Diagnostics and therapy

If a vascular disease (arteries or veins) is suspected in a patient, all the examination methods required for diagnosis are available in the vascular medicine functional area of our vascular consultation. These include

• Duplex sonography
• CW Doppler sonography and Doppler pressure measurement
• Treadmill ergometry
• Capillary microscopy
• Arterial and venous step and occlusion plethysmography
• Acral light plethysmography
• MRI of the vessels

If the suspicion of a vascular disease is confirmed, further examination methods are available. Further diagnostics are often carried out using catheter techniques and in many cases already allow targeted therapy.
In detail, these are

• Digital subtraction angiography of the vessels
• CO2 angiography for renal dysfunction
• Intravascular ultrasound and pressure wire measurement (FFR)
• Interventional therapy for constrictions or occlusions of the arteries by means of balloon dilatation and insertion of vascular supports (stents) and application of drug-coated balloons
• Catheter atherectomy
• Special balloon techniques (cutting balloon, scoring balloon)
• Interventional therapy for acute and chronic pelvic vein thrombosis
• Interventional therapy for acute pulmonary artery embolisms

Peripheral arterial occlusive disease (PAD):
PAD is caused by narrowing (stenosis) or occlusion of the arteries and is most commonly caused by atherosclerosis. It can occur acutely or chronically. Pain occurs on exertion due to insufficient blood flow, commonly known as intermittent claudication in the legs. Constrictions or occlusions of the arteries are opened when symptoms occur due to the circulatory disorder and conservative therapy with walking training and medication is not sufficient.
In addition to traditional surgery (bypass operation), the less invasive method using catheter technology is increasingly being used today. Usually, any area of the body can be reached with a catheter via the inguinal artery and constrictions and blockages can be treated with balloons and the insertion of stents without the need for surgery. The treatment of complex vascular occlusions is a particular focus.

Acute arterial vascular occlusion:
Occasionally, an artery may suddenly become blocked, often accompanied by severe symptoms (pain, feeling cold, weakness of the limb). The causes are varied, but more frequently a certain cardiac arrhythmia (atrial fibrillation) is the cause. We treat sudden occlusions of the leg arteries or other arteries using catheter technology, avoiding surgery if possible. The clogged blood clots are dissolved or aspirated. The triggering cause is also sought.

• Rotational thrombectomy
• Thrombolysis therapy
• Aspiration thrombectomy

Diseases of the carotid artery
Narrowing of the carotid arteries can lead to a stroke. Depending on the extent of the constriction and the symptoms, these constrictions are treated with optimal drug therapy, surgery or with a balloon and stent.
Each of the methods has its areas of application, which are determined by certain criteria, and the best therapy is selected and applied individually for each patient.

Difficult-to-adjust high blood pressure
Difficult-to-adjust high blood pressure can be caused by a narrowing of the kidney vessels, hormonal disorders or changes in the unconscious nervous system. We specialise in the diagnosis and treatment of difficult-to-control high blood pressure. To this end, we use all current and state-of-the-art procedures for diagnosis and treatment. Customised drug therapy is the basis of treatment. If the cause of the high blood pressure is a narrowing of one or both renal arteries, this can be treated by balloon dilatation and stent implantation.

Constrictions on dialysis shunts
In the vast majority of cases, chronic haemodialysis in people with kidney disease is carried out via so-called dialysis shunts. A shunt is a short-circuit connection between an artery and a vein that is surgically created in the lower or upper arm. If constrictions in the shunt vessels cause problems during dialysis, the constrictions must be removed. For this purpose, conventional balloons and special balloons (cutting balloons) are used for balloon dilatation, as well as drug-coated balloons in individual cases.

Vascular inflammation
Inflammation of the blood vessels can occur as an independent disease or as a concomitant symptom, particularly in rheumatic diseases.
We have a great deal of experience in clinical assessment and in capillary microscopy, which allows us to directly assess the smallest vessels and blood flow. We work closely with neighbouring specialist areas such as rheumatology and dermatology.

Catheter treatment of venous thromboses
Thromboses are usually treated conservatively, i.e. by wearing compression stockings and with immediate blood thinning after diagnosis. However, some patients may experience pronounced symptoms due to acute or chronic occlusions, particularly in the pelvic veins. Despite this conservative treatment, there may be a gradual increase in symptoms with, for example, a feeling of heaviness in the legs, swelling or the development of non-healing wounds. These symptoms are known as post-thrombotic syndrome and occur most frequently in cases of pelvic vein thrombosis.
In selected cases, such occlusions of the pelvic veins can be effectively treated in the acute situation within 3 weeks or even later in the case of chronic complaints using balloons and the insertion of vascular supports, and in many cases relief can be provided. Thanks to the development of the latest techniques, we are now able to reopen acute venous thrombotic occlusions and remove the thrombus or to open chronic occlusions by means of balloon dilatation and support them with stents.

Procedures that are used for this in the acute situation are

• Thrombectomy (mechanical, e.g. using Angiojet, Aspirex)
• Pharmacomechanical thrombolysis (EKOS catheter)
• Implantation of specific venous stents

Which treatment is the most suitable and is applied remains in each case an individual decision after detailed prior examination and counselling of each patient.