E-cigarettes are devices that heat a liquid to produce an aerosol (vapor) that the user inhales. The liquid typically contains nicotine, flavorings, and other chemical compounds. Many people assume they are less harmful because they do not contain tar or the same levels of combustion-related toxins found in conventional cigarettes. However, “less harmful” does not mean harmless. From a scientific standpoint, is vaping truly less harmful than smoking? Is it scientifically valid that the electronic cigarette is less harmful than conventional smoking?

 

How can e-cigarettes affect our blood vessels?

E-cigarette aerosol contains nicotine and other chemicals that can cause vasoconstriction (narrowing of blood vessels), oxidative stress, and inflammation. These mechanisms impair vascular elasticity and function and, over time, may increase the risk of hypertension and cardiovascular disease.

While switching completely from smoking to vaping may reduce exposure to certain toxins in some cases, it is not risk-free. Vascular injury is real and well documented. In addition, many people become dual users —they use both e-cigarettes and conventional cigarettes—which increases overall cardiovascular risk.

 

How does nicotine from e-cigarettes affect heart and circulation?

Nicotine—regardless of how it is delivered—raises heart rate, blood pressure, and cardiac workload. This effect is immediate and, over time, may contribute to hypertension, atherosclerosis, and an increased risk of heart attack or stroke.

 

What do recent studies show about vaping and blood vessels?

Recent clinical and laboratory studies indicate that e-cigarette use can lead to endothelial dysfunction—damage to the inner lining of blood vessels. In addition, increases in blood pressure and heart rate have been observed immediately after use, even in young, otherwise healthy individuals.

Adolescents are particularly vulnerable, as nicotine can affect brain development and blood pressure regulation. Early exposure to substances that impact the vascular system may also increase long-term cardiovascular risk.

 

Do different e-liquid formulations have different vascular effects?

Yes. Different flavors and additives may have varying toxicity. Some flavorings—such as cinnamon- or butter-flavored compounds—have been associated with increased oxidative stress and endothelial toxicity, placing additional strain on blood vessels.

Preventing vascular damage

If someone stops using e-cigarettes, further vascular damage may be prevented. Endothelial function can improve significantly within weeks to months after cessation—especially in younger individuals without other cardiovascular risk factors. However, with long-term use or combined exposure to other harmful factors, full recovery may not always be possible.

E-cigarettes are not harmless and may have serious consequences for vascular health. Although they may reduce harm for chronic smokers who switch completely, they are not recommended for non-smokers or young people. The best strategy for vascular health is complete abstinence from all forms of nicotine and vaping products.

Organizations such as the American Heart Association (AHA) and the European Society of Cardiology (ESC) emphasize that e-cigarettes are not safe and are not recommended for long-term use. They also highlight the need for further research and support evidence-based smoking cessation methods with established safety and effectiveness.

Protect your vascular health responsibly. Consult Dr. Bisdas for expert assessment and guidance on reducing cardiovascular risk related to e-cigarette use.

Η Erectile dysfunction (ED) is one of the most common conditions affecting the penis and can significantly impact a man’s quality of life. Although it remains a “taboo” topic for many, early diagnosis and identifying the underlying cause greatly increase the chances of successful treatment.

 

What is Erectile dysfunction?

Η στυτική Chronic ED is defined as the inability to achieve or maintain an erection sufficient for sexual activity. An erection is a complex process that requires the proper function of the nervous, vascular, and hormonal systems. If any of these systems are impaired, erectile dysfunction may occur.

Occasional ED due to stress or fatigue differs from στυτική Chronic ED , which persists for more than three months.

Causes of erectile dysfunction

Common causes include:

• Of vascular origin60–80% of cases, often related to atherosclerosis of penile arteries in the context of hypertension, smoking, and diabetes.
• Of neurological nature: 10–20% of cases, e.g., multiple sclerosis.
• Of pharmaceutical origin: 5–10% of cases; certain medications (including some antidepressants) may contribute.

 

An important clinical point: approximately 50% of men experience ED before developing clinically apparent coronary artery disease. Therefore, early evaluation of ED can serve as a valuable early warning sign for cardiovascular disease.

 

Erectile dysfunction in the 50s and 60s

Erectile dysfunction in men increases at the age of 50 to 60 years. In the στυτική δυσλειτουργία στα 50 50s it is often associated with metabolic and hormonal changes, while in the 60s it becomes even more prevalent due to vascular wear and chronic disease. However, it is not a “normal” part of aging and should not be ignored..

Common symptoms include:

• Of reduced erection firmness
• Short duration of erection
• Reduced or absent morning erection

 

Treatment of erectile dysfunction

Η Treatment is tailored to the cause and severity and is determined by the treating andrologist/urologist. When ED is due to vascular dysfunction, medical therapy is typically initiated (with or without intracavernosal injections and shockwave therapy). If there is no meaningful improvement within 3–6 months, referral to a vascular surgeon may be recommended for further evaluation with diagnostic angiography

 

Vascular management – angioplasty

Ο Αγγειοχειρουργός During angiography, the vascular surgeon can both diagnose and treat the underlying vascular cause. If a narrowing or occlusion is found, angioplasty may be performed using a specialized drug-coated balloon. A drug-eluting stent may be placed if the angioplasty result is not satisfactory.

