroke and the treatment of arteriosclerosis also belong in the hands of a vascular surgeon. Further specialties are the removal of blood clots (embolism), varicose veins (varicose veins on the leg), all types of injuries to the blood vessels, compression syndromes, diabetic foot syndrome and shunt surgery. A shunt is the short-circuit connection between the vein and artery through which dialysis is performed. Other vascular diseases that are successfully treated are the narrowing of the carotid artery (internal carotid artery, carotid stenosis) and the abdominal aortic aneurysm. The carotid artery supplies the brain's internal carotid artery. If this process no longer works properly, there is a carotid stenosis, which leads to reduced blood flow to the brain.

The vascular surgeon recognizes these signs with a timely diagnosis and treats the dangerous vascular disease. Vascular surgery removes the narrowing of the carotid artery by means of surgical peeling of the diseased vessel. A less invasive option is to expand the affected vessel using a balloon catheter in order to then place a stent in the form of a metal vascular wall support. If this dangerous dysfunction is not recognized and treated in good time, it can not only lead to a stroke, but also to long-term care or even death of the patient. In the past, the aneurysm of the abdominal aorta was treated exclusively surgically.

How far vascular surgery is now shows that the bulging caused by the aneurysm is no longer exclusively surgically bridged with a plastic prosthesis, but is eliminated by a less invasive treatment option. The angiologists place a “stent-graft” prosthesis inserted through the inguinal arteries up to the affected area and switch off the aneurysm through targeted placement. However, this method is not yet a routine operation, as only a few German clinics have treated aneurysms that also include visceral and renal arteries. To enable successful treatment, doctors use prostheses that have so-called windows that allow blood flow to other abdominal organs and the kidneys.

According to experts, the field of vascular surgery is currently in an interesting phase. The future goal of this specialist area is minimally invasive interventions that should almost completely exclude the injury of vessels during a gentle endovascular operation. Vascular surgeons, in cooperation with nephrologists (diseases of the kidney and their conservative therapy), neurologists, angiologists (doctors for vascular diseases) and cardiologists, make a valuable contribution to keeping patients healthy and achieving the goals set.

Diagnosis & examination methods

Thanks to the significant improvement in non-invasive diagnostics such as ultrasound and CT and MR angiography, device-based vascular medicine is in a fascinating development phase. New therapy options for the treatment of the abdominal and thoracic aorta using endoluminal stent prostheses could be further developed through these imaging diagnostic procedures.

Increasingly, vascular surgeons are using combinations of endovascular therapy and conventional vascular surgery. These examination procedures are called hybrid procedures. Modern devices based on ultrasound in angiological and phlebological diagnostics are able to detect diseases of the abdominal artery, neck vessels, pelvic vessels, cerebral vessels, veins as well as the arm and leg arteries at a high level. For further diagnostics, the clinics use all possibilities of imaging diagnostics. High-performance magnetic resonance tomographs display all the vascular provinces of the body without exposure to radiation or the use of contrast media. The advantage is that patients who have previously shown an allergic reaction to the use of contrast media or who suffer from renal insufficiency can be subjected to this examination method.

The diagnostic range of services of the specialist departments includes further examination methods such as the CW Doppler examination of the arterial and venous system, the color-coded duplex sonography, the light reflection rheography, the walking distance examination on the treadmill as well as the intraoperative diagnostics with flow measurement, angiography and CW Doppler measurement. A large number of drugs are available to surgeons. Thomocyte function inhibitors, such as acetylsalicylic acid (ASA) and clopidogrel, are used to prevent serious risks such as heart attacks, acute vascular occlusions or strokes.

With certain blood clots, the administration of substances is induced that have no effect on the blood platelets, but instead reduce blood clotting in other ways. Angiologists therefore prefer to use anticoagulants (anticoagulants, e.g. heparin) after operations if there is a risk of blood clots forming on the heart. Medicines that promote blood circulation improve the flow properties of the bloodstream and have a vasodilating effect.

Painkillers and antibiotics are also available. Doctors use these substances depending on the indication. The future of conventional vascular surgery lies in a profound reduction in tissue trauma, a goal that is achieved through ever smaller access points in the form of tailor-made, windowed and branched endoprostheses and bypasses to the vessels.