Endovascular surgery

Endovascular surgery is a form of minimally invasive surgery that was designed to access many regions of the body via major blood vessels.

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Endovascular techniques were originally designed for diagnostic purposes. Basic techniques involve the introduction of a catheter percutaneously or through the skin, into a large blood vessel. Typically the blood vessel chosen is the femoral artery or vein found near the groin. Access to the femoral artery for example, is required for coronary, carotid, and cerebral angiographic procedures. The catheter is injected with a radio-opaque dye that can be seen on live xray or flouroscopy. As the dye courses through the blood vessels, characteristic images are seen by experienced viewers and can assist in the diagnosis of diseases such as atherosclerosis, vascular trauma, or aneurysms.

In recent years, however, the development of intravascular balloons, stents and coils have allowed for new therapies as alternatives to traditional surgeries such as CABG, Carotid Endarterectomy and Aneurysm clipping. Stents and coils are composed of fine wire materials such as platinum, that can be inserted through a thin catheter and expanded into a predetermined shape once they are guided into place.

Endovascular surgery is performed by radiologists, neurosurgeons, cardiologists, and vascular surgeons. The field is rapidly growing as its minimally invasive techniques offer an immediate advantage over more traditional, yet highly invasive surgeries. However, the science of endovascular surgery and its developing techniques are so new that it is currently difficult to compare the long term outcomes and complications of these patients. Several trials are underway, including CREST, and ISAT, among others.

The most common and advanced form of endovascular surgery taking place today is an EVAR. This is a new technique developed to treat aortic aneurysms.

References

• RSNA Interventional Radiogolgy. Basics of Endovascular techniques