The placement of a drug-coated endograft  (stent) is performed if the result of the angioplasty is not satisfactory.

Particularly important is angiography using carbon dioxide (CO₂) to assess perfusion of the corpora cavernosa. Due to its low viscosity, CO₂ can penetrate the microcirculation when no vascular disease is present. In patients with diabetes and microcirculatory impairment, CO₂ may not diffuse adequately into the corpora cavernosa—highlighting severe vascular dysfunction. In such cases, patients should not be subjected to ineffective treatments; penile prosthesis implantation by an experienced andrologist may be the only effective option

What is the “best pill” for erectile dysfunction?

There is no single “best” pill for everyone. The optimal choice depends on medical history, the desired duration of action, and individual response. An andrologist is best placed to recommend the most appropriate medication.ED can affect men of any age. With correct diagnosis and individualized treatment, most men can restore sexual function. Because ED is often vascular in origin, the role of an experienced vascular surgeon can be decisive

Η Erectile dysfunction that can affect every man, regardless of age. With the correct diagnosis and individualized treatment, most men can restore their sexual function. Because erectile dysfunction most often has vascular dysfunction, the contribution of a specialized Vascular Surgeon is of decisive importance. Contact with Dr. Theodosio Bisda, Professor of Vascular Surgery and Director of the Vascular Surgery Clinic at Athens Medical Center, for expert consultation.

Η Chronic venous insufficiency is a condition in which the veins cannot return blood to the heart effectively, leading to blood pooling in the lower limbs varicose veins—dilated, swollen veins—are often a result of this condition and most commonly appear in the legs Professor of Vascular Surgery and Director of the Vascular Surgery Clinic at Athens Medical Centre,, Associate Professor of Vascular Surgery and Director of the 3rd Department of Vascular Surgery at Athens Medical Centre, explains venous insufficiency (varicose veins) and the available treatments.

 

What are chronic venous insufficiency and varicose veins?

Η Chronic venous insufficiency insufficiency occurs when the veins—mainly in the legs—do not function properly and struggle to return blood to the heart. This is usually due to venous valves failing to close correctly, allowing blood to stagnate or flow backwards (reflux). Varicose veins are a common sign of chronic venous disease: the veins become enlarged, twisted and visible under the skin, typically in the lower limbs.

 

Symptoms of Venous Insufficiency & Varicose Veins

Symptoms may include:

• Swelling of the leg of the legs or ankles, especially later in the day or after prolonged standing
• Feeling of heaviness or fatigue in the legs
• Aching pain or a burning sensation during activity or after standing for long periods
• Visible varicose veins (dilated, blue or purple veins) that may be swollen and uncomfortable.
• Pale or bluish skin discolouration around the affected veins, such as darkened spots or excessive dryness.
• Open sores/venous ulcers near the ankle that may heal slowly
• Muscle cramps particularly at night.
• Itching or irritation around the affected veins

 

Causes and Risk Factors

The causes and risk factors for venous insufficiency and varicose veins include:

Causes:

• Valve weakness/failure: valves may weaken or become damaged, causing reflux
• Genetic predisposition: inherited tendency towards weaker vein walls/valves
• Ageing: veins lose elasticity and valves may not close effectively
• Sedentary lifestyle or prolonged standing: reduces efficient venous return

Risk factors

• Increasing age: Οι μεγαλύτεροι σε ηλικία άνθρωποι είναι πιο επιρρεπείς στη φλεβική ανεπάρκεια.
• Female sex (often related to hormonal changes, pregnancy, or contraception): Women are more prone to developing venous insufficiency and varicose veins, mainly due to hormonal changes during pregnancy or the use of contraceptives.
• Pregnancy: The increased pressure on the veins in the legs during pregnancy can lead to varicose veins.
• Excess weight: Obesity increases pressure on the veins in the legs, worsening the condition.
• Family history: If someone in the family has varicose veins or venous insufficiency, the risk is higher.
• Lack of regular exercise: Lack of mobility reduces blood circulation and promotes fluid buildup in the veins.
• Smoking (may damage blood vessel walls and contribute to progression): Smoking can damage the walls of blood vessels and contribute to the development of varicose veins.

 

Treatment: venous insufficiency / varicose veins

Treatment depends on severity and individual needs.

1. Conservative management:

• Antiplatelet/anticoagulan(when appropriate) to relieve swelling, discomfort and inflammation
• Graduated compression stockingsto improve venous return and reduce swelling
• Regular exerciseto improve circulation and reduce symptoms

2. Interventional Methods:

• Sclerotherapyinjection of a sclerosant to close affected veins and relieve symptoms
• Ablation of superficial veins (using endovenous laser, radiofrequency, or medical adhesive (glue))
• Traditional open surgery (stripping of the vein) in selected cases

Preventing progression

• Avoid of prolonged standing or sitting
• Increase of daily physical activity(walking is particularly helpful)
• Maintain a healthy weight and avoiding obesity

If you notice swelling, pain, or skin changes in your legs, prompt specialist assessment is recommended. Visit Dr. Bisdas for a comprehensive evaluation and an individualised treatment plan aimed at improving quality of life and preventing complications.

