The vascular surgery division is specialised in the treatment of acute and chronic peripheral vascular diseases. The arterial system is most commonly operated on for atherosclerosis or aneurysms. These interventions are performed in arteries of the aortic arch, in the abdominal artery and its branches and in arteries of the limbs. Surgical treatment can be combined with endovascular interventions. We also perform interventions in the venous system, most commonly for chronic venous insufficiency. Procedures to establish or modify the access for haemodialysation are a non-negligible portion of our programme. Thanks to a narrow interconnection with the transplantation programme, we are able to perform vascular reconstruction also using arteries and veins from deceased donors.
Carotids are the main arteries for the brain supply. In patients with significantly narrowed carotids, the patency can be surgically renewed. This procedure is done in patients who have suffered a cerebral event and their carotid is narrowed by more than 50%. The procedure is also done for preventive reasons in patients without a cerebral event; in such a case the artery must be narrowed by at least 70%. The procedure is most commonly performed under local anaesthesia, it is not too demanding for the body and hospitalisation lasts only several days.
Surgeries for acute limb ischaemia
Sudden limb pain may have various causes. The most common vascular cause is embolism, i.e. obstruction of an artery with a loosened blood clot. It is an acute condition, especially if the pain is associated with a movement disorder and sensitivity of fingers of the affected limb. This condition can be resolved through surgical removal of the embolus; in some cases, the catheterisation approach can be offered in cooperation with radiologists – in this case a several hour lasting infusion in the artery may dissolve the clot (the so-called thrombolysis). When patency of the artery is renewed, the condition usually quickly normalises.
Surgeries for chronic limb ischaemia
Chronic obstruction and narrowing of arteries of lower limbs may present either by gait interrupted in certain intervals (the so-called claudications) or critical ischaemia with pain at restor with a limb defect (gangrene). In principle, the situation can be resolved by opening the artery and renewing its patency (endarterectomy), or by bypassing the affected segment (bypass). Rather mild conditions can be resolved by catheterisation (angioplasty); both methods often need to be combined. The demands of the procedure and the duration of hospitalisation depend on the level and scope of the vascular involvement.
Surgeries for an aneurysm
Some patients experience weakening of the arterial wall, usually for genetic causes. This may lead to the development of aneurysms (widening of an artery). The most common complications of aneurysms in the abdominal cavity include perforation and bleeding. Outside the abdominal cavity, problems are posed rather by obstructions of aneurysms and subsequent perfusion disorder of the affected limb. Aneurysms can be managed by catheterisation (stent-graft implantation) or surgical replacement, usually using artificial materials. Catheterisation is less demanding for the body and is associated with short hospitalisation, but it is not suitable for all patients.
Venous system surgeries
Surgery for varicose veins is the most common procedure in veins. It is done both for cosmetic reasons and especially in patients with threatening crural ulcer, and last but not least, also in patients with an open crural ulcer. Not only is classical surgery of varices performed, but also the so-called radiofrequency ablation. The radiofrequency ablation catheter is not reimbursed by health insurance companies and its use must be paid in advance by the patient.
Vascular access for haemodialysis, the so-called shunt, can be established in patients with chronic renal insufficiency. The shunt can be made using special vessels, most commonly during an outpatient procedure under local anaesthesia. If the patient’s own vessels cannot be used, vascular prostheses are often applied, which require at least short-term hospitalisation. Our department also performs implantation of catheters for peritoneal dialysis.