Vascular outpatient office

Assessment(s) at outpatient offices of transplantation surgery (TS) should be scheduled in advance by phone: +420 236 052 816.

VASCULAR SURGERY OUTPATIENT OFFICE

The Transplantation Surgery Department has a long tradition in the treatment of vascular diseases. Based on the number of procedures it is one of the largest accredited units in the Czech Republic, the department is also involved in pre-graduate education of students of faculties of medicine, Charles University in Prague and is a training centre for vascular surgery in the field of postgraduate education. Currently, the department offers non-stop comprehensive therapy of arterial and venous diseases according to evidence-based medicine.

Chronic conditions are managed through the outpatient office open on all working days. The patient is examined by a specialised vascular surgeon or angiologist; subsequently, laboratory and imaging assessments are done (vascular sonography, computed tomography, magnetic resonance imaging, angiography, phlebography). The results are presented at the indication seminar of IKEM where the optimal therapeutic strategy is determined based on the consensus of all specialists (vascular surgeon, angiologist, interventional radiologist). 

We offer conservative therapy (regimen measures, administration of adequate medication), endovascular therapy (angioplasty), surgical therapy (bypass, endarterectomy) and the so-called hybrid therapy (use of endovascular and surgical methods in a single period).

Non-stop management of acute conditions is provided; we offer all conventional laboratory and imaging methods with subsequent acute interventional, surgical or the so-called hybrid therapy.

After the therapeutic procedures, the patient is hospitalised according to the difficulty of the procedure – at the standard ward, intensive care unit or anaesthesiological and resuscitation unit.

After discharge, patient follow-up is ensured at our outpatient office for the necessary period of time, and if allowed by the patient’s clinical condition, the patient is then transferred to the care of a specialist in the area of the patient’s home.

Most commonly treated conditions

Ischaemic disease of lower limbs

• Disease of lower limb arteries from the asymptomatic stage, the stage of claudication (pain while walking, limping) up to the stage of pain at rest and defects
• Therapeutic options: conservative therapy, endovascular therapy, surgical therapy (including venous transplantation from a donor – if a venous graft of the patient cannot be used), hybrid therapy

Diseases of the aortic arch arteries

• Involvement of arteries that supply the brain (most commonly the carotids) and arteries that supply upper limbs
• Prevention of cerebrovascular events
• Therapeutic options: conservative therapy, endovascular therapy, surgical therapy

Abdominal aortic aneurysm

• Disease caused by an enlargement of the abdominal aorta
• Prevention of complications, particularly rupture of the aortic wall
• Therapeutic options: endovasculartherapy (EVAR – endovascular aortic repair), surgical therapy

Chronic mesenteric ischaemia

• Disease involving arteries branching off the abdominal aorta, which supply intra-abdominal organs (especially the intestine, liver, pancreas)
• Therapeutic options: endovascular therapy, surgical therapy

Infections of vascular prostheses

• Infection of vascular prostheses after a previous angiosurgical procedure
• Therapy: surgical (including the use of the so-called fresh arterial / venous replacements from deceased donors in the tissue transplantation regimen)

Chronic venous insufficiency

• Disease from the asymptomatic stage, varices in lower limbs, up to the stage of crural ulcers
• Therapeutic options: conservative therapy, endovenous therapy (radiofrequency ablation – partially paid by the patient), conventional surgical therapy, endoscopic therapy (SEPS – subfascial endoscopic perforator surgery)
• Considering the large number of transplantations and acute conditions managed at our unit, your scheduled therapeutic procedure may be postponed.

OUTPATIENT OFFICE FOR VASCULAR ACCESS POINTS FOR HAEMODIALYSIS

Kidney transplantation is the only treatment of chronic renal failure; the transplantation offers incomparably better results than dialysis therapy. In patients unable to undergo transplantations or placed on the waiting list for kidney transplantation, the renal function must be substituted with peritoneal dialysis or haemodialysis.Three vascular access points exist for the needs of haemodialysis:

• Native arteriovenous fistula (AVF)
• Prosthetic arteriovenous graft (AVG)
• Central venous catheter (CVC)

According to international guidelines, AVF is the first-choice method (and should be established whenever it is possible), followed by AVF and in exceptional cases CVC. The Transplantation Surgery Department offers non-stop comprehensive care in the form of AVF and AVG. The catheter for peritoneal dialysis may be established via our abdominal surgical outpatient office of TSD. CVCs are implanted at the haemodialysis centre of IKEM.

The outpatient office for vascularaccess points for haemodialysis is open preferably every Wednesday. We offer the establishing and modification of complicated AVF/AVG (especially aneurysms and high-flow AVF). The patient is examined by a specialised vascular surgeon (history, physical examination and sonography of upper limb vessels); if an aneurysm is present, high-flow AVF is completed with sonography of the heart (ECHO); subsequently, the date is scheduled for establishing or modifying vascular access – usually within 1 month. Most AVF establishment procedures are done in the outpatient setting under local anaesthesia. The procedures of AVF modification and AVG establishment are most commonly performed under general anaesthesia.

After AVF establishment under local anaesthesia, the patient is followed for a short period of time at the TSD unit; after AVG establishment or AVF modification, the patient is hospitalised at the standard ward or at the intensive care unit for 2-3 days depending on the difficulty of the procedure. During hospitalisation, haemodialysis is performed via the haemodialysis centre of IKEM. After the procedure, the patient is followed at our outpatient office for as long as necessary, and if allowed by their clinical condition, the patient is transferred to the care of the dialysis centre near the patient’s home.

The so-called fistulography (AVF/AVG radiography) is performed in cases of insufficient function of the vascular access point; based on the finding, angioplasty or surgery is done.

Acute conditions (particularly bleeding, obturation) are handled non-stop. 

Considering the large number of transplantations and acute conditions managed at our unit, your scheduled therapeutic procedure may be postponed.