Η is an inflammatory condition is a type of venous thrombosis that usually develops in a superficial vein of the leg or arm. It often occurs after injury, immobility, advanced venous insufficiency, or other conditions that affect blood flow and clotting. Professor of Vascular Surgery and Director of the Vascular Surgery Clinic at Athens Medical Centre,MD, PhD, FACS, Associate Professor of Vascular Surgery and Director of the 3rd Department of Vascular Surgery at Athens Medical Centre, highlights the importance of early diagnosis and treatment to prevent complications.

 

What is superficial thrombophlebitis;

Η is an inflammatory condition affecting superficial veins, most commonly in the lower limbs. Compared with deep vein thrombosis (DVT),which involves larger and deep veins superficial thrombophlebitis typically carries a lower risk of severe complications. However, if untreated, it can cause significant discomfort and local complicationsIn neglected cases, it may lead to pulmonary embolism if the clot extends to the junction between superficial and deep veins.

 

What causes superficial thrombophlebitis?

Η is an inflammatory condition It develops when the wall of a superficial vein becomes irritated or injured, leading to clot formation and inflammation. Common causes include:

• Trauma or minor injuries Ένας μικρός τραυματισμός ή ιατρικές διαδικασίες όπως η τοποθέτηση φλεβοκαθετήρα ή η γρήγορη έγχυση κάποιου φαρμάκου μπορούν να ερεθίσουν τη φλέβα.
• Medical procedures, such as an IV cannula or rapid infusion that irritates the vein
• Prolonged immobility (κιρσοί): Η δυσλειτουργία των φλεβικών βαλβίδων προκαλεί συγκέντρωση αίματος και αυξάνει την πιθανότητα θρόμβων.
• • Increased blood clotting tendency , e.g. pregnancy, combined oral contraception (especially with smoking), cancer, or inherited thrombophilia
• Λοίμωξη ή φλεγμονή: Infection/ιnflammation near the vein (rare)

 

Symptoms

Τα Sypmtoms typically occur along the course of a superficial vein and may include:

• Redness: over the vein
• Pain and tenderness especially on touch.
• Swelling of the vein and surrounding tissues
• A firm , "cord-like" vein under the skin
• Local warmth Η φλεγμονή προκαλεί αύξηση της θερμοκρασίας στην περιοχή της φλέβας.

 

How serious is it?

Η is an inflammatory condition It is usually a mild, self-limiting condition. In some cases, however, it can progress to DVT, increasing the risk of pulmonary embolism κίνδυνο πνευμονικής εμβολής.

 

Treatment

Η is an inflammatory condition is usually treated with simple and non-invasive methods, which aim at reducing pain, inflammation and preventing complications. The basic treatment methods include:

1. Anti-inflammatory medicines (e.g. ibuprofen, if appropriate)
2. Ανύψωση των ποδιών: Elevation of the affected limb
3. Compression stockings to support venous flow
4. Gentle mobilisation (walking helps prevent stasis)
5. Anticoagulation: depending on clot extent and proximity to the deep venous system; rarely, surgical ligation of the superficial–deep junction may be recommended

 

Η Early diagnosis and treatment are essential. If you develop redness, pain, or swelling along a vein, consult Dr. Theodosios Bisdas promptly for individualised assessment and care.

Blood clots in the arteries are a serious health threat because they can interrupt blood flow and lead to dangerous conditions such as arterial thrombosis or embolism. In this article, we explain what an arterial clot is, how it forms, the difference between thrombosis and embolism, symptoms, complications, treatment options, and preventionvascular surgeon Dr. Bisda in modern treatment techniques.

 

What is a clot?

A clot is a mass of blood that forms through coagulation. Under normal conditions, clotting is essential for healing wounds. However, when a clot forms inside a blood vessel without injury, it can obstruct blood flow and cause serious harm.

 

How do clots form in arteries?

Arterial clot formation is linked to abnormal blood flow, injury to the vessel lining (endothelium), or increased tendency of the blood to clot. Key contributors include:

1. Atherosclerosis: lipid/cholesterol build-up damages the arterial wall and promotes clot formation
2. Trauma or surgery: vessel injury increases clotting risk
3. Prolonged immobility:(in selected contexts)
4. Underlying conditionsthrombophilia, malignancy, and cardiac arrhythmias increase risk

 

Arterial thrombosis vs arterial embolism

• Arterial thrombosis: a clot forms within an artery and remains at the site of formation, partially or completely blocking blood flow and causing ischaemia.
• Arterial embolism: a clot (or other material such as fat or air) travels through the bloodstream and suddenly blocks an artery elsewhere.

Arterial embolism is often more sudden and may be more dangerous because it causes abrupt loss of blood flow. A common cause is atrial fibrillation.

