The Angiology and Vascular Surgery Service at Hospital Germans Trias i Pujol is responsible for the diagnosis, medical and surgical treatment, and follow-up of diseases related to the body's blood vessels.

It is recognized for its high quality of care and the application of advanced technologies. It is a service that has adapted to the demands of providing care for the vascular conditions of the population in the North metropolitan area.

The mission of the Angiology and Vascular Surgery Service is to provide excellent care for vascular pathology while training top-tier professionals. Among others, the service pursues clear objectives:

• Consolidate the Service's clinical leadership through excellent patient outcomes and technological innovation.
• Strengthen residency training with advanced tools such as simulation.
• Promote a patient-centered care model with the ambition of becoming a national and international reference.
• Support a cohesive professional team capable of sharing solutions and knowledge.
• Identify areas for improvement to increase the service's competitiveness.
• Strengthen research and innovation by structuring clinical data to generate valuable knowledge.

The service currently has 10 beds on the 3rd floor of the main building, with 2 additional beds in the Multipurpose Day Hospital for outpatient medical treatments. Outpatient services operate on the ground floor with daily high-resolution appointments, offering ultrasound and other hemodynamic imaging services and collaboration with nursing staff for complex care.

A hybrid operating room is available daily for various surgeries, including endovascular, open, and hybrid surgery, amputations, hemodialysis vascular accesses, and varicose vein surgery. A locatable nursing on-call service has been established to ensure the proper functioning of the hybrid operating room, which requires specialized equipment and staff.

Emergency surgeries requiring the use of the hybrid operating room are indicated by the on-call physician, and other surgeries take place in the conventional emergency operating room. Additionally, the service utilizes the program's resident physicians.

The service has a strong relationship with the internal medicine department for the medical treatment of complex hospitalized patients, for patient optimization, and for the prevention of cardiovascular diseases. It also collaborates with the cardiovascular surgery and cardiology departments for aortic arch surgeries.

Additionally, it has a strategic relationship with Hospital del Sant Esperit and Municipal Hospital of Badalona, where services are provided, and at Germans Trias, the most complex interventions are performed for better patient care.

Top News from the Department of Angiology and Vascular Surgery

• Vascular Surgeons at Germans Trias Successfully Perform Complex Aneurysm Surgery with a Modified Endoprosthesis

An aneurysm is the widening of an artery beyond its usual diameter. Depending on its size and location, it carries a risk of rupture and of hemorrhage or thrombosis of the artery.

• Medical Treatment/Follow-up: Upon initial diagnosis of an aneurysm, the department initiates medication to improve cardiovascular risk factors and provides close monitoring of patients to detect any changes in the size or morphology of the aneurysm.
• The Angiology and Vascular Surgery Service at Hospital Germans Trias is a referral center for performing complex abdominal aortic aneurysm repairs with custom-made aortic endoprosteses that adapt to patients' anatomy (branched and fenestrated endoprosteses) and now with physician-modified aortic prostheses (PMEG).
• Thoracic Aorta:
  • Implantation of total thoracic aortic endoprostheses (standard or custom devices) through peripheral vascular accesses.
  • Hybrid aortic arch surgery in collaboration with cardiac surgery.
• Abdominal aorta:
  • Open abdominal aortic surgery via transperitoneal or retroperitoneal approach for placement of unilateral or bilateral aortofemoral or aorto-aortic bypass grafts.
  • Endovascular surgery of the abdominal aorta: aneurysm repair with an endoprosthesis. Depending on the aneurysm's anatomy, more complex repairs with custom fenestrated, branched endoprostheses may be required to maintain circulation of the visceral, renal, or hypogastric arteries.

Between 60 and 70% of ischemic strokes may be due to a narrowing (stenosis) of the arteries in the neck, especially where the common carotid artery bifurcates. Depending on the diseases and the characteristics of these lesions, the need for revascularization surgery of these arteries is evaluated jointly with the neurology department.

• Medical Treatment and Follow-up
• Carotid Thrombendarterectomy Surgery
• Carotid stenting (interventional neuroradiology)
• Supra-aortic trunk bypass grafts

Peripheral arteriosclerosis is the disease of the body's arteries. Arteries are responsible for delivering oxygenated blood to tissues. When there is a lack of this blood flow, either due to stenosis or blockages in the arteries, the tissues suffer ischemia. Depending on the severity of the ischemia, the remaining tissues may not be viable and may require amputation.

• Medical treatment: At any stage of the disease, the service recommends antiplatelet and lipid-lowering therapy with control of cardiovascular risk factors. Depending on the disease stage, it is sometimes better to intensify medical treatment and exercise than to offer surgery upfront.
• Endovascular surgery: Recanalization of arteries via guides and catheters and treatment of stenotic or occluded arteries with angioplasties, drug-eluting angioplasties, stents, thrombectomies, etc.
• The service is a pioneer in the use of innovative endovascular materials and is also part of international registries for these materials.
• Open surgery
  • Endarterectomy of vessels and repair with vein, graft, or bovine pericardium.
  • Anatomical and extra-anatomical bypass grafts (venous or prosthetic).
  • Arterial thrombectomy and embolectomy.

