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Open Endarterectomy or Angioplasty for treatment of Diabetic Foot in European hospitals

St. Franziskus-Hospital Muenster

10/10
location_onGermany, Muenster

Innovation Center for Endovascular Medicine

The Innovation Center for Endovascular Medicine offers the full range of highly effective treatment for any diseases of the arteries and veins. Of particular interest is the endovascular treatment of aortic aneurysm, carotid stenosis, occlusive peripheral arterial disease and varicose veins. The center is equipped with two high-tech hybrid operating rooms for endovascular treatment of vascular diseases, as well as one operating room for classical open vascular interventions. The treatment can be provided both on an inpatient and outpatient basis. The highly qualified doctors of the center treat more than 3,000 patients every year, and therefore they can boast of extensive clinical experience and excellent treatment success rates. The specialists of the medical center prefer a complex and interdisciplinary approach to treatment, therefore, in appropriate clinical cases, radiologists, oncologists, cardiologists, cardiac surgeons, nephrologists and diabetologists are involved in the therapeutic process. In addition, each patient receives an individual treatment regimen corresponding to his needs and particular clinical indications. Such an approach guarantees high-quality results even in particularly complex clinical cases.

Include:
people Interpreter up to 15 hours
list Translation up to 10 pages
card_membership Visa support
book Insurance against increased costs in case of complications with a cover of 200,000 €

University Hospital of Ludwig Maximilian University of Munich

10/10
location_onGermany, Munich

Department of Vascular Surgery

The Department of Vascular Surgery offers the full range of diagnostics and treatment of vascular diseases. The doctors of the department have excellent skills and deep knowledge in vascular surgery, ranging from complex interventions on the aorta and ending with modern (minimally invasive) techniques for the treatment of varicose veins using ultrasound. Also, in close collaboration with the specialists of the Center for Vascular Diseases, individual interdisciplinary therapy is provided for the patients with complex vascular and concomitant diseases.

Charite University Hospital Berlin

9/10
location_onGermany, Berlin

Department of General, Abdominal and Vascular Surgery

According to the Focus magazine, the Department of General, Abdominal and Vascular Surgery ranks among the top German medical facilities specializing in the treatment of bowel and lung cancer! The department offers all the modern surgical options for the treatment of diseases of the abdominal cavity and blood vessels. The department's doctors have expert knowledge and vast experience in the treatment of colorectal cancer, stomach, esophageal, pancreatic cancers, liver metastases, inflammatory bowel diseases (diverticular disease, Crohn's disease, ulcerative colitis). Also, they specialize in the surgical treatment of vascular pathologies and thyroid diseases.

University Hospital Carl Gustav Carus Dresden

9.1/10
location_onGermany, Dresden

Department of Abdominal and Colorectal Surgery, Hepatobiliary Surgery, Hernia Surgery, Bariatric Surgery, Endocrine Surgery, Thoracic and Vascular Surgery

The Department of Abdominal and Colorectal Surgery, Hepatobiliary Surgery, Hernia Surgery, Bariatric Surgery, Endocrine Surgery, Thoracic and Vascular Surgery offers the full range of services in these medical fields. It provides surgical treatment of diseases of the gastrointestinal tract, thyroid and parathyroid glands, thoracic organs, vascular system, rectum, anus and colon. In addition, the department performs bariatric interventions for the treatment of morbid obesity. A special focus is made on the treatment of gastrointestinal cancer. Minimally invasive surgical techniques are always preferred, if clinically indicated. The team of the department's surgeons has 8 progressive operating rooms equipped with everything necessary for successful treatment. The department also has the da Vinci Xi surgical system for high-precision minimally invasive robot-assisted interventions. The patient's health is in the safe hands of the best German surgeons who have gone through a rigorous selection and have vast clinical experience.

University Hospital Frankfurt am Main

10/10
location_onGermany, Frankfurt am Main

Department of Vascular and Endovascular Surgery

The Department of Vascular and Endovascular Surgery offers the full range of services in these medical fields. The department positions itself as a supraregional medical facility specializing in the planned and emergency treatment of all diseases of the vascular system (with the exception of the pathology of the coronary arteries and vessels located near the heart). The therapeutic options cover both open surgery and advanced interventional catheter techniques (alone or in combination with classical surgery). Modern conservative treatments are also available here.

