Vascular Surgery

I. Department overview

The Department of Vascular Surgery of the Affiliated Hospital of Qingdao University is a key discipline in Qingdao and one of the hospital’s master’s degree-granting sites. Under the leadership of Professor Wang Haofu, the Department of Vascular Surgery became an independent department in 2007. It currently has two wards, at the Shinan Campus and the West Coast Campus, with a total of 47 open beds. Through continuous technological innovation and improvement, the Department of Vascular Surgery has brought a number of technologies to internationally leading levels. While serving the extensive patient population in the eastern part of the Shandong Peninsula, 10% of its patients come from other provinces and cities, including Heilongjiang Province, Jilin Province, Liaoning Province, Hebei Province, Henan Province, Jiangsu Province, Inner Mongolia Autonomous Region, Shanghai Municipality, Sichuan Province, and Zhejiang Province. It has also cured many foreign patients, including patients from Japan, South Korea, Ukraine, the United Kingdom, Australia, and the United States.

II. Talent structure

The Department of Vascular Surgery has strong talent resources and has developed into a high-level medical, teaching, and research group headed by Professor Wang Haofu and supported by a large number of highly qualified young and middle-aged technical specialists. The discipline currently has 16 full-time physicians, including 6 with doctoral degrees and 10 with master’s degrees. The proportion of personnel with a master’s degree or above is 100%. There is 1 senior professional title holder, 1 associate senior professional title holder, and 1 master’s graduate student supervisor. The discipline has a rational talent structure, and its academic leader is in the prime of life and highly capable. The position is held by a senior professional with recognized high academic attainments, outstanding achievements, and the ability to lead the discipline in completing its established objectives. The discipline has the authority to grant master’s degrees and is a member unit of the national specialty group, with overall strength ranking among the advanced level in the province.

III. Professional specialties

1. Endovascular aneurysm repair for abdominal aortic aneurysm: Abdominal aortic aneurysm (Abdominal Aortic Aneurysm, AAA) is a relatively common disease in vascular surgery and tends to rupture, seriously threatening human health. The mortality rate of ruptured abdominal aortic aneurysm reaches 90%. AAA is often associated with multiple risk factors, such as advanced age, a history of smoking, coronary artery disease, hyperlipidemia, and chronic obstructive pulmonary disease (COPD). Elderly and high-risk patients with AAA may be unable to undergo conventional surgery, or conventional surgery may carry high risks, many complications, and a high operative mortality rate. Since Parodi et al. first successfully applied endovascular aortic aneurysm repair (Endovascular Aortic Aneurysm Repair, EVAR) to treat AAA in 1991, AAA treatment has entered an entirely new minimally invasive era, providing a treatment possibility for elderly and high-risk patients who cannot tolerate conventional surgery. EVAR involves implanting a suitable covered stent into the aortic lumen under dynamic monitoring by digital subtraction angiography (DSA), fixing it to the normal aortic wall proximal and distal to the aneurysm, and isolating the aneurysm wall from blood flow within the vessel lumen to achieve the treatment objective.

Our department has completed more than 300 EVAR procedures, with a high operative volume, including 8 renal artery chimney-technique procedures, 4 main uni-iliac stent-graft plus femorofemoral arterial bypass procedures, 4 access-vessel PTA plus stent angioplasty procedures, 1 procedure using a prosthetic vessel to establish access, 13 bare-stent angioplasty procedures for iliac-limb stenosis, 10 staged coverings of the internal iliac artery, 20 simple balloon dilations for type I endoleaks, 28 procedures with an additional Cuff, and 11 in situ internal iliac artery transplantations.

2. Resection of abdominal aortic aneurysm and prosthetic vascular replacement: With the development and maturation of endovascular aneurysm repair for abdominal aortic aneurysm, treatment has become possible for elderly and high-risk patients who cannot tolerate conventional surgery. However, for young patients or patients unsuitable for endovascular repair, abdominal aortic aneurysm resection plus prosthetic vascular replacement is their only curative treatment.

Our department has completed more than 200 abdominal aortic aneurysm resections plus prosthetic vascular replacements. These include 4 thoracoabdominal aortic aneurysm resections plus prosthetic vascular replacements, 40 ruptured abdominal aortic aneurysms, an operative mortality rate of 25% for ruptured abdominal aortic aneurysm, and an operative mortality rate of 1% for elective abdominal aortic aneurysm surgery, all reaching internationally leading levels. Our department summarized the clinical data on abdominal aortic aneurysm surgery and established an evaluation system, thereby reducing operative mortality. It also applied for and completed an appraisal of a Qingdao municipal project, reaching an internationally advanced level.

