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Medical Departments

Vascular and Endovascular Surgery

Treatment and Care Priorities at a Glance:

Varicose Veins

Varicose veins (varices) are tortuous dilated veins on the legs. The transport of blood back to the heart is disturbed. The main cause is a genetic predisposition to connective tissue and weakness of the vein wall and vein valve. A varicosis is exacerbated through activities involving standing, pregnancies, lack of exercise and being overweight.

1. Radio-Frequency Obliteration (Closure FAST)
The saphenous vein is not removed, but its lumen is closed. This procedure can be carried out exclusively using a local anaesthetic without narcosis, or regional anaesthesia procedures.

2. Cryoexeresis
Here, the defective saphenous varicosis is surgically removed - a long-proven method. The varicose veins are removed using probes (so-called stripping). The patient has to wear a compression stocking postoperatively. The operation can be performed both as inpatient and outpatient.

3. Compression Therapy
A professional compression treatment using specially-fitted compression stockings is performed either as a single therapy, or as an adjunctive therapy to surgery. One benefit is clearly demonstrated: A compression treatment leads to the relief of the venous return, the muscle venous pump is improved.

4. Sclerotherapy
This treatment is only suitable for small to medium-sized veins. Here, a sclerosing agent (aethoxysklerol) is injected into a vein triggering an artificial inflammation. This leads to the bonding of the vein walls and ultimately to the disappearance of varicose veins. Even after the sclerotherapy, a compression treatment is required short-term.

Circulatory Disorders of the Legs

In the so-called peripheral arterial occlusive disease, the blood supply to the legs is reduced by atherosclerosis. When walking, this creates an oxygen and nutrient deficiency with severe pain especially in the calf. These mobility problems are more commonly known as smoker's leg (intermittent claudication). In advanced stages of PAOD, tissue death results and amputation may be necessary.

Treatment Options

1. Operative and Interventional Treatment The existing vascular narrowings or closures are enucleated (pulmonary thromboendarterectomy) or bypassed with a bypass. For a bypass, endogenous (body's own) veins are used whenever possible.

 

2. Balloondilatation and Implantation of Stents

3. Drug Therapy
An important part of any treatment of circulatory disorders is the use of different drugs. In our department, circulation-enhancing drugs are used. Blood thinners, such as aspirin and clopidogrel are also used and the results regularly checked using wound swabs.

4. Spinal Cord Stimulation
If all vascular surgical treatment options have been exhausted, a Spinal Cord Stimulation (SCS) can be performed to keep the leg. Under local anaesthesia, an electrode is placed in the spine. The electrical pulses cause an interruption in the transmission of nerve pain and an improvement in blood flow. This treatment is only carried out in a few hospitals.

Stroke – Narrowing of the Carotid Arteries

Narrowing of the carotid arteries can lead to regional circulatory disorders of the brain causing a stroke. Approximately 200,000 patients are affected each year in Germany.

Warning signs of a larger stroke are smaller neurological deficits, such as visual disturbances, speech disorders or paralysis of the arms or legs. These are caused by emboli from the narrowing of the carotid arteries.

Treatment Methods

1. Carotid Artery TEA
During surgery, the carotid artery is exposed through a longitudinal section and the narrowing is enucleated. The carotid artery is closed again using various techniques. Overall, it is a minimally invasive procedure. The hospital stay is about five days. After surgery, a so-called platelet aggregation inhibitor (aspirin or clopidogrel) is taken for life.

 

2. Balloon Dilatation (PTA)
Here, in a narrowed vessel section, the lumen of the vessel is increased or reopened using balloon expansion. A stent is implanted to keep the vessel open and to prevent the shedding of small vascular particles. The dilation is done via an access to the inguinal arteries with long catheters and so-called sluices.

Abdominal Artery Extension/Aneurysm

The aneurysm is defined as a spindle or bag-like, localised and permanent extension of the cross-section of blood vessels. This disorder usually develops as a pathological response to atherosclerosis, but can also arise secondary to trauma, infection, inflammation or congenital connective tissue.

The main danger is the rupture (tear) of the aneurysm which leads to a haemorrhage. The aneurysm only rarely causes symptoms, such as back pain. Risk factors include smoking, high blood pressure, diabetes and dyslipidemia.

An abdominal artery aneurysm is usually diagnosed by ultrasound. For a more detailed examination, computed tomography is used.