 

Symptoms

Symptoms vary depending on the location and severity of the blockage, but often include:

1. Sudden,severe pain at the site of obstruction
2. Numbness and weakness(often in a limb)
3. Pale or bluish skin discolouration: Ωχρότητα ή κυάνωση στο δέρμα.
4. Weak or absent pulses below the blockage: Οι σφύξεις είναι συχνά μειωμένες ή ανύπαρκτες κάτω από το σημείο της απόφραξης.
5. Coldness of affected limb: Το προσβεβλημένο μέλος μπορεί να είναι κρύο.
6. Symptom stroke: facial droop/weakness on one side, speech difficulty, loss of vision, or balance problems

 

Complications of arterial ischaemia

If not treated urgently, arterial ischaemia can lead to:

• Tissue necrosis(irreversible damage)
• Gangrene: Εάν δεν αντιμετωπιστεί άμεσα, η έλλειψη οξυγόνου μπορεί να οδηγήσει σε απόπτωση ιστών.
• Permanent loss of functiondue to nerve and muscle injury
• Systemic complications, such as sepsis when dead tissue becomes infected

 

Treatment

Early treatment is critical. Options include:

1. Medication:
   • Anticoagulantsto prevent further clotting
   • Thrombolytics(clot-dissolving treatment) in selected cases
2. Endovascular techniques:
   • Η Catheter-based thrombectomy (minimally invasive clot removal)
   • Η balloon angioplasty and stenting to restore flow in narrowed/blocked arteries
3. Open surgery:
   • Surgical removal of the clot when endovascular options are not feasible

 

Prevention

Prevention focuses on managing risk factors and adopting a vascular-protective lifestyle:

• Healthy diet(less saturated fat; more fruit, vegetables, fibre)
• Regular exercise: Η τακτική σωματική δραστηριότητα βελτιώνει την κυκλοφορία του αίματος.
• Smoking cessation: Το κάπνισμα βλάπτει τα αγγεία και αυξάνει τον κίνδυνο αθηροσκλήρωσης.
• Control of hypertension, diabetes and cholesterol: Όπως η υπέρταση, ο διαβήτης και η υπερχοληστερολαιμία.
• Antiplatelet/anticoagulantherapy in high-risk patients, when indicated

 

The importance of specialist vascular care

Ο Professor of Vascular Surgery Mr. Bisdass has extensive expertise in modern management of arterial thrombosis and embolism, including advanced endovascular techniques such as aspiration thrombectomy and angioplasty. Individualised care and contemporary technology aim to provide safe, effective treatment and optimise long-term quality of life. For personalised advice and specialist assessment, contact Dr Bisdas.

 

 

Ο Clot clot is a solid mass of blood cells that forms inside a vein. Size can vary from a small clot to one that extends along a long segment of the vessel. Clots in the veins are associated with symptoms of impaired venous drainage and may lead to serious complications involving the lungs and heart, particularly pulmonary embolism. Early diagnosis and treatment by a specialist Vascular Sergeonis therefore vital to prevent complications and reduce the risk of death.

 

What is a clot?

A clotforms when blood coagulates and becomes solid within a blood vessel. While clotting is a normal mechanism to stop bleeding after injury, clot formation in other circumstances is typically due to pathological causes

 

 

Types of Clots

Ο Clot may be classified by vessel type and nature. The main categories include:

1. Vein Clot (Venous clot): forms in veins and can migrate, causing pulmonary embolism. Two common forms are superficial venous thrombosis (thrombophlebitis) and deep vein thrombosis (DVT). εν τω βάθει φλεβική θρόμβωση.
2. Arterial clot: forms in arteries and may cause myocardial infarction (heart attack) stroke or gangrene. Causes include atherosclerosis and embolism from atrial fibrillation.
3. • Microthrombi: form in small vessels, often due to coagulation disorders or microvascular injury, and can affect organs such as kidneys, lungs, or skin.

 

 

How does a venous clot form?

Ο Clot formation occurs through coagulation, involving platelets and clotting proteins, either physiologically (bleeding) or pathologically (e.g. cancer, thrombophilia). Key steps include:

1. Vesselwall damage: platelets adhere to the damaged lining
2. Chemical signalling: platelets release substances that recruit more platelets
3. Activation of clotting factors: thrombin converts fibrinogen to fibrin
4. Clot formation: fibrin creates a mesh trapping platelets and red cells

For a venous clot to form, at least one component of Virchow’s triad is usually present: stasis (e.g. venous insufficiency, May–Thurner syndrome), hypercoagulability (thrombophilia, cancer), or vessel wall abnormality (previous thrombosis, May–Thurner syndrome).

