By Janelle Mallett and Lilly Manske, Veins1 staff
Living and practicing in Duesseldorf, Germany, Prof. Ralf Kolvenbach serves as Chief of the Department of General and Vascular Surgery at Augusta Hospital. Prof. Kolvenbach is also a Professor of Vascular Surgery at the University of Duesseldorf. He is affiliated with the German Board of Vascular Surgery as a Fellow, the European Society of Vascular Surgery as a full member, and the Royal Society of Medicine (UK) as a Fellow, among others.
He received his training at the University of Duesseldorf Medical School where he specialized in Surgical Therapy of Ventricular Tachycardias. He completed his residency at Augusta Hospital in Duesseldorf and was a Visiting Fellow at Columbia Presbyterian Hospital and Medical School in New York City.
Veins 1: How did you become interested in vascular surgery and treatment?
Prof. Kolvenbach: I became interested in vascular surgery because it is one of the most fascinating surgical specialties. A vascular specialist can treat a broad spectrum of diseases such as carotid artery stenosis, venous surgery, or aortic surgery. In my present position as chief of vascular surgery of a tertiary referral center, I have to treat a variety of patients with a special emphasis on minimally invasive techniques.
Veins 1: How did studying in both the United States and in Germany influence your success as a vascular surgeon?
Prof. Kolvenbach: The United States and Canada employ state-of-the-art surgical methods that have a great impact on surgeons throughout the world. My US training has become an important part of my career as a vascular surgeon. Patients in the US are treated in a very efficient and competent way with the latest techniques. German vascular surgeons were among the first who developed endoscopic techniques for venous and perforator surgery.
Veins1: Can you explain the importance of developing new minimally invasive treatments?
Prof. Kolvenbach: We have learned since the introduction of endoscopic surgery that the patient clearly benefits from these minimally invasive techniques. Postoperative recovery is faster, the patient has less pain, and he or she can resume daily activities in less time than with open surgery. In the past, vascular surgeons were preoccupied with endovascular techniques. Many vascular surgeons were reluctant to acquire endoscopic skills to treat their patients in contrast to general surgeons. This practice will change because now we have the skills and instruments to offer our patients videoendoscopic procedures with the same proven results as conventional surgery.
Veins1: Describe the minimally invasive videoendoscopic techniques that enhance the quality of vascular surgery.
Prof. Kolvenbach: My colleagues and I have developed laparoscopic techniques to treat patients with aortoiliac occlusive disease or with aortic aneurysms. Additionally, our special interest lies in endoscopic vein surgery to treat patients with advanced venous disease.
Veins 1: How do your new techniques compare to the vascular surgery options currently available?
Prof. Kolvenbach: When performing a laparoscopic aneurysm resection the hospital can discharge the patient after three or four days in contrast to a week or longer after open surgery.
The techniques are the same (aneurysm resection or bypass surgery), but the access is considerably smaller. Therefore, postoperative recovery is faster and the patient experiences less pain. Long-term results of these procedures are
equivalent to open surgery and better compared to other minimally invasive techniques.
Veins 1: Besides aortic aneurysms, what other conditions do your techniques target?
Prof. Kolvenbach: We can treat patients with abdominal aortic aneurysms that otherwise would rupture causing instant death. Patients with occlusive disease, which ultimately can cause limb loss, also benefit from these procedures. Throughout the world, there are numerous centers performing this kind of surgery that was first introduced in Canada and the United States. We adopted the techniques developed by these North American surgeons and tried to develop them further.
Veins 1: Can you describe how you and your team developed endoscopic perforator surgery?
Prof. Kolvenbach: My team and I have a special interest in subfascial endoscopic perforator surgery (SEPS). For the first time we have conducted a prospective-randomized study proving that SEPS is advantageous in patients with severe venous disease. The results of this study will be published in one of the major US medical journals. They show that patients can benefit from endoscopic venous surgery.
Veins 1: How successful are the new treatments you developed for candidates for vascular surgery?
Prof. Kolvenbach: The long-term results of vidoendoscopic vascular surgery is comparable to the results of open surgery. In contrast to other less invasive techniques with this kind of minimal invasive surgery we can achieve bypass-patency rates of more than 90 percent.
Veins 1: Can you explain more about your work with TriVex?
Prof. Kolvenbach: The TriVex system enables us for the first time to treat patients with superficial varicosities in a minimally invasive way. It also offers a more radical approach so that patients will have fewer recurrent varicosities, which will significantly improve the outcome of these cases. Smith and Nephew has a strong interest in videoendoscopic surgery. It has introduced the HandPort device for hand-assisted laparoscopic surgery. We now have the opportunity to treat patients laparoscopically that require complex intra-abdominal operations such as aneurysm surgery.
Veins 1: Do you predict your new techniques will replace the existing ones?
Prof. Kolvenbach: I am convinced that these new techniques will replace conventional operations. The patients will ultimately decide that they prefer minimally invasive techniques because they will have less pain and a faster recovery.
Veins 1: How accessible are these new treatments?
Prof. Kolvenbach: In Europe, there are more than a dozen centers where specialists perform these techniques. North America has even more centers, and the number is steadily increasing. Patients can find these centers when using the Internet or when searching for these surgeon’s publications.