The service treats all the vascular pathology.
Technical equipment used:Acuson Aspen Advanced, EsaoteTechnos, Philips T 700.
The surgical capacity reach 1000 patients/year, having an especial development in endovascular treatments and pelvic venous pathology.
Pelvic congestion syndrome
Pelvic congestion syndrome causes painful sexual intercourse in woman and testicular varicocele in man.
The pelvic varicose veins are diagnosed and treated at the same time by multidisciplinary teams as Ruber International Hospital team.
Varicose veins pathology is widespread among population, particularly in women. It is also related to pregnancy.A large number of patients with varicose veins in legs, also have varicose veins in the pelvis, which is called Pelvic Congestion Syndrome (PCS).Varicose veins appear between the uterine-ovarian regions to the pelvis and are developed due to pregnancies and the significant increase of vascularization. These varicose veins produce blood pressure intensification. Then they generate other ones in lower areas as in genital region (vulva) and in legs.
This is a poorly known disease; it is suffered by up to 20% of women who have had children. Its treatment is simple, almost without complications, and it has also a crucial inheritable element.
The most important symptoms of PCS are chronic pelvis pain, heaviness in low region of abdomen, particularly in stand position and painful sexual intercourse. They are also typically accompanied by varicose veins in the vagina (vulva) and varicose veins in lower limbs.
While legs varicose veins have been widely studied and treated by different methods, “there is a big lack of knowledge even at a professional level of intrapelvic varicose veins which, in a considerable majority of cases, are the origin of lower limbs varicose veins,” points out Javier Leal Monedero, M.D., Head of Angiology and Vascular Surgery Unit, Ruber International Hospital.
At present, this disease can be diagnosed and treated simultaneously thanks to the medical teams of vascular surgeons and vascular interventional radiologists (multidisciplinary team) with a wide experience in diagnosis and treatment of this problem, as the one available in Ruber International Hospital.
Diagnosis is also achieved by the above mentioned clinical signs and symptoms, with ultrasound and Doppler ultrasound performing, a non-invasive technique that provides great information.Sometimes, it is useful to have other imaging techniques such as Angio CT and Angio MR (AMR).“The accurate diagnosis which is done in the same performance with the treatment done by “pelvic phlebography'” via a small catheter (tube) less than the 2mm caliber placed from an elbow flexure vein sailing under x-ray control to canalize pelvis varicose veins.This same performance can be treated by embolization. In other words, an occlusion is made with a sclerosing substances deposit and devices called coils, which close completely the ill veins” as says Doctor Santiago Zubicoa, from Imaging Diagnosis Service. Ruber International Hospital.
As legs varicose veins are treated by punctures or small incisions since they are really superficials, “to treat these other ones inside the abdomen, it would be necessary a very complicated surgery,” says Dr. Leal Monedero “however, with the mentioned technique, our working team can perform the treatment without anaesthesia, an 20-30-minute operation and a minimum hospitalization of four hours,” asserts remarks the doctor.
Ruber International Hospital has a high-technology digital interventionist angiography where many diagnoses and treatments are performed improving considerably the quality of life of patients affected by this disease. The follow up is performed through the clinical routine and the eco-Doppler each 6 months. There are many chances to happen again if new pregnancies.
After doing an embolization, patients ameliorate noticeably their pelvic pain, abdominal heaviness, varicose veins in lower limb symptoms. Moreover, they also gain a significant improvement in painful sexual intercourse.
Within men, there is a vein pathology rather related known as testicular varicocele, and they are located varicose veins around the testicle that produce pain and sperm alteration; they even could cause testicular atrophy. Among a 16 and a 20% of men have the varicocele in one of their testicles. This is one of the most frequent origins of infertility. Diagnosis is also made by eco-Doppler and the treatment is alike pelvic varicose veins treatment, a small catheter is inserted from the arm to close the sperm vein which causes the varicose veins.
Abdominal aorta aneurysm
Abdominal aorta aneurysm treatment without open surgery.
Ruber International has performed more than 200 operations using the endovascular technique. It is made through small incisions or punctures from groins, being not necessary to open the abdomen.
One of the most common arterial disease indicators (atherosclerosis) is the aneurisms development, the enlargement of the arterial light provoking a weakness of its wall and predispose it to the spontaneous break with a large abdominal hemorrhage and with a very high mortality risk.
The aorta arterial diseases and the lower limb are really frequent in population, particularly in elderly. The aorta is the main tube that distributes the blood to the abdomen viscera, to pelvis and lower limbs.The legs arteries carry oxygen to muscles and when they strengthen due to arteriosclerosis, there is a lack of irrigation obliges patients to stop walking what is known as intermittent claudication or showcase disease.
