Classic methods
The classic "open" vascular surgery methods are the ones that have developed and established the specialty of vascular surgery and are the ones to which basically all new methods are being compared to, when they make their appearance, as medicine and technology evolve. In general, their application is never incorrect or obsolete when the correct indication is present, but their scope has now been limited and is essentially identified with the field of contraindications of endovascular methods. Simply put, when we cannot apply an endovascular solution (known as "stent" or "balloon"), open surgery is almost always technically possible if its danger is reasonable and the patient's biological reserves good enough.
1. Abdominal Aortic Aneurysm
In the classical "open" treatment of abdominal aortic aneurysms, the first essential step is the opening of the abdominal cavity with an incision throughout its wall. The aneurysm is then prepared throughout its length and excluded. Afterwards, a synthetic implant with as many branches as required to completely exclude the aneurysm is sutured in place. It is necessary to monitor the patient postoperatively in an intensive care unit for 1 - 2 days. The total stay in the clinic ranges from 5 - 8 days.
2. Peripheral Arterial Disease (PAD)
In the PAD the basic principles of open surgical treatment are the removal of the atherosclerotic plaque that causes the narrowing/obstruction of the arteries (endarterectomy) and/ or
the bypass of the arterial occlusion . In case of an endarterectomy , the lumen of the vessel is opened and the atherosclerotic plaque is removed. The incision in the vessel is closed with a graft - the so -called patch - which is sewn on the wall of the vessel.
Bypass is chosen as a treatment when the occlusion of the artery is long and/or the atherosclerotic plaque very hard
. In this case skin incisions above and below the occlusion are performed (usually in the lower extremities, less often in the pelvis) and an elongated graft is placed in order to bypass the obstruction. The grafts can be either autologous, (biological material from the patient himself, such as the major saphenous vein), heterologous (specially processed biological grafts from other species, e.g. bovine pericard) or synthetic . Autologous grafts are strongly preferred, if possible.
In the case of embolism or thrombosis, catheters with balloons at their end ( fogarty) are used which are inserted away from the thrombus, permeate it and ultimately "fish" the thrombus and clean the vessel.
These procedures are also performed in case of abdominal vessels (aorta, iliac arteries) and their method of reconstruction approaches technically the classical treatment of the abdominal aortic aneurysm with variations as appropriate.
3. Carotid Disease
There are two methods of open surgical treatment.
in internal carotid artery stenosis The first is the classic endartectomy where the vessel is opened longitudinally from the common to the internal carotid artery, the atherosclerotic plaque is removed and the incision closed with a patch (similar to that mentioned in peripheral obstructive arterial disease).
The second method is called reversed endartectomy. In this case we perform an incision at the base of the internal carotid artery, remove the plaque and close the vessel with a direct anastomosis between the internal and the common carotid artery. The use of a graft is not necessary here.
This procedures are performed by my team under local anesthesia and the hospitalisation ranges from 1 to 2 days.
4. Varicose Veins
The classical surgical treatment of varicose veins consists in the excision of the main superficial veins (major or minor saphenous vein) by "stripping" them "off".
In this method we perform incisions in the groin or the popliteal region, as well as at the level of the lower point of venous insufficiency (which may variate from the thigh to the ankle). Through these incisions, the insufficient vein and its branches are completely removed.
5. Deep Vein Thrombosis
In case of patients with recent thrombosis of iliac or femoral veins, the first step of treatment is conservative with specific anticoagulant medicaments. Sometimes, however, there is an indication of surgical treatment with the aim to remove the blood clots. This is done with the help of special catheters (fogarty). This happens rarely and concerns mostly young patients with heavy clinical symptoms.
Particularly when the so called Phlegmasia Cerulea Dolens, a massive and acute thrombosis of all lower extremity veins, surgery is considered urgent due to increased risk of developing gangrene and amputation.
In many cases, endovascular methods are combined with open surgery (see hybrid surgical methods ).