University Hospital Jena

8.9/10
location_onGermany, Jena

Department of General, Abdominal and Vascular Surgery

According to the Focus magazine, the Department of General, Abdominal and Vascular Surgery ranks among the top German medical facilities specializing in the treatment of bowel cancer! The department offers the full range of surgical treatment of diseases of the abdominal organs and blood vessels, including the transplantation of abdominal organs. The sparing minimally invasive surgical techniques are widely used in the clinical practice, which allow to provide treatment in simple and complex clinical cases by making small incisions and using special tiny surgical instruments. The exceptional experience and profound knowledge of the department's doctors are also an integral part of the high treatment success rates.

University Hospital Halle (Saale)

9.6/10
location_onGermany, Halle

Department of General, Abdominal, Vascular and Endocrine Surgery

The Department of General, Abdominal, Vascular and Endocrine Surgery offers the full range of medical services in these fields. The department specializes in the surgical treatment of gastrointestinal cancers (surgical treatment of pancreatic, liver, stomach, esophageal and colon malignancies), hernia repair, treatment of gastrointestinal inflammatory diseases, endocrine surgery and surgical correction of vascular diseases and defects. The treatment of patients is carried out in close cooperation with the experts from related fields, particularly, with oncologists, gastroenterologists, radiologists, angiologists, etc.

University Hospital Erlangen

9.1/10
location_onGermany, Erlangen

Department of Vascular Surgery

The Department of Vascular Surgery offers the full range of diagnostics and surgical treatment of vascular diseases. The department specializes in the surgical treatment of carotid artery stenosis, open and endovascular treatment of abdominal aortic aneurysm, as well as in the treatment of occlusive peripheral arterial disease. In addition, the department deals with the treatment of patients with venous diseases and diabetic foot syndrome. The priority areas of work of vascular surgeons also include the correction of both common and rare types of vascular malformations. The department's specialists cooperate closely with interventional radiologists and angiologists, so patients can count on an interdisciplinary approach to treatment. Surgical treatment is carried out in progressive operating rooms with state-of-the-art surgical equipment and computer-assisted systems for vital signs monitoring. The department successfully uses sparing endovascular techniques to avoid severe postoperative complications and minimize postoperative pain. The optimal type of surgical treatment is prescribed to the patient based on his specific clinical indications, stage of vascular disease, general health condition, age and other decisive factors. Whenever possible, preference is given to minimally invasive surgery.

University Hospital Würzburg

9.2/10
location_onGermany, Würzburg

Department of Adult and Pediatric Cardiothoracic Surgery

According to the Focus magazine, the Department of Adult and Pediatric Cardiothoracic Surgery is included in the ranking of the top departments in Germany specializing in the surgical treatment of diseases of the cardiovascular system! The department offers the surgical treatment of all congenital and acquired heart diseases in adulthood, including heart transplantation, as well as the treatment of respiratory diseases in adults and children. It performs more than 2,000 interventions on the heart and about 600 operations on the lungs every year.

University Hospital Heidelberg

9.8/10
location_onGermany, Heidelberg

Department of Vascular and Endovascular Surgery

The Department of Vascular and Endovascular Surgery offers the full range of accurate diagnostics and effective treatment of diseases of the arteries and veins. The department specializes in all modern vascular interventions, in particular, open, interventional (catheter) procedures, hybrid surgeries, as well as innovative vascular prosthetic techniques. All this makes the department one of the most advanced medical institutions in Germany with a university level of service.

University Hospital Bonn

9.2/10
location_onGermany, Bonn

Department of General, Abdominal, Thoracic and Vascular Surgery

The Department of General, Abdominal, Thoracic and Vascular Surgery offers the full range of diagnostic and treatment services in these fields. The special competence of the department’s specialists lies in the field of surgical treatment of malignant diseases of the esophagus, stomach, intestines, liver, pancreas, lungs, thyroid, adrenal glands and tumor metastases in tissues and organs. The service spectrum is complemented by transplant surgery, namely liver and pancreas transplantations. Key role is played by interdisciplinary collaboration.