While these arterial problems in legs produce known symptoms, the aneurism of the abdominal aorta is a disease without any indication. It must be diagnosed typically in a casual manner “when doing an ultrasound or CT for another disease as could be prostatic, of lumbar column, etc.,” Dr. Santiago Zubicoa, points out from Imaging Diagnosis Service. Ruber International Hospital.
“The risk of spontaneous breaking depends on aneurysm sac calibre what obliges to do a treatment when 5cm diameters are reached” – points out doctor Javier Leal Monedero, Chief of Angilogical and Vascular Surgery Unit from Ruber International.Open surgery has been the traditional treatment, a very aggressive technique with a significant rate of medical complications related to it:Renal failure, myocardial infarction, pneumonia, etc., with a hospitalization and ICU of ten days approximately.
In the lasts years a very efficient technique has been developed for aneurisms treatment, which is made by minor incisions or punctures from groins and is not necessary to open the abdomen. This technique called endovascular, “involve excluding the aneurism bag through a bifurcated stent, there are coated stents that exclude the aneurism bag, and they are placed under renal arteries, spreading to iliac arteries.”This technique allows a minimal hospitalization of 24 to 48 hours, and the complications’ rate is significantly inferior to traditional surgery; therefore, it is specially indicated particularly in elder patients who have major anaesthesia risk.
Although it is not an open surgery, this technique requires the participation of several specialists. Ruber International Hospital has a multidisciplinary medical team (vascular surgeons, interventionist vascular radiologists) with a wide expertise. They accomplish this treatment in a digital angiography room with the best performances and the benefit of be located in the surgical area, allowing to combine high technology with an asepsis area.“This situation –adds Dr. Santiago Zubicoa- makes really easier the treatment, since the image quality to see the aorta and its branches is of a highest level and help the accurate placement of the stent.”
“Looking backwards, a high percentage of aneurisms came to the hospital when the breaking already occurred, but now, thanks to the imaging techniques it is detected in an early stage.The aneurisms origin depends on the factors combination as: Genetic factors, arterial walls weakness and among all, mainly arteriosclerosis and hypertension. It is frequent in men, with an approximate proportion of 5-6 men per one case in women,” explains Doctor Zubicoa.
Once this aneurism is solved “it is important to establish a patient’s monitoring, not for the operation itself, –states Doctor Javier Leal Monedero– but because it is a chronic disease and other signs can arise, as occlusions or aneurysms in other areas.”
Sociedades a las que pertenece:
• Socio de Honor de la Sociedad Ecuatoriana de Flebología.
• Socio de Honor de la Sociedad Colombiana de Flebología.
• Socio de Honor de la Sociedad Argentina de Flebología.
• European Venous Forum (Miembro Fundador).
• International Union of Angiology.
• Sociedad Española de Angiología y Cirugía Vascular.
• Sociedad Centro de Angiología y Cirugía Vascular (Miembro Fundador).
• Union Internationale de Phlébologie.
• Société Française de Phlébologie.
• Society of American Vascular Technology.
• Doppler Club Ibérico (Ex-Presidente).
• Doppler Club España (Ex-Presidente).
• Doppler Club Portugués (Ex-Miembro).
• Society of Non-invasive Vascular Technology (USA).
• Miembro honorario de la Sociedad Peruana de Angiología y Cirugía Vascular.
• American Venous Forum.
• Vicepresidente para España de la Sociedad Panamericana de Flebología y Linfología.
• Miembro honorario de la Sociedad Brasileña de Flebología y Linfología.
• Docente ad-honorem por la Facultad de Medicina de la Universidad Militar Nueva Granada de Bogotá.
• Docente ad-honorem por la Facultad de Medicina de San José, Bogotá.
Sociedades científicas a las que pertenece:
Arterial pathology.Direct arterial surgery
To supraaortic trunks sector, carotid
Subclavian of abdominal aortic sector
Aneurysms.Femoro-popliteal sector occlusions and distal arteries.Endovascular treatment, in partnership with Radiology Service:
Aortic endoprosthesis, iliac stent, femoro-popliteal and distals.
Study and treatment of pelvis veins insufficiency: Pelvic varicose veins, pelvic varicocele. May-Thurner Syndrome. Stent implantation in the postthrombotic syndrome.
Conventional surgery and by endovascular laser technique. Closour.
Aesthetic treatments by sclerotherapy, microfoam, cryosclerosis.
Study and treatment of lymphedema, primary or secondary, (post-mastectomy)
Arterial and vein system study of head, neck, abdomen and limbs with high quality equipments.
Plethysmographic studies by transcranial Eco-doppler, rolling belt.