End-stage chronic renal failure requires periodic hemodialysis. Hemodialysis requires an arteriovenous access; one option for obtaining this access is to surgically create an arteriovenous fistula.

Treatment of chronic venous insufficiency using minimally invasive techniques.

• CHIVA technique: Ultrasound-guided search for the venous leak in the venous system that is causing venous hypertension and surgical disconnection.
• Saphenous vein ablation using radiofrequency
• Phlebectomies
• Pelvic varicose veins

The Angiology and Vascular Surgery Service participates in clinical trials and national and international multicenter studies. It promotes the conduct of these studies to apply the most innovative treatments and surgical techniques in daily practice.

The service is part of international registries for innovative endoprostheses and endovascular materials (ILICO, Gore VSX-Trial Registry, TIGER, PRIZER...).

Selected Publications:

• González-Sagredo, A., Gil, M., D'Oria, M., Spanos, K., Salinas, Á., Matus, S., Carnaval, T., Llagostera, S., Lepidi, S., Giannoukas, A., Bellmunt, S., García-Vidal, R., Videla, S., Vila, R., & Iborra, E. (2022). Groin surgical site infection incidence in vascular surgery with intradermal suture versus metallic stapling skin closure: A study protocol for a pragmatic open-label parallel-group randomized clinical trial (VASC-INF trial). Medicine, 101(50), e31800. https://doi.org/10.1097/MD.0000000000031800
• Gil Olaria, M., Esteban Gracia, C., Riera Hernández, C., Altés Mas, P., Figuereo Beltre, D., Berastegui García, E., & Llagostera Pujol, S. (2024). Short- to medium-term outcomes of hybrid and endovascular aortic arch surgery. Angiology, 76(6), 356-362. https://doi.org/10.20960/angiologia.00659
• Altés, P., Martínez, V., Casellas, P., & Llagostera, S. (2024). Chapter 18: Drug eluting technologies in femoropopliteal disease. In Tips & Tricks in Endovascular Surgery. Volume II: Peripheral Arterial Section. ISBN 978-84-9957-283-3.
• Altés Mas, P., & Martínez Carnovale, L. (2024). Women's under-representation in aortic arch treatments: Revisiting the evidence. European Journal of Vascular and Endovascular Surgery, 68(3), 324. https://doi.org/10.1016/j.ejvs.2024.04.038
• Fité Matamoros, J., Dilmé Muñoz, J., Soto Carricas, B., Tello Díaz, C., & Altés Mas, P. (2024). Consultation document for the diagnosis and follow-up of aortic pathology. ISBN 978-84-9957-284-0. Legal Deposit: GR-62-2024.
• Figuereo Beltre, D., Berastegui Garcia, E., Mescola, V., Gil Olaria, M., Altés Mas, P., & Muñoz Guijosa, C. (2024). Hybrid repair of type I (without ascending aorta replacement) and type II (with ascending aorta replacement) aortic arch as a bridge to TEVAR. Cardiovascular Surgery. https://doi.org/10.1016/j.circv.2024.02.008
• Gil-Sala, D., Riera, C., García-Reyes, M., Rodríguez, M., Marrero, C. E., Martínez, L., Gil, M., Ruiz-Rodríguez, J. C., Ferrer, R., De Nadal, M., Suito-Alcántara, M. A., Llagostera, S., & Bellmunt-Montoya, S. (2022). Mortality and bleeding complications of COVID-19 critically ill patients with venous thromboembolism. International Angiology, 41(1), 1–8. https://doi.org/10.23736/S0392-9590.21.04704-0

The Angiology and Vascular Surgery Service at Hospital Germans Trias i Pujol has been a leader in medical education and training in the vascular field and has maintained a continuous commitment to medical education and training. It is considered one of the leading departments in the high-tech hospitals of the Catalan Health Institute.

The service's mission has been to foster excellence in medical education and the training of new healthcare professionals, always placing the patient at the center of its activities.

Currently, several innovative projects are being developed, focusing on the service's super-specialization in all the pathologies within its service portfolio, including complex aortic pathology, cerebrovascular pathology, diabetic foot, hemodialysis access, and venous pathology.

 
Undergraduate Teaching

The service provides lectures, seminars, and hospital practicals for the Medical degree program in this specialty at the UAB Faculty of Medicine on the Can Ruti Campus.

Additionally, medical students can opt for a vascular surgery rotation during the undergraduate program, a highly valuable training opportunity as it allows the student to acquire fundamental knowledge of the specialty and develop clinical and surgical skills.

Postgraduate Teaching

► Information for residents

The Angiology and Vascular Surgery Service at Germans Trias Hospital is one of 9 services in Catalonia that offers MIR training, providing a solid education in the specialty with a focus on both open and endovascular surgery.

It offers 5 residency positions, and these professionals are among the team's greatest assets.

Residents rotate through other specialties, attend national and international conferences, and take training courses to complement their education at the Hospital.

• Consult the Training Guide.

Continuing Education

The service's professionals teach courses on open abdominal aortic surgery using 3D-printed models of abdominal aortic aneurysms, endovascular simulator training courses, nursing training courses on ultrasound, and vascular and endovascular surgery courses in association with the Spanish Society of Vascular Surgery and its Endovascular Surgery Chapter.