The basis of every diagnosis is a comprehensive anamnesis/case history and a physical examination. In a consultation, the patient initially describes their symptoms, then the doctor examines the patient for visible skin changes, for example, and for abnormal pulses and peculiar blood flow noises, etc.
Further examinations in the event of venous diseases include, for instance, colour-coded duplex sonography, the venous occlusion plethysmography, the light-reflection rheography and venous pressure measurement.
Further examinations in the case of arterial circulatory problems include, for instance, Doppler scan, treadmill ergometry, oscillography and capillary microscopy.
Provocation tests (treadmill ergometry) and, if necessary, compartment pressure measurements are also performed on exercise-related leg pain in patients that are engaged in sporting activities. We investigate innate vascular diseases and malformations by performing a contrast agent ultrasound. In the case of specific queries to complement the aforementioned examinations and before performing more complex catheter interventions, we perform radiological examinations, such as an MR angiography, a CT angiography or a digital subtraction angiography.
The care of patients with atherosclerosis also requires the recording and the treatment of the basic risk factors, such as an increased cholesterol level, high blood pressure, diabetes mellitus or nicotine consumption. Any necessary laboratory tests are performed in the surgery itself.
Special tests are performed for all venous diseases and arterial circulatory problems whenever further information is needed in order to make a diagnosis.
With the aid of a blood pressure cuff and a Doppler ultrasonic probe, the blood pressure of the ankle arteries is measured, thereby determining the extent of the drop in blood pressure in the leg compared to that in the arm. If the blood pressure in the ankle is lower than that in the arm, a circulatory disorder is present.
By means of sensors attached to the fingers or toes, the circulation of the micro-circulation and/or the arterial blood influx is measured as a bilateral comparison.
A measuring process for assessing the blood transport of the veins. Diseases such as vein valve damage or varicose veins can be determined.
With the aid of sensors on the leg, the elasticity of the leg’s veins, the blood volume and the backflow of the venous blood to the heart are measured. If they are impaired due to thrombosis, a dysfunction of the vein valves or a dysfunction of the drainage via the stomach veins, this is picked up on.
Treadmill ergometry testing simulates walking and enables the doctor, under standardised conditions (normally a walking speed of 3.2 km/h and a 10% slope) to identify complaints in the legs that occur when walking.
If further provides us with information about the distance walked before the discomfort begins and about which part of the body is affected (e.g. muscles in the calves, thighs or buttocks) and where the pain radiates to.
The doctor can also identify further important information by measuring the maximum walking distance as well as how long symptoms persist after completing the test.
This ultrasound method illustrates the conditions of the walls of arteries and veins, and enables the early identification of arteriosclerotic, calcified vessel wall deposits as well as blood clots and venous inflammation. Colour coding makes the blood flow visible, enabling constrictions and occlusions to be precisely localised and the degree of constriction to be precisely determined.
Combined with the use of modern, high-resolution ultrasound equipment, the doctor’s many years of experience are essential for the quality and informative value of this examination.
The capillary microscopy makes the tiniest, thinnest blood vessels and the blood flow of the nail fold visible by means of a special microscope. These capillary vessels could be changed in the case of circulatory disorders of the fingers. Rheumatic diseases are also characterised by circulatory disorders of the fingers, leading to characteristic changes in the vessels.
Capillary microscopy is also used to clarify so-called Raynaud’s Phenomenon (white finger disease) and certain immunological diseases.
It measures the graph of the electrical activity of the heart at rest, providing information about the quality of the heart rhythm and the stimulus conduction in the heart muscle. In the event of abnormal heart rhythms, such as is the case with atrial fibrillation, the heart beat is not regular, meaning that blood clots can form in the heart.
The major danger associated with the formation of a blood clot is that clot material may be washed into the vessels of the head (danger of a stroke) and into those of the legs (sudden vessel occlusion with severe impairment of blood flow – danger of amputation).
This examination, performed whilst the patient is pedalling on an exercise bike, can be used to identify stress-related irregular heart rhythms, blood pressure fluctuations and circulatory disorders of the coronary vessels (potential precursors of a heart attack).
This ultrasound of the heart allows an assessment of the cardiac anatomy, such as size of the heart cavities, myocardial wall thickness and pumping ability of the heart. If the patient has had a heart attack, relevant scarring can be identified.
The morphology and the functionality of the heart valves are also illustrated (they might be pathologically changed as a result of calcification, malformations or inflammation), the state of the pericardium is made visible (this is changed in the case of pericarditis) and thromboses (blood clots) in the heart cavities can be detected (causes for artery blockages).
This is carried out to complement the colour-coded duplex sonography, and enables the assessment of the condition of the abdominal and pelvic arteries, even under unfavourable conditions for an ultrasound examination, such as on overweight patients or on those with excessive intestinal gas.
In special cases, a CT angiography is performed in advance of planned operations to enable the assessment of the perfect size of stents, for instance, or in the event of abdominal aortic aneurysms or on patients with pacemakers on whom it is not possible to perform an MR angiography.
It is only in rare cases that, these days, a DSA is used – if the aforementioned methods (MRA, CTA) are not informative enough. This is carried out in our catheter room.
Vascular diseases can have any one of an array of causes. Our Vascular Centre combines the experience and competence of 5 doctors with decades of professional experience in their fields.
Our approach to therapy: “Minimally invasive – maximally gentle”. Thanks to the latest treatment methods, open surgery can be avoided in most cases.
Outside of surgery hours,
please call the emergency
medical assistance service on:
Telephone number 116 117.