Definition and Overview

An endovascular surgery is a minimally invasive surgical technique that is used to treat a variety of diseases, with surgeons accessing the affected body parts via the major blood vessels. It is performed by inserting a catheter through a small skin incision and passing it through a major blood vessel, which is usually the femoral artery or the one located near the joint, but can also be the radial/brachial artery located in the arm or the pedal artery located in the foot. The choice as to which blood vessel is used depends on which part of the body needs to be accessed.

This type of surgery can help treat a large number of diseases affecting different parts or organs of the body, making it highly versatile. The procedure has become a popular choice among surgeons and patients alike because when compared to invasive operations, it is safer and comes with minimal risk and shorter recovery time.

Who Should Undergo and Expected Results

An endovascular surgery can be used for the treatment of:

• Aortic aneurysms – Aneurysm refers to either the bulging or dilation of a weakened blood vessel or artery usually due to disease or abnormal blood pressure. Severe aneurysms may cause the blood vessel or artery to burst leading to internal bleeding and potentially fatal consequences.

• Deep vein thrombosis – Also known as thrombophlebitis, venous thrombosis, or pulmonary embolism depending on the specific type and location of the clot, this refers to a blood clot that occurs in any of the deep veins of the body. This is caused by the thickening and clumping together of blood cells. When left untreated, it can lead to life-threatening conditions.

• Atherosclerosis – This is a condition characterized by hardened arteries due to the accumulation of plaque, making it harder for blood to pass through properly.

• Coronary artery disease – Considered as the most common type of heart disease, this condition may lead to angina, heart attack, arrhythmias, and heart failure, mainly because the heart is unable to properly deliver blood throughout the entire body.

• Fibromuscular dysplasia – This refers to a non-inflammatory blood vessel problem characterized by the presence of abnormal growths within artery walls. The majority of cases affect the carotid and renal arteries.

Different types of endovascular surgery

• Endovascular stent graft – This refers to a procedure wherein a stent, or a small tube, is inserted into an artery to support proper blood flow. This expands the walls of clogged arteries to allow blood to flow through with ease.

• Aortic aneurysm repair, reconstruction, or replacement – This refers to all endovascular procedures used to repair, reconstruct, or replace a clogged or hardened aortic aneurysm.

• Carotid endarterectomy – Also known as carotid artery stenting, this refers to surgery performed on carotid arteries that are narrowed by up to 70% of their normal size.

Regardless of what condition is being treated and what specific kind of endovascular surgery is performed, this type of procedure is largely more beneficial than traditional open surgery because:

• As a minimally invasive surgical technique that uses a number of small incisions to replace a single big incision, the procedure reduces bleeding and lessens potential blood loss.

• The patient is subjected to significantly less pain and discomfort both during and after the procedure.

• The procedure requires a much shorter recovery period, with most patients out of the hospital in 3 days, resuming their normal activities by the 2nd week, and fully healed by the 4th week, as compared with traditional open surgery, which requires patients to stay in the hospital for up to 10 days and is followed by a full recovery timeframe of up to three months.

• Endovascular surgical procedures are safer for patients who face a higher risk of complications, such as elderly patients, those with serious medical conditions, and those whose bodies are unable to handle too much stress.

How Does the Procedure Work

Endovascular surgery can be performed by general, cardiothoracic, and peripheral vascular surgeons.

The procedure begins with the administration of anesthesia followed by the creation of small incisions in the body part that is closest to the artery that the surgeon is planning to use. Once the incisions are made, the surgeon will insert a catheter into it and start performing the procedure by inserting other tools through the catheter and the blood vessels.

For example, in endovascular surgery for the treatment of aneurysms, the surgeon will insert a guide wire and the graft itself through the catheter and through the blood vessels that will eventually lead it to the site of the aneurysm.

It is normal for the surgeon to schedule a follow-up check a couple of weeks after the surgery. The goals are to ensure that the patient is recovering well, has benefited from surgery, and is free from any complications.

Possible Risks and Complications

Despite being minimally invasive, endovascular surgery is still associated with certain risks and potential complications, such as:

• Local blood flow obstruction
• Fever
• Increase in white blood cells
• Graft fracture
• Infection
• Blood leakage on areas surrounding the graft
• Movement of the graft into an incorrect position
• Burst artery
• Major obstruction of blood flow
• Delayed aneurysm rupture
• Kidney injury

• Paralysis
  References:

• Brinjikji W, Lanzino G, Cloft HJ, Rabinstein A, Kallmes DF. Endovascular treatment of very small (3 mm or smaller) intracranial aneurysms: report of a consecutive series and a meta-analysis. Stroke. 2010;41:116-21. PMID: 19926837 www.ncbi.nlm.nih.gov/pubmed/19926837.

• Mack W, Dusick JR, Martin N, Gonzalez N. Principles of endovascular therapy. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 47.