University Hospital Rechts der Isar Munich

9.8/10
location_onGermany, Munich

Department of Adult and Pediatric Vascular, Endovascular Surgery

The Department of Adult and Pediatric Vascular, Endovascular Surgery offers the full range of classical and endovascular surgical interventions on the blood vessels. The department specializes in the treatment of patients with acute and chronic diseases of the arteries and veins, circulation disorders in the extremities, pathological changes in the carotid arteries, venous diseases and other pathologies. The patients' health is in the safe hands of a competent team of doctors and nursing staff. Surgeries and interventional procedures on the blood vessels are performed in well-equipped operating rooms that meet current hygiene and safety requirements. The department has 38 beds. The department's medical team annually admits more than 1,400 inpatients and about 7,000 outpatients. The department has been carrying out successful clinical activities for over 25 years and during this time has gained a reputation of one of the best medical facilities of this kind in Germany.

University Hospital Duesseldorf

9.5/10
location_onGermany, Duesseldorf

Department of Vascular and Endovascular Surgery

The Department of Vascular and Endovascular Surgery offers the full range of services in these medical fields. The department specializes in kidney transplantation, minimally invasive and classical vascular interventions. The priority task of the department's doctors is the treatment of carotid stenosis, aortic aneurysm, circulatory disorders in the pelvic and leg vessels, the formation of arteriovenous shunts in dialysis patients and the treatment of varicose veins. The department offers all modern surgical techniques, as well as conducts active research activities for the development of innovative surgical treatment methods.

University Hospital Muenster

9.8/10
location_onGermany, Muenster

Department of Vascular and Endovascular Surgery

The Department of Vascular and Endovascular Surgery offers the full range of services in these fields and is one of the largest medical institutions of this kind in Europe. A distinguishing feature of the department is the unique competence in the treatment of especially severe and rare vascular diseases. The department has a modern outpatient operating room, as well as a hybrid operating room, in which the patients are provided with the most effective and sparing treatment, if possible. Depending on the complexity of the surgery, the surgical treatment is carried out either on an inpatient or outpatient basis.

University Hospital Essen

9.6/10
location_onGermany, Essen

Department of Adult and Pediatric Vascular, Endovascular Surgery

The Department of Adult and Pediatric Vascular, Endovascular Surgery offers the full range of surgical treatment of arterial and venous diseases, including vascular anomalies. The specialization includes the treatment of diseases of the aorta, carotid artery, circulatory disorders in the lower extremities, as well as venous surgery, the formation of dialysis access in adults and children, specialized treatment of chronic wounds. The department's doctors have in their arsenal the modern and effective treatment methods, which allow to achieve positive results even in particularly difficult clinical cases.

University Hospital Giessen UKGM

9.5/10
location_onGermany, Giessen

Department of Adult and Pediatric Cardiac Surgery, Vascular Surgery

According to the Focus magazine, the Department of Adult and Pediatric Cardiac Surgery, Vascular Surgery ranks among the top German medical facilities in its areas of ​​specialization! The department offers the full range of surgical interventions for the treatment of diseases of the cardiovascular system in patients of all age groups. The department specializes in coronary artery surgery, heart valve diseases, heart arrhythmias, vascular surgery and aortic surgery. The therapeutic options are complemented by heart transplantation. The experienced cardiac surgeons of the departments perform more than 2,000 operations annually.

In 25% of cases, patients with diabetes suffer from diabetic foot. This is the most common cause of leg amputation. To prevent the loss of a lower extremity, a patient should receive timely treatment, since the progression of the disease causes not only the development of ulcers on the skin, but also the destruction of deep tissues, the development of osteomyelitis, and ankle joint destruction. Doctors in the countries with advanced medicine perform modern minimally invasive and open interventions aimed at restoring the blood supply to the foot.

Content

  1. Revascularization for diabetic foot
  2. Open endarterectomy
  3. Endovascular interventions
  4. Treatment after revascularization
  5. Why is it better to undergo treatment abroad
  6. Treatment in Europe with Booking Health

Revascularization for diabetic foot

 

Patients with diabetic foot undergo surgery for the revascularization (blood supply restoration) of the lower extremity.