 

Symptoms of venous thrombosis

Symptoms depend on the location and severity, and may include:

• Severe pain and cramping(often in the calf)
• Swelling of the legor affected limb, sometimes with heaviness
• Redness and warmth in the area: Η περιοχή γύρω από τον θρόμβο μπορεί να γίνει κόκκινη και ζεστή στην αφή.
• Difficulty movingdue to pain/stiffness
• A firm, tender superficial vein (“cord”) in superficial thrombosis(e.g. saphenous thrombophlebitis; arm veins after IV medication)

Potential complications

Venous clots may be life-threatening due to:

• Pulmonary embolism:
  • chest pain
  • severe breathlessness
  • heart strain/failure
  • fainting
  • Sudden death
• Post-thrombotic syndrome: valve damage leads to chronic swelling, skin darkening (brown), and sometimes venous ulcers
• Paradoxical stroke:

in some (often younger) patients with a patent foramen ovale, a venous clot can pass to the arterial system and cause stroke

 

Treatment options

Treatment depends on severity and extent:

1. Anticoagulant(e.g. heparin, the warfarin or newer oral anticoagulantsis the mainstay. These medicines prevent extension/new clots; they do not “dissolve” existing clots—your body does that over time.
2. Endovascular clot removalin severe cases (extensive pelvic/abdominal vein thrombosis or pulmonary embolism causing significant cardiac strain), using aspiration devices to restore flow.
3. Venous stentingfor chronic obstruction/post-thrombotic syndrome, to improve outflow from the leg.
4. Graduated compression stockingsto relieve symptoms and reduce post-thrombotic syndrome risk. κάλτσες συμπίεσης) μπορεί να βοηθήσει στην ανακούφιση του πόνου και στην αποφυγή μεταθρομβωτικού συνδρόμου.

Prevention

• Thrombophilia genetic testing (when indicated)
• Lower-limb venous duplex ultrasound (Triplex) when clinically appropriate
• Smoking cessation
• Avoid combined oral contraception plus smoking
• Compression stockings in venous insufficiency
• Treat varicose veins/superficial venous reflux
• Good hydration
• Daily activity/exercise
• Preventive anticoagulation after surgery, trauma, or immobilisation (as advised

Early diagnosis and treatment are crucial. Dr Theodosios Bisdas,, Professor of Vascular Surgery and Director of the Vascular Surgery Clinic at Athens Medical Centre,, can guide you through diagnosis and the full range of modern treatment options

The vascular system is a highly complex yet precisely organised closed network of vessels through which blood circulates to all tissues and organs of the body, delivering oxygen, essential cells and proteins required for normal function

An overview of the vascular (circulatory) system

The vascular or circulatory system transports blood throughout the human body. Its central component is the heart. The left side of the heart pumps oxygenated blood through the arteries to all organs and tissues. As arteries branch, they gradually become smaller and form capillaries, where oxygen and nutrients are exchanged with tissues. After delivering oxygen, blood continues through the venous capillaries and returns via larger veins (the superior and inferior vena cava) to the right side of the heart. From there, it is pumped to the lungs for oxygenation before returning to the left side of the heart, beginning a new cardiac cycle.

Components of the vascular system

Arteries

Arteries Arteries carry oxygenated blood under pulsatile pressure throughout the body. They consist of three layers and are highly elastic. The largest artery is the aorta, which is particularly important due to its association with aneurysm formation. Smaller arteries vary in importance depending on the organs they supply and the availability of collateral circulation.

Veins

Veins Veins return deoxygenated blood from tissues back to the lungs. Their walls are thinner, more compressible and more fragile than arterial walls. Veins can dilate significantly, which explains the development of varicose veins. The largest veins are the superior and inferior vena cava. Many smaller veins may remain inactive and become functional when needed (e.g. pregnancy, thrombosis, inflammation).

Capillary vessels

Capillaries Capillaries are microscopic vessels connecting arteries and veins, allowing exchange of oxygen, nutrients, carbon dioxide and metabolic waste between blood and tissues.

How the vascular system works

The system consists of the heart, arteries, veins and capillaries. The heart acts as the central pump with four chambers: two atria and two ventricles. Oxygenated blood is pumped from the left ventricle into the aorta and distributed through arteries, arterioles and finally capillaries.
At the capillary level, oxygen and nutrients pass into tissues while carbon dioxide and waste products enter the bloodstream. Deoxygenated blood then returns through venules and veins to the heart and lungs for reoxygenation.
Τα τριχοειδή αγγεία είναι τα λεπτότερα αγγεία του κυκλοφορικού συστήματος και λειτουργούν ως σημεία ανταλλαγής. Μέσω των τριχοειδών, το οξυγόνο και τα θρεπτικά συστατικά περνούν από το αίμα στους ιστούς, ενώ το διοξείδιο του άνθρακα και άλλα απόβλητα απορροφώνται από τους ιστούς στο αίμα.
Το αίμα, πλέον φτωχό σε οξυγόνο και γεμάτο απόβλητα, συλλέγεται από τα φλεβίδια, τα οποία ενώνονται για να σχηματίσουν τις φλέβες. Οι φλέβες επιστρέφουν το αίμα στην καρδιά. Η άνω και η κάτω κοίλη φλέβα φέρνουν το αίμα στον δεξιό κόλπο, ο οποίος το προωθεί στη δεξιά κοιλία. Η δεξιά κοιλία αντλεί το αίμα στους πνεύμονες μέσω της πνευμονικής αρτηρίας για να οξυγονωθεί.
In this way, the circulatory system ensures the continuous supply of oxygen and nutrients to the tissues, as well as the removal of waste products from the body.