3. Thoracic endovascular aortic repair: Aortic dissection is a relatively common acute and critical condition in vascular surgery. It can cause hypoperfusion syndrome involving the cerebral vessels, viscera, kidneys, and peripheral arteries; cardiac complications, including acute aortic valve insufficiency, coronary ischemia, and cardiac tamponade; or rupture. Stanford type A aortic dissection in particular has an extremely high mortality rate. During the initial 48 hours, mortality increases by 1% with each passing hour; the mortality rate is approximately 50% on the second day, 75% at 2 weeks, and 90% at 1 year. Conventional surgical treatment involves extensive trauma and a high complication rate. Since Dake et al. first reported the successful treatment of aortic dissection with stent-grafts in 1994, thoracic endovascular aortic repair has been widely used to treat aortic dissection.

Our department has completed more than 100 thoracic endovascular aortic repairs, with a high operative volume, including 8 supra-aortic hybrid procedures, 10 left subclavian artery chimney-stent implantations, 13 restrictive stent implantations, 12 covered-stent treatments for the distal entry tear of aortic dissection, and 1 cured case of Stanford type A aortic dissection.

4. Surgery and endovascular treatment for lower-extremity atherosclerotic occlusive disease: The incidence of lower-extremity atherosclerotic occlusive disease has increased year by year. The prevalence of peripheral arterial occlusive disease is 1.4–1.9% at 40–49 years of age, 6.9% at 50–59 years of age, and 20% at 70 years of age. Mild lower-extremity atherosclerotic occlusive disease manifests as intermittent claudication. Critical limb ischemia (Critical limb ischemia, CLI) manifests as rest pain, limb ulceration, or gangrene and may even threaten the patient’s life. The 1-year amputation rate for CLI is 27%, and the 5-year mortality rate is 46%.

The department has completed more than 200 bypass operations for lower-extremity atherosclerotic occlusive disease, profunda femoris artery angioplasty, and other procedures, as well as more than 500 endovascular treatments for lower-extremity atherosclerotic occlusive disease (PTA and/or stent angioplasty), including more than 200 hybrid operations for complex lower-extremity atherosclerotic occlusive disease.

5. Catheter-directed thrombolysis for lower-extremity deep venous thrombosis: The dangers of lower-extremity deep venous thrombosis are increasingly recognized. In addition to causing pulmonary embolism, its sequelae can seriously affect patients’ work and life, and may even cause disability; therefore, active treatment should be provided. A consensus has been reached on anticoagulant treatment for acute deep venous thrombosis. After anticoagulant treatment alone, although recanalization of thrombosis in the main trunks of the lower-extremity deep veins and the establishment of collateral circulation may occur, deep venous valve function is seriously impaired, and the recanalization rate of the iliac vein is low, only 1%. This is the main factor leading to post-thrombotic sequelae of lower-extremity deep venous thrombosis. Surgical thrombectomy can rapidly relieve deep venous obstruction, restore deep venous patency, prevent destruction of the venous valves by thrombus organization, and maintain normal deep venous function of the lower extremity. It also relieves acute edema of the gastrocnemius muscle, prevents deterioration of the gastrocnemius muscle pump function, and minimizes the occurrence of post-thrombotic syndrome. However, surgery can cause venous intimal injury and secondary thrombosis. In addition, in patients with Cockett syndrome and lower-extremity deep venous thrombosis, the left iliac vein is stenotic or occluded, and surgical thrombectomy cannot relieve the iliac vein stenosis or occlusion. Catheter-directed thrombolysis places a catheter within the thrombus and locally administers thrombolytic drugs. The drug concentration is high, allowing rapid dissolution of the thrombus. The use of a thrombolysis catheter is particularly convenient for dissolving long-segment thrombi.

Our department strictly follows international guidelines and has completed 124 cases of inferior vena cava filter implantation plus catheter-directed thrombolysis, with a high technical level, including repeated iliac vein PTA in 38 cases, inferior vena cava PTA in 5 cases, and femoral vein PTA in 17 cases.

6. Endovenous laser treatment of lower-extremity varicose veins

Lower-extremity varicose veins are very common in vascular surgery. Their treatment includes high ligation of the saphenous vein plus local stripping, which involves extensive trauma, multiple incisions, slow recovery, and an effect on appearance. Laser treatment of varicose veins has the advantages of minimal trauma, rapid recovery, and good cosmetic results, and its use is becoming increasingly widespread. Our department has completed more than 1,000 cases of endovenous laser treatment for varicose veins, with good results.