Most cases of the disease are associated with macroangiopathy, which implies damage to the arteries. Their lumen is closed by atherosclerotic plaques, in which calcium salts can then be deposited and blood clots are often formed. This results in the development of ischemia (oxygen starvation) of the tissues of the lower extremity that can progress to critical limb ischemia. After the development of critical limb ischemia, revascularization is required as soon as possible. Without the help of vascular surgeons, the risk of death within 6 months is 20%, and the risk of lower limb amputation reaches 60%.

In countries with advanced medicine, doctors try to provide timely treatment, even before the development of critical limb ischemia. They carry out a Doppler ultrasound scan and angiography to find out which arteries have impaired blood flow. The corresponding vessels are then dilated using open surgery or minimally invasive procedures.

Here are the arteries that can be operated on: 

  • External iliac artery. 
  • Superficial and deep femoral arteries. 
  • Popliteal artery.
  • Anterior and posterior tibial arteries.
  • Fibular artery. 
  • Lower leg arteries.

After a surgical procedure for the restoration of vascular patency, the blood supply to the tissues improves, and their oxygen saturation increases. Necrotic processes stop. Doctors perform radical surgical debridement of the diabetic foot only after revascularization. They remove dead tissue and close defects with local tissues or using skin grafts.

Open endarterectomy

 

In the twentieth century, open surgery for diabetic foot was considered the main one. Today, they are still often performed in countries with poorly developed medicine, but in developed countries open interventions are used less and less.

The main open surgical interventions for the treatment of diabetic foot are as follows:  

  • Endarterectomy and dilation of the artery – removal of atherosclerotic plaques, the blood vessel defect is closed with a patch.
  • Bypass surgery – formation of a new blood flow path bypassing the narrowed artery. 

Instead of open endarterectomy, doctors increasingly prefer minimally invasive interventions for diabetic foot. Nonetheless, standard surgical operations sometimes have to be performed as well. They are usually required in case of significant calcification of plaques or a large extent of the artery stenosis zone. Sometimes doctors use both approaches in the same patient during the same intervention: endovascular and surgical treatment. Such surgical procedures are called hybrid ones.

Endovascular interventions

 

Initially, angioplasty was considered only as a procedure to save a limb in the most severe cases: when the patients with diabetes cannot undergo open surgery due to a high surgical risk or in the absence of a distal bed (vessels located closer to the foot), which can receive a shunt (an additional vessel, carrying blood bypassing the narrowed section of the artery).

However, with the accumulation of experience in performing angioplasty and obtaining research results, this procedure gradually replaced open surgical techniques. As it turned out, it gives comparable results with open surgery. Since 2007, European guidelines have indicated it as the main method of treatment for neuroischemic and ischemic (associated with impaired blood supply) forms of diabetic foot. Today, doctors in developed countries perform 80% of all interventions using a minimally invasive technique, and only in 20% of cases they have to do an open surgical intervention.

Options for endovascular surgery for diabetic foot include: 

  • Balloon angioplasty – dilation of a narrowed blood vessel with an inflating balloon. 
  • Stenting – implantation of a metal frame that prevents the blood vessel from repeated narrowing. 

Both types of surgical interventions can be performed on the same patient with diabetes: the blood vessel is dilated, and then a stent is placed inside.

The surgery is performed under local anesthesia. The doctor inserts a catheter into the arterial bed through a small incision in the groin. It delivers a balloon to the narrowed area, and a saline solution with a contrast agent is injected into it. The blood vessel expands and blood flow through it is restored. Whenever required, a stent can be placed in the narrowed area to reduce the risk of recurrence of the stenosis. The procedure is X-ray guided. An excellent result is considered if, after endovascular intervention, the patency of the blood vessel is restored by 80% or more.

Benefits of minimally invasive treatment: 

  • Minimal trauma – just a single small incision in the groin.
  • Short hospitalization period.
  • No need for rehabilitation.
  • Low risk of complications – the surgical intervention is safe for health.
  • No need for general anesthesia.
  • Possibility of successful lower limb revascularization even in patients with high surgical risk, with poor health, for whom conventional surgery is contraindicated. 

Both immediate and long-term outcomes after open and endovascular interventions are the same. Therefore, in countries with developed medicine, minimally invasive, safe for health treatment is always a priority.