Importance of a healthy vascular system

The importance of a healthy vascular system is vital for overall health and the proper functioning of the body. A healthy vascular system ensures the efficient transport of oxygen and nutrients to all cells and tissues, allowing the organs to function properly. In addition, it contributes to the removal of carbon dioxide and other waste products from the body, helping to maintain homeostasis.
A healthy vascular system reduces the risk of cardiovascular diseases, such as arteriosclerosis or atherosclerosis, hypertension, peripheral arterial disease, phlebitis or venous insufficiency, and venous thrombosis. It keeps blood pressure within normal levels, preventing excessive strain on the heart and blood vessels. In addition, good blood circulation promotes the health of the skin, kidneys, and brain, helping to prevent conditions such as strokes and dementia.
In conclusion, maintaining a healthy vascular system through a balanced diet, exercise, and avoiding smoking and excessive alcohol consumption is crucial for well-being and longevity.

Understanding and caring for the vascular system is crucial for preventing vascular diseases, maintaining blood pressure within normal levels, and promoting overall well-being. Healthy blood circulation helps ensure longevity. The specialist responsible for examining our blood vessels is the vascular surgeon, also known as an angiosurgeon or angiologist. This doctor performs everything from vascular ultrasound examinations and vascular diagnosis to the treatment of any disorders of the vascular system, such as angioplasty or bypass surgery.

What is a hybrid operating theatre and how does it benefit patients undergoing vascular procedures? Why is it considered a major advancement in vascular surgery?

Dr Theodosios Bisdas, Director of the 3rd Department of Vascular Surgery at Athens Medical Centre and Associate Professor of Vascular Surgery at Universitätsklinikum Münster, explains the concept and advantages of the hybrid operating theatre and how highly specialised procedures for complex vascular disease are performed within this environment.

Read everything you need to know in the article that follows.

https://www.ethnos.gr/health/article/318104/ybridikoxeiroyrgeiohepanastashsththerapeiatonpolyplokonaggeioxeiroyrgikonpathhseon

 

 

The main vascular diseases are the following: arterial diseases and the venous diseasesThe main vascular diseases are the following:. Other conditions also include diseases of the lymphatic vessels, which we will address in a separate text. The treatment of arterial and venous diseases does not rely solely on their surgical repair, but primarily on early prevention and the elimination of risk factors.

Understanding Vascular Diseases

Arterial diseases involve any artery in the human body. The most common arterial condition is the narrowing or blockage of a vessel, which leads to ischemia (reduced blood supply) of an organ or to the risk of embolism of the organ (e.g., carotid artery disease). The second most common arterial condition is an aneurysm, meaning the dilation of a blood vessel. Depending on the location of the aneurysm, the patient is at risk either of a life-threatening rupture (abdominal and thoracic aorta, splenic, renal artery) or thrombosis (popliteal artery). Less common conditions include dissection of an artery (mainly the aorta) or injury to an artery.

Venous diseases mainly involve thrombosis of the superficial or deep veins, with the most significant risk being the migration of the thrombus and the development of potentially fatal pulmonary embolism. In the case of the veins of the lower limbs, dysfunction of the internal valves (venous insufficiency) leads to blood stasis and represents one of the most commonly occurring venous conditions.

Risk Factors for Vascular Diseases

Non-modifiable risk factors

The most common risk factors, which... cannot be influenced the patient are the following:

• Increasing age (increases the likelihood of peripheral arterial disease and aneurysm)
• Family history (increases the likelihood of developing aneurysm, aortic dissection, or venous insufficiency)
• Genetic factors (genetics play a very important role in the development of aneurysms and aortic dissection, peripheral arterial disease, and thrombophilia)

Modifiable risk factors

The most common risk factors, which... can be influenced the patient himself are the following:

• Smoking (may damage blood vessel walls and contribute to progression) (immediate cause of all arterial diseases and venous thrombosis)
• High blood pressure (is associated with all arterial diseases)
• High cholesterol and unhealthy diet (is associated with all arterial diseases and especially with peripheral arterial disease)
• Diabetes (is associated with narrowing and occlusion of the arteries and causes the worst-prognosis form of arterial disease, that of the small vessels)
• Obesity and lack of exercise (is associated with all vascular diseases as well as with lymphedema)
  Symptoms and Early Detection

The common symptoms of the most frequent vascular diseases are the following:

Arterial narrowing or occlusion

Depending on the organ affected by poor blood supply (ischemia), the patient presents corresponding symptoms. In the lower limbs, the patient experiences pain during walking, or in more advanced cases develops gangrene of the toes. In occlusion of the artery of the arm, the patient may experience paradoxical dizziness due to blood being “stolen” from the brain. An exception is carotid artery stenosis, where the patient has no symptoms until a stroke occurs.