From an aneurysm transverse diameter of 5 cm, surgery must be considered because there is a significantly increased risk of rupture. The patient should then seek medical attention from a vascular surgeon.

Treatment Options

Depending on the location of the aneurysm, the following treatments are possible:

1. Aneurysm of Thoracic Aorta
The aneurysms of the descending aorta in the chest are generally supplied endovascularly (inside the vessel). The application of stent prostheses significantly minimises the extent of the surgery and thus the surgical risk. A continuous, careful control with a special ultrasound device is very important here.

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2. Aneurysms of the Abdominal Aorta

- Elimination of the aneurysm through an aortic stent prosthesis (EVAR) With this method, a wire-reinforced prosthetic is inserted into the inner splint via the femoral artery. This relieves the pressure on the arterial wall and prevents rupture. The surgery is minimally invasive for the patient.

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- Surgical Elimination of the Aneurysm

With conventional surgery, the abdomen is opened with a middle incision. After careful preparation, the abdominal artery is replaced with a plastic prosthesis. The surgery has been proven for decades. The burden on the patients is especially great for few days postoperatively.

Vascular Access - Dialysis Shunt System, Port Catheter System

The treatment of many diseases requires vascular access which enables the delivery of also toxic medicines, concentrated nutrient solutions, or the removal and return of large amounts of blood. This applies, above all, to dialysis patients and tumour diseases.

The treatments include:

1. Dialysis Shunt Surgery If a permanent blood wash (dialysis treatment) is required, the vascular surgeon creates a short-circuit connection between the artery and vein in the area of the arm, so that dialysis is possible on the then fast-flowing blood.

2. Port Surgery In order to ensure that the drugs can be given pain-free, safe access to the large veins is necessary. To do this, we implant so-called port systems. These are small catheters which are inserted under the skin, along with a chamber. They can then be pierced from the outside and drugs can be injected directly into a central vein. The port systems are inserted under local anaesthesia.

Chronic Venous Insufficiency

After a deep leg vein thrombosis or due to long-standing varicose veins, a chronic ulcer may occur (mostly in areas of the lower leg above the foot). Through the targeted elimination of so-called perforating veins (compounds of deep and superficial veins), long-standing ulcerations can also be healed. This operation can be performed at our hospital endoscopically and minimally invasive.

In addition, an intensified physical decongestion with compression bandages and lymph drain devices is performed.

The Diabetic Foot

This includes infections, wounds, or destruction of the deep tissues of the foot in connection with nerve damage and/or circulatory problems in diabetics. A distinction is made depending on the type and severity of symptoms.

Treatment Options

With existing blood circulation disorders, healing of the ulcers can be achieved by installation of a bypass or a vascular dilation (with balloon). An orthopaedic shoe supply or load relief (orthoses) is necessary in the treatment of diabetic foot.

Focus on Wound Management: The care of the wound is crucial to the healing process. Since 24th January 2011, the Vascular and Endovascular Surgery Department has been certified by the Deutsche Diabetes Gesellschaft (DDG) [German Diabetes Association] as a centre for the inpatient treatment of the diabetic foot. We have the capacity to care for patients with chronic wounds, both inpatients and outpatients.

The most modern bandaging techniques (among other things, the polyurethane foam and alginate bandages in many different variations) are used as part of the treatment of wounds. In deeper wounds, we use vacuum therapy in our department - this consists of an airtight wound closure with a drainage system for secretions. Maggot therapy (biosurgery) is used in especially difficult cases. The sterile maggots of the common green-bottle fly (Lucilia sericata) are bred in special laboratories and applied to the wound after delivery to relieve it of dead tissue and bacteria. The maggots feed on tissue, so that the intact tissue is spared.


Contact

Chief secretariat
Mrs. Wiener
Theresienkrankenhaus
Bassermannstraße 1
68165 Mannheim
1st floor, room 103
Phone (0621) 424-4303
Fax (0621) 424-4676
E-Mail: info.gc
@theresienkrankenhaus.de

Vascular Surgical Outpatient Clinic

Phone (0621) 424-4303

Vascular Surgical Wards

Ward 2B
Phone (0621) 424-4214

Ward 2D
Phone (0621) 424-4302

Certifications

The Vascular and Endovascular Surgery Department is since 2011 certified by the Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin as a centre. Recertification: 2014