Angiology Treatment of vascular diseases

Angiology deals with diseases of the vessels in general. These diseases may affect big, so called arterial vessels which lead away from the heart and which supply the internal organs with blood. One example for arterial diseases is the peripheral artery occlusive disease which causes circulatory disorders in the legs and as a result, patients are only able to walk a short distance. Furthermore, even smaller blood vessels might be affected, in the course of chronic inflammations of the body for instance. Blood circulation disorders affecting the hands are one example for this. In addition to that, angiology also deals with venous diseases such as thromboses or varicose veins.

For the purpose of a precise diagnosis, angiologists can resort to a broad range of methods. Apart from medicinal and physical treatments, the number of catheter-assisted (interventional) procedures has been increasing recently.
In catheter assisted procedures, the interventional angiologist works closely together with the vascular surgeon in order to determine the best and most gentle treatment for every single patient.

General Diagnosis

Colour Doppler Sonography

This technique can be applied to all accessible vessels. The Colour Doppler Sonography is an imaging technique used for visualising blood vessels. The speed of blood flow is measured with this ultrasound technology by means of colour-coded processing of the ultrasound signals according to the Doppler principle.

Capillaroscopy

Capillaroscopy is used to examine the structure of the capillaries by means of a light microscopic device. For this purpose, the nail folds of fingers and toes are particularly suitable because there you can examine the entire architecture of the smallest blood vessels. Capillaroscopy plays an important role, especially for the diagnosis of rheumatic diseases of small vessels.

Treadmill Ergometry

Treadmill ergometry serves to measure the exact walking distance of a patient when blood circulation disorders of the legs are suspected or known. We carry out this procedure on a treadmill, which is suitable for medical purposes, according to an internationally recognized protocol (Gardner protocol). Analogical to the exercise ECG, this examination is necessary to objectify the cause of leg pains on the one hand and to ascertain the success of a therapy on the other hand.

Pulse Oscillography

This procedure serves to measure the “blood pulsation”, for example at the finger tips and the toes. Special sensors are placed like a clip on the phalanxes of the fingers and toes. By doing so, changes in blood circulation due to temperature influences, medicinal influences or special compression tests can be visualized. Thus, pulse oscillography provides valuable indications for diagnosis.

Transcutaneous Measurement of the Partial Pressure of Oxygen

In a transcutaneous measurement of the partial pressure of oxygen, the oxygen level in the tissue is measured for the purpose of assessing the state of blood circulation.

Ankle Brachial Pressure Index

When an arterial occlusive disease is suspected, an ankle brachial pressure index is performed. The blood pressure is measured from your ankle and your upper arm by means of the Doppler sonography, an ultrasound procedure.

Medicinal therapy

The agent Cilostazol provides for an efficient treatment of peripheral arterial diseases (PAD), especially the peripheral artery occlusive disease. It is the only drug which has proven to be able to clearly enhance the walking distance and the quality of life of patients.

The agent has three effects:

The drug inhibits the ingrowth of vascular smooth muscles. Thus, the vessel remains wide.
Furthermore, the drug enhances the effect of Prostacyclin (a substance which is produced in vascular walls and which causes the vascular muscles to relax). By doing so, the function of the inner vascular wall is improved, the vessel is expanded and eventually blood flow is increased.
Additionally, Cilostazol inhibits the activation of thrombocytes (platelets) and thus prevents them from adhering.

Certain circumstances have to be taken into account, especially regarding Cilostazol’s interactions with other drugs.
In addition to the medicinal therapy, it is necessary to fight typical risk factors.

Interventional angiology procedures

Angiography (imaging of blood vessels)

Angiography refers to the depiction of blood vessels using diagnostic imaging procedures, such as X-rays or magnetic resonance imaging. This involves a contrast medium, a substance that enhances the image contrast, being injected into the blood vessel. The interior of the blood vessel containing the contrast medium stands out on the image of the part of the body in question. The resulting image is known as an angiogram.

Expanding narrowed arteries in the leg

This minimally invasive procedure merely requires a small incision in the skin, through which a catheter can be pushed up to the constriction via a blood vessel. This expands constrictions in the leg arteries. This method is used both to treat peripheral artery occlusive disease not sufficiently treatable by conservatively means as well as for critical limb ischemia. Blood vessels in the pelvic region, thighs and lower legs can be treated in this way. It may be necessary to insert blood vessel supports known as “stents” for support. These are very flexible for the periphery and resume their original form even when bent and squashed. At locations that are subjected to strong bending and shearing forces (knee area) particularly flexible and stable stents woven from nitinol wire are used.

Expanding narrowed arteries in the neck

Here constrictions in the arteries in the neck are expanded using an introduced balloon and covered with a stent. The decision as to whether an expansion and stent treatment, an operation or a purely medicinal therapy is the most promising therapy is made in an interdisciplinary conference made up of neurologists, vascular surgeons and angiologists.

Expanding narrowed arteries in the kidneys

This method is used to clear constrictions in the arteries in the kidneys using an introduced balloon (PTA percutaneous transluminal angioplasty). Today this method is combined with the implementation of a wire mesh (stent). This ensures that the elastic properties of the blood vessels do not cause them to constrict again. The blood vessel is supported and held open by this endoprosthesis. An expansion of the constriction of the kidney artery should be performed if the blood vessel is constricted by more than 60%.

Treatment of aortic aneurysm or iliac aneurysm

This treatment method is described in detail under the spectrum of treatment of vascular surgery as this procedure is done in direct collaboration between the interventional angiologists and the vascular surgeons in the hybrid catheter laboratory. Coated stents are used that prevent the aneurysm.

Laser angioplasty

A different procedure used to remove deposits as opposed to just pushing them aside is known as laser angioplasty. Here a catheter with a cold light laser at the tip is used. This enables in particular very calcified constrictions to be “vaporized”. Following that we frequently used balloons coated in medication aimed at preventing new constrictions.

Lysis catheter

A further procedure for treating acute occlusions is local thrombolysis. Here a special catheter with many small lateral openings through which the medication can escape is laid in the blood vessel and a medication that dissolves the blood clot is applied over several hours.

Rotational thrombectomy

In the case of acute occlusions of the blood vessels by blood clots we use special catheters that enable these blood clots to be syphoned off using an Archimedean screw.