Treatment after revascularization

 

Blood circulation in the extremities improves immediately after revascularization. Nonetheless, patients with diabetic foot still require additional treatment.

Vascular surgery is usually performed when the patient's foot already has ulcers, and sometimes deep tissues are destroyed, an infection has joined. Revascularization is quite often performed even against the background of phlegmon or gangrene, but even the most severe infectious complications can usually be eliminated after the blood supply is restored.

Patients undergo necrectomy, which is a procedure for the excision of dead tissue. Doctors open and drain purulent foci. Within a few weeks, the wounds heal. The defects are then closed with skin grafting.

Revascularization gives not only good immediate, but also long-term outcomes. Even if the surgery was performed against the background of critical limb ischemia, the risk of amputation within 12 months does not exceed 10%. However, in the future, the disease may progress again, and some patients suffer from a repeated blockage of the arteries with a deterioration in blood flow. Therefore, patients with diabetes receive constant conservative therapy: antiplatelet agents, statins, hypoglycemic drugs, insulin, antihypertensive therapy.

Why is it better to undergo treatment abroad

 

In developed countries, better treatment results can be obtained with low health risks. Healthcare professionals abroad use the latest technologies. The treatment is provided in accordance with international protocols.

In countries with poorly developed medicine, even with critical limb ischemia, revascularization is performed only in 50% of patients.Moreover, in 90% of cases, these are open surgical interventions. Most patients are treated in general surgical hospitals.

Europe offers specialized clinics for diabetic foot. All patients with ischemic and neuroischemic forms of the disease undergo revascularization. Doctors do not wait for the occurrence of critical limb ischemia, but perform the operation in a timely manner, prior to the development of severe complications.

Several reasons for you to entrust your health to foreign specialists: 

  • You will receive medical care in specialized clinics for diabetic foot. 
  • In 80% of cases, revascularization is performed using a minimally invasive method that is safe for health, with angioplasty.
  • Even if open surgery is required, its invasiveness will be lower due to the use of hybrid interventions: they involve simultaneous open surgery and endovascular procedures on different arteries. 
  • Vast experience in performing angioplasty and vascular stenting, since in Europe these interventions are considered the main methods of diabetic foot treatment.
  • High efficiency of surgical procedures –  more than 90% of patients fully restore blood circulation in the lower extremity after angioplasty or open endarterectomy.
  • Comprehensive approach: you will also receive conservative therapy, if necessary, surgical debridement of the foot, skin grafting.

Treatment in Europe with Booking Health

 

To undergo diabetic foot treatment in one of the European hospitals, you can use the services of the Booking Health company. On our website, you can see the cost of treatment and compare prices in different hospitals in order to book a medical care program at a favorable price. Treatment in European hospitals will be easier and faster for you, and the cost of treatment will be lower.

You are welcome to leave your request on the Booking Health website. Our specialist will contact you and provide a free consultation on treatment in Europe. Booking Health will fully organize your trip abroad. We provide the following benefits for you:

  • We will select the best medical hospital for treatment in Europe, whose doctors specialize in diabetic foot treatment and achieve the best results.
  • We will solve the problem of the language barrier, establish communication with the doctor of the European hospital.
  • We will reduce the waiting time for the medical care program. You will receive diabetes treatment on the most suitable dates for you.
  • We will reduce the price. The cost of treatment in Europe will be lower due to the lack of overpricing and additional coefficients for foreign patients.
  • We will take care of all organizational issues: we will prepare documents, meet you abroad and take you to the hospital, book a hotel, and provide interpreting services.
  • We will prepare a program and translate medical documents. You will not need to repeat the previously performed diagnostic procedures.
  • We will keep in touch with the hospital after the completion of treatment in Europe.
  • We will organize additional diagnostic examinations and treatment of diabetes in European hospitals, if required.
  • We will buy medicines abroad and forward them to your native country. 

Your health will be in the safe hands of the world's leading doctors. The Booking Health specialists will help reduce the cost of treatment, organize your trip to a European hospital, and you can fully focus on restoring your health.

Authors: Dr. Nadezhda IvanisovaDr. Farrukh Ahmed




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