Open Endarterectomy or Angioplasty for treatment of Diabetic Foot in Germany
Treatment prices are regulated by national law of the corresponding countries, but can also include additional hospital coefficients. In order to receive the individual cost calculation, please send us the request and medical records.
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.
University Hospital of Ludwig Maximilian University of Munich
Department of Vascular Surgery
The Department of Vascular Surgery offers the full range of diagnostic services and surgical interventions for patients with diseases of the arteries, veins, and lymphatic vessels. The department's doctors have excellent skills and deep knowledge in the field of vascular surgery, ranging from complex interventions on the aorta to advanced endovascular methods for treating varicose veins using ultrasound. In close cooperation with the specialists from the Center for Vascular Diseases, the department's doctors provide an individual and interdisciplinary therapy for patients with severe vascular and concomitant diseases. The department has prestigious quality certificates from the German Society of Vascular Surgery (DGG) and a certificate from the Institute for Quality and Patient Safety (BQS). The health of patients is in the safe hands of highly qualified specialists, for whom it is important that a patient receives the most sparing and effective treatment in a pleasant atmosphere.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
More than 400 million people in the world suffer from diabetes mellitus. Chronically elevated blood sugar levels lead to the fact that vasoconstriction progresses against the background of the disease. As a result, the blood supply to the lower extremities deteriorates.
However, blood flow can be restored. The narrowed arteries are dilated with angioplasty, which is a minimally invasive procedure performed from inside the arteries. Open surgery is less commonly used in Germany to restore the blood supply to the lower extremity.
Content
- Vascular foot lesions in diabetes
- What is the danger of impaired blood supply in the lower extremities
- Endovascular surgery
- Open endarterectomy
- Additional treatment after lower limb revascularization
- Why it is worth undergoing treatment of diabetic foot in Germany
- Treatment in Germany with Booking Health
Vascular foot lesions in diabetes
The disease affects not only the blood vessels in the legs, but also in the whole body. High blood glucose levels lead to rapid progression of atherosclerosis: the disease develops on average 5 times faster than in patients without diabetes mellitus.
There are three key mechanisms of tissue destruction in diabetic foot. These include:
- Ischemia (insufficient blood supply).
- Neuropathy (nerve damage).
- Infection.
The best treatable form of the disease is associated with impaired blood supply. If the vessels are narrowed, they can be dilated. The larger the blocked arteries, and the higher they are located, the better the prognosis of the disease.
In fact, patients with diabetes mellitus and a vascular form of diabetic foot suffer from atherosclerosis of the lower extremities. Against the background of hyperglycemia, the pathology develops 15 years earlier and its course is more severe. This form of disease is characterised by lesions of small and medium-sized arteries. In most patients, several arteries on both legs are involved in the process.
What is the danger of impaired blood supply in the lower extremities
Angiopathy (vascular lesion) is the main cause of complications and death in diabetics. In 100% of patients, small vessels are affected by the disease, while about 70% of patients have problems with large vessels, including the lower extremities.
Blockages in the arteries of the legs cause ischemia (insufficient blood supply). If it is critical, the patient needs surgical treatment of the disease as soon as possible. In this case, conservative therapy is ineffective. If only conservative therapy of the disease is used, the risk of death within the next 6 months reaches 20%, the risk of lower limb amputation within the same period reaches 60%, and with longer follow-up monitoring – 95%.
Nonetheless, modern medicine has a solution to this problem for patients with diabetes. Doctors in Germany perform surgical procedures on the large vessels in order to restore blood supply to the lower extremity. As a result of such interventions, the lumen of the arteries dilates, more blood enters the tissues, the metabolism in them is restored, so amputation can be avoided.
With all the advances in medicine, patients with diabetes receive appropriate treatment mainly in developed countries. In countries with poorly developed medicine, in 25% of cases, the doctor immediately decides to amputate a limb, and in another 25% of cases, a patient with critical limb ischemia receives only conservative therapy for the disease. In fact, this means that the amputation will still be performed, but only after a few months. Only in 50% of cases doctors perform vascular surgery to preserve the lower extremity. Moreover, only 10% of patients undergo minimally invasive interventions.
The situation is much better in developed countries. Almost all cases of critical ischemia are subject to revascularization, so amputations are becoming more and more rare. Most arterial interventions are performed using endovascular invasive techniques (from inside the vessels).
Endovascular surgery
In Germany, as in other countries with developed medicine, endovascular surgery is used in 80% of cases for the treatment of ischemic diabetic foot (a form of the disease with impaired circulation). Doctors have to resort to open surgery through large incisions only in 20% of patients. These are mostly bypass surgeries – the formation of a blood flow path bypassing the narrowed area.
Percutaneous transluminal balloon angioplasty is the first choice for diabetic foot since 2007. This procedure is minimally traumatic, safe for health, and does not require general anesthesia.
