Endovascular Surgery
The term endovascular refers to the inner parts of the blood vessels. Therefore, endovascular surgery is a surgical procedure to treat and repair complex diseases and disorders of the blood vessels.
There are several forms of treatment to address the damaged blood vessels. According to most patients, this surgical procedure is less invasive as compared open type of surgery. It also comes with various benefits including, a shorter hospital stay, quick recovery period, less pain, small to no incisions, and limited risks of complications.
Why is it performed?
Endovascular surgery is an effective treatment option for a wide range of blood vessel diseases. The most common condition that requires endovascular surgery is an aneurysm. An aneurysm is the swelling or bulging of the blood vessels that can occur in the artery, especially in the abdominal aorta. This is the section of the main artery that carries blood towards the abdomen. The surgery aims to prevent rupture of the aneurysmal sac.
Other health conditions that require the vascular and endovascular surgery include;
Atherosclerosis: This is a cardiovascular disease that involves the accumulation of cholesterol and plaque with the artery walls. It usually results in the narrowing and blocking of the arteries.
Chronic venous deficiency: This is the damage of the valves or the weakening of the veins. It causes the inability of the veins to carry blood from the limbs towards the heart efficiently.
Carotid artery disease: This is associated with blocking and narrowing of the arteries that carry blood to the brain.
Chronic limb ischemia: This is the narrowing or blocking of the main arteries transporting blood towards the legs or the arms.
Peripheral vascular conditions: This is associated with diabetes complications. The leading cause is atherosclerosis in the arteries that transports blood towards the legs.
Deep vein thrombosis: This is where blood clots form in the main, deep vein, especially in the legs.
Pulmonary embolism: This is associated with the blood clots that form in the arm or leg arteries and move towards the arteries in the lungs.
Stroke: This is a partial or complete blockage of the blood flowing towards the brain. It can result when the blood clot blocks the artery or if an artery ruptures in the brain.
Renal vascular disease: This is a condition where the veins and arteries of the kidneys block or narrows down.
Varicose veins: These are enlarged, bulging, and visible veins that mainly develop in the legs. It can result in swelling and other associated symptoms.
Vascular defects: Includes clusters of abnormal and enlarged veins, arteries, and lymph nodes caused by genetic conditions.
Tumors: Comprises both malignant and benign tumors
Types of Endovascular Surgery
Endovascular surgery ranges from the minimally invasive type of endovascular surgery to open-heart procedures. The common types of endovascular surgery include the following;
- Aneurysm repair
To address aneurysm condition, the surgeon often performs the traditional open surgical procedure. Endovascular aneurysm repair aims at replacing the diseased or damaged part of the aorta using an artificial graft. Alternatively, surgeons can opt for the minimally invasive technique. This guides the stent-graft to the weak section of the aorta wall and imaging guidance via a small incision.
- Carotid angioplasty and stent placement
This is a minimally invasive surgery that involves inserting a catheter into the blood vessel in the groin. The catheter is usually attached to a balloon at the tip. It’s directed towards the blocked or narrowed carotid artery, where the surgeon inflates the balloon to open the carotid artery. Sometimes, a stent is placed to help maintain the artery open and allow normal blood flow.
- Bypass surgical procedure (peripheral)
This is an open type of bypass surgery that surgeons conduct to restore the normal blood flow in the affected area. This also includes the associated essential organs where blockage of the artery is severe. However, the treatment of arterial blockage can vary. This depends on extend of the damage, symptoms, general health condition, and blockage anatomy.
- Carotid endarterectomy
Carotid endarterectomy is a surgical procedure to remove plaque that accumulates and blocks the carotid artery. Surgeons perform this surgery via the small incision created in the neck and can also help prevent stroke.
- Endovascular repair
This is a procedure to treat complex and significant vascular diseases. It applies the endovascular technique that involves directly inserting the catheter into the blood vessels. The surgeon will then use the catheter to administer medication and efficiently guide the surgical tool. An example of these surgical procedures is the aortic valve or aortic aneurysm repair.
