Vascular Surgery

Policlinico San Donato

key figures 

CLINICAL SERVICES:

  • Surgery for the ascending aorta and arch diseases, thoracic and thoracoabdominal aortic aneurysm and diseases
  • Surgery for abdominal aortic aneurysm and diseases
  • Surgery for supra-aortic, visceral, renal, and peripheral vessel diseases
  • Surgery of diabetic foot

PROCEDURES PERFORMED PER YEAR:

  • 1.000 vascular interventions

The Unit performs more than 1.000 surgical procedures anually, dealing with patients affected by a broad spectrum of vascular diseases. The Unit’s clinical activity focuses on the treatment of aortic aneurysmal disease, cerebrovascular occlusive disease, peripheral artery disease (PAD) via both, open and endovascular methods, the provision of dialysis access, and minimally invasive treatments for venous disease.

The open aneurysm repair used to be the standard surgical treatment of aortal aneurysms but San Donato’s surgeons nowadays are able to treat many abdominal, thoracic and thoracoabdominal (occurring in the lower part of the thoracic aorta and the upper part of the abdominal aorta) aneurysms with a minimally invasive procedure called an endovascular stent graft. Professor Giovanni Nano is considered a pioneer in vascular treatments, his Unit is among the first centers in Italy to undertake an endovascular treatment program in 1995, starting with the Professor’s fellowship in the Division of Vascular Surgery at the Cardiovascular Institute of Buenos Aires (headed by Dr. J.C. Parodi), and in the Department of Surgery at the Sydney University (Head Dr. G. H. White) and the Arizona Heart Institute (Dr. Dietrich).

 

treatmentS

Open, Endovascular or Hybrid Surgery of Ascending Aorta, Arch, Thoracic, Thoracoabdominal and Abdominal Diseases

A thoracic aortic aneurysm, an abnormal bulge in a weakened wall of the aorta in the chest or abdominal area, can cause a variety of symptoms and often life-threatening complications. Due to the serious risks it presents, timely diagnosis and treatment of the thoracic aneurysm are critical. Aortic pathologies have been treated at Policlinico San Donato with standard open surgical treatment since the '80s. Nevertheless, in order to minimize post-operative complications, the Unit has developed less invasive vascular therapies through endovascular and hybrid techniques. In 2016 Professor Nano performed a total endovascular repair of an aortic arch aneurysm with Nexus endovascular graft for the first time in Italy.  

The Unit has since performed more than 1.000 EVAR/TEVAR procedures and 5.000 open aortic surgical operations; it deals with all types of aortic disorders, providing patients with a possibility of undergoing new catheter-based interventions alongside with the traditional surgical treatments.  
   
Main Pathologies Treated:

  • Ascending aortic aneurysm
  • Aortic arch aneurysm
  • Thoracic aortic aneurysm
  • Thoracoabdominal aneurysm
  • Abdominal aortic aneurysm
  • Penetrating aortic ulcer of the entire aorta (PAU)
  • Acute aortic dissection and chronic post-dissecting aortic aneurysm
  • Intramural Hematoma (IMH)

Peripheral Artery Disease (PAD)

Peripheral artery disease (PAD) causes intermittent claudication (i.e. difficulty in walking because of the limb pain) and, in advanced stages, determines critical limb ischemia with foot ulcers.

The Unit has performed more than 1.500 endovascular procedures and 2.000 surgical revascularizations for PAD, diabetic foot and limb salvage. Visceral/renal diseases and limb artery aneurysms are treated at the Unit with endovascular techniques such as the stent graft insertion, hybrid debranching, or open surgical approach.

Carotid Endarterectomy (CEA)

Carotid endarterectomy (CEA) is a procedure routinely performed in patients who have had a transient ischemic attack (TIA) or a mild stroke due to significant carotid artery disease. For these patients, carotid endarterectomy can be highly beneficial in preventing future strokes. The Unit started its endovascular program on carotid disease in 1992. Since then more than 5.000 patients underwent the CEA and more than 1.000 patients were treated with carotid artery stenting (CAS).

Superficial Vein Surgery

Surgery for superficial venous disease is done for two main reasons. The first is to treat varicose veins. In conjunction with the removal of varicose veins, ligation and stripping of veins are often performed to prevent recurrence of the varicose veins. This is typically done if there is an evidence of valvular incompetence within the main veins that gives rise to the varicose veins.

Ligation and stripping are also done when blood pooling occurs secondary to venous incompetence, and patients suffer from symptoms of venous insufficiency. These symptoms include leg swelling, skin changes, pain and, in severe cases, ulceration. The removal of the malfunctioning vein helps to control symptoms, and in cases of ulceration it helps the ulcers to heal.

Surgical removal or stripping of the vein is rarely needed but may be recommended in some situations to treat superficial venous thrombosis or phlebitis. Endovenous thermal ablation, performed with an endovessel catheter, is a newer technique that uses a laser or high-frequency radio waves to create intense local heat in the varicose vein or the incompetent vein. Heat is directed through a catheter to close up the targeted vessel. This treatment closes off the problematic veins but leaves them in place, so there is minimal bleeding and bruising.

Compared to ligation and stripping, many patients find that endovenous thermal ablation results in less pain and a faster return to normal activities, with similar cosmetic results. The Unit started an advanced endovenous program in 2013, and more than 10.000 interventions have been performed both with surgical or endovenous technique since 1980'.

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • Last Generation of Eco Duplex Scan
  • 3D angiographer