Compression therapy even in cases of complex malformations “These are exciting times”
Vascular surgeon Dr. Thomas Hummel is the Chief Physician at the Artery Center of St. Josef’s Hospital, part of Ruhr University in Bochum. He discussed the treatment of complex venous-arterial circulation disorders, scheduled research projects about compression and the industry as a driver for continuous therapy improvements with Bauerfeind life.
life: You are a vascular surgeon, phlebologist and the Chief Physician of the Artery Center at St. Josef’s Hospital, which is part of Ruhr University (RUB) in Bochum.
What do you treat, what do you focus on?
Dr. Hummel: We see the entire spectrum of vascular diseases. In inpatient care alone, we treat around 1,300 cases per year. Treatment focuses on arterial reconstruction, such as peripheral bypass surgery, abdominal aortic aneurysms, carotid artery surgery, dialysis access and minimally invasive catheter procedures. In addition to arterial reconstruction, we also perform complex venous procedures: venous recanalization in cases of post-thrombotic syndrome, treatment of pelvic vein insufficiency and venous malformation with fistulas between the arterial and venous system. In short: all vascular diseases outside the thorax.
How often do you get patients with combined, complex circulatory disorders, venous as well as arterial?
Dr. Hummel: These are not uncommon. We start with the inflow, i.e. the arterial aspect, then we treat the outflow, meaning the underlying venous disease. A professional ultrasound examination is extremely useful for this before surgery because it clearly shows the arterial and venous pathways. When it comes to bypass material, we try to use the body’s own veins, if possible, because the five-year patency rate of venous bypasses is better, compared with prosthetic bypasses.
How important is compression in your treatment concept?
Dr. Hummel: Compression is a basic treatment for all venous disorders, be it varicose veins or post-thrombotic syndrome. But also when it comes to the complex combined malformations mentioned previously, we treat arterial-venous fistulas using minimally invasive microcatheters, and for the subsequent venous aspects, compression therapy is the primary starting point.
Patients sometimes worry that they won’t be able to cope with compression products.
Have you come across that, too?
Dr. Hummel: Of course, but compliance also depends on the consultation. Patients need to understand how important it is for them. As surgeons, we can carry out invasive procedures, but ultimately, it’s in the patient’s hands. In cases of complex malformations, for example, patients have to use compression products their whole lives. They allow them to significantly impact their well-being. By the way, when patients research information online before they come to see me, for example, this is also a form of compliance in my opinion. It really makes explanations easier.
You have been working as a surgeon at St. Josef’s Hospital since 1999, and in endovascular surgery since 2004. How has this specialist area developed since then?
Dr. Hummel: A lot of exciting things have happened, especially in vascular surgery. We have a huge choice of treatment options. This includes the new atherectomy systems. That’s a kind of scraper or drill we use to remove small occlusions from the body. Or the new embolic protection systems for treating the carotid artery: using a microfilter, we prevent particles moving from the constricted section, causing an embolism.
“As surgeons, we can carry out invasive procedures, but ultimately, it’s in the patient’s hands. In case of complex malformations, compression products allow patients to significantly impact their well-being.”
Dr. Thomas Hummel
Who keeps driving these developments so quickly?
Dr. Hummel: We have the industry to thank for a lot of that. At the moment, studies and evidence are actually lagging behind rapid technical developments. But you have to back up technical innovations with evidence and prove their superiority, of course. We would then be able to expand indications. There’s also a lack of basic research. A certain genetic mutation has been discovered, for example, which helps protect from vascular diseases. That’s an interesting starting point for further research. And then there’s prevention: nowadays, we’ve got more effective lipid-lowering drugs and new oral anticoagulants – these, too, are subjects that need to be investigated. These are exciting times.
How do you stay connected with your specialist colleagues and researchers?
Dr. Hummel: Gefäß Gesellschaft West and the German Society for Phlebology and Vascular Surgery offer high-quality training with symposia and conventions, currently not face-to-face, of course. I also get involved in these events. Plus, I teach at Ruhr University, I give lectures and seminars.
You’ve recently submitted your postdoctoral thesis for assessment. What is the research topic?
Dr. Hummel: The subject is arterial: it’s about aspects of preventing thromboembolisms, using ASA and clopidogrel, and about treatment using lysis procedures. After all, one in five is a “low responder” to antiplatelet drugs. This is where we want to provide a treatment concept that complies with the guidelines. And for lysis procedures, we want to identify risk factors and criteria for suitable patients.
Images: Katholisches Klinikum Bochum, stock.adobe.com/Khaligo
Complex venous malformations, e.g. with fistulas between the arterial and venous system, are quite a common sight in Dr. Thomas Hummel’s practice. He is the Senior Physician at Ruhr University Bochum’s Artery Center. He sees a clear connection between patient compliance and education.
- In cases of complex combined circulatory disorders, post-operative compression is the primary approach on the venous side.
- In some cases, patients will need compression products for the rest of their lives – proper education significantly improves compliance.
- Vascular surgery benefits from the development of new, high-quality surgical systems that have to be supported with evidence.