The field of endovascular surgery evolved out of interventional radiology techniques that were developed to help treat diseases that are endovascular (occurring inside blood vessels). This type of treatment has become a great alternative to vascular surgery.The basic endovascular surgery techniques have your doctor inserting a catheter into a large blood vessel in your body, typically the one chosen is your femoral artery or another vein found near your groin. Endovascular surgery is performed by neurologists, neurosurgeons, cardiologists, cardiothoracic surgeons, radiologists, and vascular surgeons.
Before your procedure, you will be given either a regional anesthesia to numb the area of operation or a general anesthesia that will put you to sleep completely. The area your surgeon will insert the catheter will be cleaned and shaved. Your doctor then makes a small incision on your hip, near the crease between your hip and thigh. This provides them with access to your blood vessels. A guide wire is taken to your aneurysm after it is inserted through your incision and pushed through the blood vessel. Special X-rays are taken to help your doctor locate the exact positioning of your aneurysm. Then they will insert a catheter over the guide wire. This catheter carries the graft through your blood vessels to your aorta. Once in place, the graft is released from the catheter and expands, blocking the flow of blood to an aneurysm. This will shrink an aneurysm over time. Before the procedure is over, your doctor will take X-rays to confirm that the blood in your aorta is flowing through the graft, not the aneurysm. The incisions will then be sewn shut.
Types of Diseases helped by endovascular surgery
A weakening of your abdominal aorta wall that can result in abdominal pain, back pain, and life-threatening bleeding should it rupture. Endovascular aneurysm repair that utilizes angiography and stenting can occlude this type of aneurysm and prevent its continued growth.
Acute Limb Ischemia
Blood clots and other debris can cause a sudden disruption of blood flow to your arm or leg. It can potentially be treated with catheter-directed thrombolysis or mechanical thrombectomy.
Acute Mesenteric Ischemia
This occurs when your mesenteric arteries or veins are blocked, and the blood supply to your abdominal organs is interrupted. Treatment varies by the underlying cause but may include thrombolysis, stenting, or angioplasty.
Aneurysms of Visceral Arteries
This occurs when the visceral arteries that supply blood to your vital organs like your spleen, liver, or gastrointestinal tract, and can result in pain and life-threatening bleeding. Stenting, embolization, liquid occlusion, and thrombin injection are some available interventional therapies.
Deep Vein Thrombosis (DVT)
The formation of blood clots in the deep veins in your leg, leading to discoloration, swelling, and pain. Pulmonary embolisms and post-thrombotic syndrome may result from this condition.
Peripheral Artery Disease (PAD)
This is usually attributed to atherosclerosis. The normal blood flow in the upper and lower extremities is compromised, resulting in pain, skin ulcers, and even gangrene. Stenting, angioplasty, and mechanical atherectomy are available interventional treatments.
An occlusion of the arteries supplying the lungs with blood clots that could be potentially life-threatening. Shortness of breath, fainting, palpitations, and fatigue are common symptoms. Catheter-directed thrombolysis may be performed to help this condition.
Thoracic Aortic Aneurysms (TAA) and Aortic Dissection
Atherosclerosis, trauma, syphilis, and other various conditions can cause aneurysms or dilatations, of your thoracic (chest cavity). Trauma and the weakening of your aortic vessel walls (caused by conditions like hypertension, atherosclerosis, and congenital conditions like Marfan syndrome) can cause aortic dissections, tears in your thoracic aorta. Stent grafts, sometimes in combination with surgery, are performed to prevent blood flow from enlarging the diseased area or rupturing your aorta.
Blood pools in your veins when the valves become weak. Blood vessels become enlarged and swollen. Pain and cosmetic complaints are the results. Laser treatments and sclerotherapy are some surgeries that are known to help.
In some cases, standard endovascular surgery will not be a feasible idea. If your aneurysm is too close to the important branches of your aorta, or your arteries are too narrow or too complicated for the catheter used in endovascular surgery to pass through safely, endovascular surgery may not be a good option for you. This can be dealt with by making the decision to undergo no treatment, go through open surgery, research complex endovascular repair, and talking with your physician about non-surgical treatments for your particular underlying condition.
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