 ABDOMINAL

Aortic aneurysm generally does not produce any symptoms. More rarely, it may lead to pain in the abdomen or the back. Aneurysms of the visceral vessels are also, in most cases, asymptomatic.

Venous thrombosis

Thrombosis of the superficial veins (thrombophlebitis) mainly causes intense local pain, redness, and a palpable hardening along the vein. In deep vein thrombosis, the patient presents with severe pain throughout the limb, swelling, and redness.

Prolonged immobility

The main symptoms of venous insufficiency or phlebitis are leg pain during standing, ankle swelling, a burning sensation, and the appearance of varicose veins and spider veins. In pelvic varicose veins (pelvic congestion syndrome in women, varicocele in men), patients may experience a feeling of heaviness or pain in the pelvis, hip or lower back pain, urinary leakage during coughing or intense laughter, pain during sexual intercourse (dyspareunia), heavy menstrual bleeding, hemorrhoids, varicose veins in the testicle or vulva, and in some cases it has been associated with infertility.

The main preventive and diagnostic test for all vascular diseases is the vascular duplex ultrasound (vessel triplex) which, depending on the patient’s risk factors, should be performed at regular intervals as determined by the treating vascular surgeon.

Prevention Strategies for Vascular Diseases

Lifestyle changes

The immediate and complete cessation of smoking, vaping, or the use of e-cigarettes plays a primary role in maintaining vascular health, as all of them lead to vascular damage through different mechanisms. Gradual reduction does not lead to any improvement.

In addition, a healthy diet—namely foods low in saturated fats and high in fiber (fruits, vegetables)—as well as daily physical exercise are essential prerequisites for vascular health.

Beneficial exercises are generally aerobic exercises (walking, running, swimming, cardio). Our recommendation is moderate-intensity exercise 3 times per week for at least 1 hour. In particular, for patients with venous insufficiency, swimming is preferred over running, which is best performed while wearing graduated compression stockings. In patients with concomitant heart disease or coronary artery disease, the cardiologist should assess the frequency and intensity of exercise.

In this way, the patient can maintain a healthy body weight. In cases where weight loss is not achieved, it is important to consult a specialist physician for obesity (internists, endocrinologists, diabetologists) in order to perform hormonal evaluation and subsequently follow specialized diets prescribed by nutritionists.

Medical interventions

The treatment of choice for almost all vascular diseases is minimally invasive (endovascular) repair. In peripheral arterial disease, this is called angioplasty with stent placement or removal of atherosclerotic plaque using an atherectomy device. Aneurysms are treated with the use of endografts (EVAR). In cases of younger patients, genetic aortic diseases (e.g., Marfan syndrome), or complications, the vascular surgeon always retains the option of open surgical repair with direct artery replacement or the creation of a bypass.

In venous thrombosis, treatment is conservative, involving the administration of anticoagulant medications and frequent follow-up with duplex ultrasound (triplex). In special cases of massive thrombosis of the pelvic veins (iliac veins, inferior vena cava) or in severe pulmonary embolism, the vascular surgeon may perform minimally invasive thrombus removal and restoration of circulation accordingly. If there are chronic extensive thromboses in patients with severe post-thrombotic syndrome, treatment is performed with the placement of special venous stents that help relieve congestion in the leg.

Finally, in venous insufficiency, after conservative treatment with graduated compression stockings, the patient may undergo minimally invasive methods for the elimination of superficial veins (laser, radiofrequency, or glue). The use of sclerotherapy for larger veins tends to be decreasing due to the high recurrence rate of insufficiency. In cases of superficial varicose veins, treatment includes local phlebectomy (varicose vein removal) or sclerotherapy.

Management of Vascular Diseases

Most forms of vascular diseases can be successfully treated with modern endovascular methods, which reduce surgical trauma and hospital stay. In cases where endovascular treatment is not indicated, open surgical repair can be applied with great success, but it involves greater surgical trauma and a longer hospital stay. Very few and rare vascular diseases are considered incurable.

As a general rule, endovascular treatment offers major advantages for the patient and a low rate of complications. However, the literature shows that it carries a risk of re-interventions, which for the most part remain minimally invasive. The cause of re-interventions may be either the incorrect use of endovascular techniques or the disease itself. Specifically, in patients with diabetes and in those on hemodialysis, as well as in those who do not eliminate exposure to risk factors (e.g., smoking, etc.) or do not adhere to appropriate medical therapy, the risk of re-intervention is high, since atherosclerosis affects all blood vessels. For this reason, all patients with vascular diseases should be under regular follow-up by a vascular surgeon.

The condition of the blood vessels is an indicator of a patient’s overall health. With the exception of genetic vascular diseases, most vascular conditions are associated with exposure to various modifiable risk factors. Prevention and early diagnosis are the keys to proper treatment. If elimination of risk factors and completion of conservative therapy do not lead to improvement, or in urgent cases, modern vascular surgery offers minimally invasive or open surgical solutions. The selection of the ideal treatment in each case does not follow a general rule but is tailored to each patient individually (personalized medicine) by the treating vascular surgeon.

