Vascular surgery eliminates disorders and diseases of the blood vessels, for example, vascular stenosis or varicose veins through the conservative (non-invasive) or surgical therapies. It is a subspecialty of surgery. A commonly performed operation to eliminate vascular disorders is the placement of bypasses and vascular prostheses.
What is vascular surgery?
Vascular surgery is concerned with the conservative and surgical treatment of diseased blood vessels. A common procedure is the placement of vascular bypasses. Specialists in vascular surgery (vascular surgeons) are concerned with interventional (targeted interventions) and endovascular (inside the vessel) treatment of diseases of the blood vessels. Therapy is either conservative (non-invasive) or surgical. In this case, the diseased blood vessels are hyperemized (blood flow stimulated), reconstructed (restored), fitted with prostheses or resected (removed). Prior to treatment, a risk assessment and prognostic evaluation is performed. It is used for prevention, detection and follow-up treatment of vascular injuries, diseases and malformations. Vascular surgeons also accompany their patients in the rehabilitation phase after the surgical intervention. This medical subspecialty includes instrumental examination methods including blood flow measurement, survey of angiological findings, as well as surgical preparation and follow-up care. Prior to surgery, the collection of intraoperative radiological findings in compliance with radiation protection is necessary.
Treatments and therapies
Vascular surgery is concerned with the conservative and surgical treatment of diseased blood vessels. A common procedure is the placement of vascular bypasses in the presence of arterial peripheral occlusive disease or circulatory disorders. Short-segment narrowings are relieved by dilating the affected vessels (balloon dilatation) and, if induced, by inserting a stent (metal tube). Long-stretch constrictions or occlusions are treated either by medication or surgery. This method exposes the diseased vessel and removes the calcification (thromboendarterectomy, TEA). Alternatively, a bypass from a vein in the patient’s own body or a plastic prosthesis is implanted. This treatment bridges the vascular occlusion by rerouting the bloodstream. Prosthetic inserts (vascular inserts) are placed when an aneurysm is present. This medical subdiscipline 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. Other specialties include the removal of blood clots (emboli), varicose vein surgery (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 vein and artery through which dialysis is performed. Other vascular diseases that are successfully treated include narrowing of the carotid artery (internal carotid artery, carotid stenosis) and abdominal aortic aneurysm. The carotid artery supplies the internal cephalic artery of the brain. If this process no longer functions properly, carotid stenosis is present, resulting in reduced blood flow to the brain. The vascular surgeon recognizes these signs with timely diagnosis and treats the dangerous vascular disease. Vascular surgery eliminates the narrowing of the carotid artery by means of surgical peeling of the diseased vessel. A less invasive option is to dilate the affected vessel using a balloon catheter and then place a stent in the form of a metal vessel wall support. If this dangerous dysfunction is not detected and treated in time, it can lead not only to a stroke but also to the patient’s permanent need for care or even death. In the past, aneurysms of the abdominal aorta were treated exclusively by surgery. How far vascular surgery has come in the meantime is shown by the fact that the bulge caused by the aneurysm is no longer bridged exclusively surgically with a plastic prosthesis, but is eliminated by a less invasive treatment option. Angiologists place a “stent-graft” prosthesis, inserted through the inguinal arteries, up to the affected area and eliminate the aneurysm through targeted placement.However, this method is not yet a routine procedure, as so far only a few German hospitals treat aneurysms that equally involve visceral and renal arteries. To enable successful treatment, physicians insert 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 specialty lies in minimally invasive procedures, which should almost completely eliminate vascular injury during gentle endovascular surgery. Vascular surgeons, in cooperation with nephrologists (diseases of the kidney as well as their conservative therapy), neurologists, angiologists (physicians for vascular diseases) and cardiologists, make a valuable contribution to keeping patients healthy and achieving the set goals.
Diagnosis and examination methods
With significant improvements in noninvasive diagnostics such as ultrasound and CT and MR angiography, device-based vascular medicine is in a fascinating phase of development. New therapeutic options for the treatment of the abdominal and thoracic aorta using endoluminal stent prostheses could be further developed using these diagnostic imaging techniques. Increasingly, vascular surgeons are using combination procedures of endovascular therapy and conventional vascular surgery. These investigative procedures are referred to in technical jargon as hybrid procedures. Modern ultrasound-based equipment in angiological and phlebological diagnostics is capable of detecting diseases of the abdominal aorta, carotid vessels, pelvic vessels, cerebral vessels, veins, and arm and leg arteries at a high level. For further diagnostics, the clinics use all the possibilities of imaging diagnostics. High-performance magnetic resonance tomographs image all vascular provinces of the body without radiation exposure and contrast agent administration. The advantage is that patients who have previously shown allergic reactions to the administration of contrast media or who suffer from renal insufficiency can also be subjected to this examination method. The diagnostic services of the departments include other examination methods such as CW Doppler examination of the arterial and venous systems, color-coded duplex sonography, light reflection rheography, walking distance examination on a treadmill, and intraoperative diagnostics with flow measurement, angiography, and CW Doppler measurement. A wide range of medications are available to surgeons. Platelet function inhibitors, for example acetylsalicylic acid (ASA) and clopidogrel, are used to prevent serious risks such as heart attacks, acute vascular occlusions or strokes. In the case of certain blood clots, the administration of substances is induced that have no effect on the platelets but reduce blood clotting in other ways. For example, angiologists prefer to use anticoagulants (anticoagulants such as heparin) after surgery when there is a risk of blood clot formation in the heart. Drugs that promote blood circulation improve the flow properties of the bloodstream and have a vasodilatory effect. Furthermore, painkilling drugs and antibiotics are available. Physicians 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 being achieved through ever-smaller approaches in the form of customized, fenestrated, and branched endoprostheses and bypasses to the vessels.