The essence of the technique is as follows: a balloon is inserted into the arterial bed of the lower extremity through an incision in the groin. It is delivered to the area of obstruction, and then expanded by injecting saline inside. The balloon expands and stretches the artery from the inside. Its lumen increases, more blood now flows through the artery, and normal blood supply to the foot is restored.
Doctors use one of two approaches to recanalize (restore) the lumen of the artery:
- Transluminal (intraluminal) recanalization involves the insertion of a catheter into the residual lumen of the vessel.
- Subintimal recanalization is used much less often (mainly in the femoral-knee segment), the catheter is inserted between the vessel wall and the adjacent atherosclerotic plaque, thus forming a new lumen of the artery.
Surgical procedures can be performed on different vessels: iliac, femoral, popliteal segment or lower leg arteries. Some patients undergo stent implantation after balloon angioplasty. A metal frame is placed in the area of the narrowing, which keeps the lumen open.
Open endarterectomy
Open endarterectomy is a surgery performed through a large incision in the leg. Doctors remove atherosclerotic plaques from a blood vessel to enlarge its lumen.
Since open endarterectomy is more traumatic, it is rarely used in countries with advanced medicine. The main indication is diffuse atherosclerotic lesion of the lower leg vessels with plastic surgery of the deep femoral artery. Endarterectomy is also carried out when other arteries are affected, if severe calcification is detected (atherosclerotic plaques hardened due to deposition of calcium salts).
Additional treatment after lower limb revascularization
Once the treatment of the disease with angioplasty or endarterectomy is completed, blood supply to the foot is restored in more than 90% of patients. A good result of a minimally invasive procedure is a reduction in the degree of narrowing to less than 20% of the lumen.
Surgery on the arteries is only the first step in the fight against the disease. In the future, the patient requires surgical treatment to remove the dead tissues of the foot, and in case of infectious complications, an autopsy and sanitation of purulent foci is performed. However, these operations after angioplasty are much more successful, because the tissues now receive blood supply, immunity is enhanced and regenerative processes are normalized.
Despite the improvement in blood flow, surgery does not solve the problem of foot disease once and for all. In 20% of patients, there is a recurrent occlusion or stenosis of the vessels or areas of narrowing appear in other parts of the arteries within a year, so the intervention has to be repeated. The risk of lower limb amputation within 12 months is about 10%. This is an excellent result, considering that without revascularization, amputation is performed in almost all patients, and the mortality rate of such patients during the first year after surgery reaches 50%.
Thus, procedures and operations to improve blood flow can save the lower extremity in most patients, save life, and create good conditions for further treatment. However, conservative therapy aimed at normalizing carbohydrate metabolism still plays an important role in controlling the disease. In the case of non-drug procedures, there is a need for additional surgical interventions from time to time.
Why it is worth undergoing treatment of diabetic foot in Germany
Germany is a country with a high level of medicine. Here you can count on the top-class medical care. The treatment of the disease in this country is always comprehensive. Endovascular procedures and vascular surgery are considered only a single step in the treatment of diabetes mellitus.
Why is it worth undergoing treatment in Germany:
- High-precision diagnostics allows detecting areas of narrowing in the arteries in order to ideally plan treatment.
- About 80% of all interventions are performed using safe minimally invasive angioplasty instead of traumatic open surgery.
- Endovascular surgical procedures can be performed even in small-caliber vascular lesions.
- High efficiency of operations even in damage to the distal (located closer to the foot) arteries.
- With a high risk of recurrent narrowing of the artery, angioplasty is complemented with stent implantation – a stage of the operation that involves the placement of a frame inside the vessel.
- Hybrid surgical interventions: open intervention on some vessels, and minimally invasive dilation of other vessels.
- Comprehensive approach to the treatment of the disease.
Treatment in Germany with Booking Health
To undergo treatment of diabetic foot in one of the German hospitals, you can use the services of the Booking Health company. On our website, you can see the cost of treatment in Germany and compare prices in different hospitals in order to book a medical care program at a favorable price. Treatment in a German hospital 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 all the necessary information about treatment in Germany. Booking Health will fully organize your trip abroad. We provide the following benefits:
- We will choose the best hospital for the treatment of diabetic foot in Germany, whose doctors specialize in this disease and achieve the best results.
- We will help you overcome the language barrier and establish communication with the attending physician.
- We will reduce the waiting time for the medical care program. You will undergo treatment on the most suitable dates for you.
- We will reduce the prices. The cost of treatment in German hospitals will be lower due to the lack of overpricing and additional coefficients for foreign patients.
- We will take care of all organizational issues, including paperwork, transfer to a hospital or a hotel and back.
- We will prepare a program and translate medical records. You do not have to repeat the previously performed diagnostic procedures.
- We will keep in touch with the hospital after treatment in Germany.
- We will organize additional diagnostic examinations and treatment in German hospitals, if required.
- We will buy medicines in Germany 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 you reduce the cost of treatment in Germany, organize your trip, and you will only have to focus on restoring your health.
Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed