Zertifizierung von gefäßzentren - erste erfahrungen der Deutschen gesellschaft für gefäßchirurgie

Background. Advances in vascular medicine in the areas of conventional vascular surgery, endovascular processes, and conservative therapy require, for both medical and economic reasons, close interdisciplinary cooperation. The designation vascular center signals to patients and admitting physicians optimal specialist and organisational competence. To maintain content and structural qualities, the German Society of Vascular Surgery has produced a criteria catalogue for the certification of interdisciplinary vascular centers. Essential to this are the availability of emergency therapy, interdisciplinary teams as well as an adequate number of cases and efficiency. Materials and Methods. A total of 60 written applications have been submitted since 2002, and 45 vascular centers have been certified for 3 years after auditing by the Quality Assurance Commission of the German Society of Vascular Surgery. Eleven centers were refused certification (19.3%) and four applications are currently being considered. The following analysis is based on 44 federal German certified vascular centers. Results. A median of 1,165 inpatients and 2,234 outpatients were handled per center per year (11.5% as emergencies). Arterial disease was associated with 60% of cases. Vascular surgery and radiology are available in all centers, angiology is available in 10/44 centers through cooperation with external specialists. Each vascular center has on average 4.3 vascular surgeons and 1.2 angiologists available. Vascular surgery is an independent entity in 28 centers and is integrated with general surgery in 16. Angiology is a separate department or section in nine centers; in the other centers it is integrated with internal medicine. Radiological and ultrasound diagnostics are available in all centers (CT, angiography, and duplex ultrasound in 100%, MRT in 95%). There are a median of 473 (207-1,320) arterial operations and 243 (5-871) interventions per vascular center every year. Added to these are varicose vein surgery, (n=207), shunt units/revisions (n=40), minor amputations (n=61), and major amputations (n=42). Conservative therapy is carried out on 392 (145-3,606) cases per year (peripheral AVK, diabetic foot, phlebothrombosis, chronic venous insufficiency). Conclusions. The certification of vascular centers assures the content and structural qualities of such interdisciplinary operations.