- Dialysis access procedure
Dialysis access surgical procedure is specially designed for long-term use. It involves creating a vein to help remove and place back blood into the patients' body going through dialysis. Dialysis is a process of extracting excess water, toxins, and solutes from the blood.
- Stent grafting
A stent graft refers to a large metallic stent that is usually covered in a woven synthetic tube. Stent grafting thus involves inserting the graft into the blood vessel when performing a catheterization procedure. It helps maintain the carotid artery, peripheral artery, and coronary artery open as well as repairing aneurysm condition.
How Endovascular Surgery is done
If you are scheduled to undergo an endovascular surgery to correct certain conditions, then you should expect the following;
Before the procedure (preparation):
Before undergoing surgery, it’s mandatory for the surgeon first to assess your medical history and perform a physical examination. Tests such as the electrocardiogram (ECG) and stress test might also be conducted to check the health state of the heart. ECG is a technique that analyzes and records the heart’s electric activity.
To further determine if the blood vessel condition is treatable via an endovascular procedure, the surgeon can recommend additional tests. This can include angioplasty and computerized tomography (CT) scan to enable visualization of the blood vessels and aorta. Besides, these tests make it easier to choose the right size of the graft.
The procedure:
The surgeon often performs endovascular surgery under regional anesthesia or sedatives. This helps keep you comfortable and prevent pain sensation by numbing the surgical site. Alternatively, they can administer general anesthesia to make you completely unconscious during the procedure.
After that, the surgeon will clean and sterilize the operation area, making it free from bacteria and infections. A small incision is then created on the skin near the blood vessel. Using special x-ray techniques, the surgeon will insert a catheter via the incision and direct it towards the affected site.
To address aneurysm condition, the graft is inserted via the catheter. It’s then directed through the blood vessels towards the aorta located above the aneurysm. Once in the target position, the graft is left free from the catheter. This allows it to expand, hence preventing blood flow toward the aneurysm. With time, the aneurysm will shrink, and the associated symptoms of the condition will gradually disappear.
When it comes to stroke, the surgeon will insert the catheter into the blood vessel and direct it towards the affected part of the brain. After that, a stent is passed through the catheter and released into the target location. This is to help restore the normal flow of blood. Once the blood flow is corrected, the clot causing the blockage is removed alongside the stent.
Recovery:
Once the surgery is done, the healthcare team will care for and closely monitor your condition. You might be required to remain in the hospital for at least two or three days. This, however, depends on the extent and type of the procedure.
After that, you can be allowed to go home once the medical team confirms that you are stable enough. The recovery period can take a week or less, after which you can resume work and other daily activities. However, you should note that complete recovery could take a month. Therefore, it’s essential to follow the doctor’s instructions to avoid interfering with the healing process.
Risks and Complications of Endovascular Surgery
Like any other surgical procedure, endovascular surgery carries a few risks and complications. It can include the following;
- The fracturing of the graft
- Fever accompanied by an increase in the count of the white blood cells after the procedure
- Blockage of the normal flow of blood via the graft
- Infection of the surgical site
- Movement or dislocation of the graft from the target position
- Blood leakage around the graft
Other rare but possible complications that might arise during or after the procedure include;
- Injury of the kidneys during the procedure
- Blockage of the flow of blood towards the lower body region
- Bursting of the artery
- Paralysis
- Prolonged aneurysm rupture
Bottom Line
Endovascular surgery is a minimally invasive type of surgery. Surgeons usually perform a range of endovascular procedures to help unblock, correct, and redirect the blood vessels. This also aims to treat various medical conditions and restore the normal circulation of blood within the body. Furthermore, this surgery is less invasive hence doesn’t carry a lot of risks.
CloudHospital is committed to providing the least invasive surgical procedure possible. It works with a team of experts who utilizes the advanced endovascular approach. This is to help address cardiovascular and blood vessel-related issues, restore impaired functions, and prevent more complications.