Aortic aneurysms are defined as a dilation of the aorta, the body’s main artery that carries blood from the heart to the rest of the body. The treatment of aortic aneurysms requires a high level of expertise and specialized training. Dr. Theodosios Bisdas,Director of the 3rd Vascular Surgery Clinic of the Athens Medical Center, answers the most critical questions.

What are aortic aneurysms and what risks do patients face?

An aortic aneurysm aneurysm is a dilation of the aorta to 2.5 times its normal diameter. In essence, the wall of the aorta weakens and expands, usually taking on a balloon-like shape. When the aneurysm exceeds 5.5 cm, the risk of rupture increases exponentially. Approximately 75% of patients with a ruptured aneurysm die before reaching the hospital, while of the remaining 25%, about half do not survive surgery or the postoperative period.

How can I have an aortic aneurysm?

Unfortunately , aortic aneurysm rarely cause symptoms. Most aneurysms are diagnosed incidentally during: • urological examinations for prostate enlargement in men • orthopedic evaluation for lower back pain in both sexes • gynecological examinations in women It should also be noted that male sex increases the likelihood of developing an abdominal aortic aneurysm by approximately 4.5 times. Ultrasound screening (duplex/triplex scan) using portable devices has been shown to be an effective and cost-efficient method for preventing deaths from ruptured aortic aneurysms.

Which Patients Should Be Screened for Aortic Aneurysm and When Should It Be Treated?

The European Society of Cardiology recommends ultrasound screening for abdominal aortic aneurysm in all men over 65 years of age, as well as in women over 65 years of age with a history of smoking. In addition, first-degree relatives of patients with a history of abdominal aortic aneurysm should undergo similar screening. In general, periodic monitoring is recommended annually for aneurysms measuring 3.5–4.4 centimeters, and every 6 months for aneurysms measuring 4.5–5.4 centimeters. When the aneurysm reaches a diameter of 5.5 centimeters or causes symptoms not related to another cause, immediate repair is recommended.

 

Aortic aneurysm: Treatment

Endovascular repair of the aortic aneurysm has become a widely accepted, minimally invasive, and safe method for treating the disease. Nowadays, next-generation grafts are used, which ensure successful exclusion of the aneurysm. The procedure is performed under general anesthesia and the grafts are placed percutaneously in the aorta. Depending on the location of the aneurysm, there are also corresponding endografts/stents.

Abdominal aortic aneurysms: treatment

Abdominal aortic aneurysms, which are also the most common, are treated with bifurcated endografts. Special endografts with integrated branches or fenestrations are used for more complex aneurysms of the aortic arch and thoracoabdominal aorta. In these cases, the complexity lies in the fact that the aneurysms involve important branches that either supply blood to the brain or to the abdominal organs, and these must necessarily be connected to the stent (Figure 1).

Image 1. Minimally invasive endovascular repair of a ruptured aortic arch aneurysm (A = before, B = after), Endovascular repair of a thoracoabdominal aortic aneurysm (C = before, D = after).

What are the advantages of endovascular repair of aortic aneurysms?

Compared with the classic Compared with open surgical treatment, the main advantages of endovascular treatment of complex aortic aneurysms are the following:

1. Minimization of surgical trauma.
2. Absence of postoperative pain.
3. Minimal blood loss.
4. Immediate mobilization of the patient.
5. Short hospital stay of a few days.
6. Avoidance of extracorporeal circulation and its potential complications.

The use of carbon dioxide instead of iodinated contrast medium in patients with kidney disease.

Until recently, the endovascular repair of aortic aneurysms, as well as other vascular diseases, was contraindicated in patients with renal failure due to the toxic effect of iodinated contrast media on the kidneys. Nowadays, iodinated contrast medium can, in specific cases, be fully replaced by carbon dioxide, which is kidney-friendly and provides excellent quality imaging of the blood vessels. At the [Athens Medical Center](https://www.iatriko.gr/en?utm_source=chatgpt.com), the first successful total endovascular repair of an aortic aneurysm and the first treatment of diabetic foot disease via CO₂ angiography were recently performed in a patient with iodine allergy and chronic renal failure, respectively (Image 2).

Image 2. Excellent quality imaging of the renal arteries during placement of the endograft for the treatment of an abdominal aortic aneurysm.

The management of aortic aneurysms in specialized aortic disease centers

Regardless of their extent or complexity, aortic aneurysms should be treated in specialized aortic centers. These centers must meet the following requirements:

1. Modern Hybrid Clinic which combines a high-resolution angiography system and the capability for open surgical intervention.
2. A stock of grafts and specialized materials for emergency situations.
3. Specialized nursing staff in endovascular techniques.
4. Collaboration between various specialties for the best patient care.
5. Specialized intensive care unit.
6. An experienced vascular surgery team in new minimally invasive endovascular techniques.

  If you have been diagnosed with an aortic aneurysm or would like to learn more about its prevention and treatment, contact the… Dr. Theodosios BisdasFor specialized solutions and safe treatments with modern medical technology. Book an appointment today to receive your personalized treatment.