Vascular surgery involves either an artery or a vein. When the surgery is done from within the blood vessel, it is called endovascular surgery.
Endovascular surgery is a relatively new, less-invasive procedure for treating the two major problems that can develop in blood vessels: an aneurysm and a narrowing (also called an occlusion or stenosis).
An aneurysm is a weakness in a major blood vessel that causes a portion of the vessel wall to balloon out. For years, the problem was repaired by exposing the vessel through an incision and replacing the weakened portion of the vessel with a synthetic graft sewn into healthy ends of the vessel. The surgery required general anesthesia.
Narrowing, or occlusion, is another condition that can occur inside an artery or a vein. In the past, when narrowing occurred in the carotid arteries (the arteries that supply blood to the brain), an incision was made in the neck to place a synthetic graft. This surgery also required general anesthesia.
Endovascular surgery uses an easily accessible smaller artery to reach the problem and does not require general anesthesia. During most endovascular procedures, a long plastic tube called a catheter is placed into the femoral artery in the groin. Using X-ray imaging, a physician advances the catheter to the aneurysm or narrowing.
To repair an aneurysm, a hollow, manufactured tube (a graft with metal attachments) is pushed through the catheter to the aneurysm and anchored in place.
To open a narrowing, an angioplasty with stenting is done. An angioplasty is a procedure in which a balloon is inserted and advanced to the narrowing. The balloon is then inflated, and a stent (a small, mesh-like stainless steel tube) is moved to the narrowing. The balloon is deflated and removed, and the stent expands and presses against the inner walls of the artery, keeping it open.
Advantages of Endovascular Surgery
Advantages of endovascular surgery include:
- Less discomfort.
- Local or regional anesthesia instead of general anesthesia.
- Reduced need for blood products.
- Less invasive, making it safer.
- Smaller incision.
- Less stress on the heart.
- Fewer risks for patients with other diseases, such as coronary artery disease, kidney or lung problems.
- Shorter recovery time.
While traditional vascular surgery procedures have been performed for more than 50 years, endovascular procedures have been widely used only since 1995. Therefore, the long-term results of endovascular surgery require further follow-up.
Evaluation for Endovascular Surgery
Abdominal aortic aneurysm
Physicians at Mayo Clinic in Florida evaluate patients to determine if they might be candidates for endovascular repair of an abdominal aortic aneurysm. Patients are evaluated on an outpatient basis using state-of-the-art computer tomography (CT) scanning to map the aneurysm anatomy and determine whether they are candidates for minimally invasive aneurysm repair. The repair itself is done in a hospital operating room. Patients usually spend one to three days in the hospital and are then seen at six month intervals for physical examination and CT scanning.
Carotid artery angioplasty with stenting
Mayo Clinic physicians evaluate patients who have a narrowing of the carotid arteries to determine if they are candidates for carotid angioplasty with stenting. The tests that are done before the angioplasty are the same as those done before traditional surgery, called a carotid endarterectomy, and include special duplex ultrasound and magnetic resonance angiography. Patients are evaluated as an outpatient. The stenting procedure is done with a neuroradiologist in a special interventional radiology suite at the hospital. Patients usually spend about 24 hours in the hospital and are then seen at six-month intervals for follow-up.