IV. Medical technology

The department has comprehensively carried out the diagnosis, surgery, and interventional treatment of various vascular diseases and has formulated clinical diagnosis and treatment routines and standards for various diseases. Dozens of new technologies and new projects have been introduced successively in the province and Qingdao. The department has accumulated highly mature experience in the diagnosis and treatment of congenital vascular malformations, various vascular injuries, aneurysms, atherosclerotic occlusion, arterial embolism, tumors involving major blood vessels, venous thrombosis, and lower-extremity varicose veins. More than 200 abdominal aortic aneurysm resections plus prosthetic vascular replacements have been completed, ranking among the leading levels in the province. The number of ruptured abdominal aortic aneurysms treated ranks among the highest in China, and the mortality rate of elective abdominal aortic aneurysm surgery is low; all have reached internationally leading levels. More than 200 endovascular abdominal aortic aneurysm repairs have been completed, with a high technical level. More than 100 thoracic endovascular aortic repairs have been performed to treat aortic dissection, also with a high technical level. The operative mortality rates for carotid artery aneurysm, carotid body tumor, and carotid artery stenosis are low. More than 400 endovascular treatments and hybrid operations for lower-extremity atherosclerotic occlusive disease have been completed, with a high level. The number of bypass and vascular replacement procedures using high-technology e-PTFE prosthetic vessels has reached 200, ranking among the highest in China. The technical level of minimally invasive endovenous laser treatment for lower-extremity varicose veins is leading in China. Many hospitals from throughout the country have come to our hospital to observe and study, and we have also been invited to hospitals in various regions to demonstrate surgery. More than 100 patients with difficult and critical conditions have been successfully treated. The level of diagnosis and treatment of difficult vascular malformations and management of vascular injuries has also reached a leading level in China. Director Wang Haofu successfully treated a patient with carotid artery injury in an emergency; the case was made into the film Emergency Rescue as a prototype. Removal of a foreign body from the internal carotid artery after trauma was reported by CCTV10’s Approaching Science and subsequently received attention and praise from domestic experts.

The main new technologies developed include: supra-aortic hybrid surgery for the treatment of thoracic aortic aneurysm; left subclavian artery chimney-stent technology for the treatment of descending aortic dissection; restrictive covered stents for the treatment of abdominal aortic dissection; covered stents for the distal entry tear of aortic dissection; thoracic endovascular aortic repair for the treatment of ascending aortic dissection; thoracoabdominal aortic aneurysm resection plus prosthetic vascular replacement plus autologous kidney transplantation; abdominal aortic aneurysm resection plus prosthetic vascular replacement plus inferior mesenteric artery implantation; renal artery chimney technology for the treatment of complex abdominal aortic aneurysm; repair of arteriovenous fistulas with multilayer bare stents; upper-extremity arterial puncture and catheterization for the treatment of lower-extremity atherosclerotic occlusion; unilateral main iliac artery covered-stent technology for the treatment of aorticocaval fistula; profunda femoris artery angioplasty; venous arterialization for the treatment of thromboangiitis obliterans; endovascular treatment of reocclusion within lower-extremity arterial stents; hybrid surgical treatment of complex lower-extremity atherosclerotic occlusive disease (a combination of surgery and endovascular treatment); repeated PTA technology for the treatment of Cockett syndrome; application of thrombolytic technology in peripheral arteriovenous thrombosis; and comprehensive treatment combining embolization and surgery for vascular malformations.

V. Scientific research and teaching

In addition to completing its clinical medical duties, the Department of Vascular Surgery undertakes teaching on peripheral vascular diseases in surgery for undergraduate clinical medicine classes, seven-year program students, and nursing students at the medical school. Since 2000, it has trained a total of 25 master’s students. The department has always emphasized international exchange and cooperation and has successively established long-term, stable cooperative relationships with relevant institutions in the United States, Germany, South Korea, and other countries.

It participated in one project approved by the Qingdao Municipal Science and Technology Bureau. The project Development of a New Surgical Method for Parotid Tumors and a Postoperative Compression Device won the first prize of the Qingdao Science and Technology Progress Award. It led three projects approved by the Qingdao Municipal Science and Technology Bureau. The project Experimental Study of Changes in Vascular Intimal Function after Venous Arterialization won the third prize of the Qingdao Science and Technology Progress Award and the third prize of the Shandong Provincial Education Commission. In 2006, Perioperative Organ Function Protection and Evaluation in Thoracoabdominal Aortic Aneurysm was appraised as completed and reached an internationally advanced level. Application and Research of New Technologies for Endovascular Repair of Abdominal Aortic Aneurysm is currently under study. The department participated in one National Natural Science Foundation project and leads one Youth Project of the Shandong Provincial Natural Science Foundation.

Since 2000, it has published more than 30 papers in domestic and international core journals, including more than 10 indexed in SCI, and has co-edited 6 monographs: Practical Diagnosis and Differential Diagnosis of Vascular Diseases in the Elderly, Reoperative Surgery, Diagnosis and Treatment of Common Surgical Skin Diseases, Establishment and Maintenance of Hemodialysis Access, Surgery of the Vena Cava, and Rutherford’s Vascular Surgery.

VI. Guide to visiting the department

(1) Department location

Shinan Campus outpatient department: 6th floor of the outpatient building

West Coast Campus: 4th floor of the outpatient building

Shinan Campus inpatient department: 3rd floor of the Medical Technology Building

West Coast Campus: 21st floor of Building A of the Inpatient Building

(2) Consultation telephone numbers

Shinan Campus: 82911685 West Coast Campus: 82919069