Endovascular surgery
Encyclopedia
Endovascular surgery is a form of minimally invasive
surgery
that was designed to access many regions of the body via major blood vessels.
Endovascular techniques were originally designed for diagnostic purposes. Basic techniques involve the introduction of a catheter
percutaneously
into a large blood vessel. Typically the blood vessel chosen is the femoral artery
or a 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 X-ray
or fluoroscopy
. 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 Coronary artery bypass surgery
(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, neurologist
s, 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, as shown by the Stenting vs. Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial, the complication rates for some endovascular procedures surpass those present after "aggressive medical management" (i.e., management without surgery). In the case of SAMMPRIS, the technique in question was intracranial arterial stenting with the use of the Wingspan stent system, with some resulting complications possibly due to "the fact that stenting of the intracranial vasculature is technically more challenging" than stenting of vessels elsewhere. Other trials examining the comparative effectiveness of endovascular procedures include the Carotid Revascularization Endarterectomy versus Stent Trial (CREST), and International Subarachnoid Aneurysm Trial
(ISAT), among others.
A common and advanced form of endovascular surgery that is performed today is an EVAR, which was first reported by Nicholas Volodos and colleagues.
Minimally invasive procedure
There are three main categories which describe the invasiveness of surgical procedures. These are: non-invasive procedures, minimally invasive procedures, and invasive procedures ....
surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
that was designed to access many regions of the body via major blood vessels.
Endovascular techniques were originally designed for diagnostic purposes. Basic techniques involve the introduction of a catheter
Catheter
In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
percutaneously
Percutaneous
In surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an "open" approach where inner organs or tissue are exposed .The percutaneous approach is commonly used in vascular procedures...
into a large blood vessel. Typically the blood vessel chosen is the femoral artery
Femoral artery
The femoral artery is a general term comprising a few large arteries in the thigh. They begin at the inguinal ligament and end just above the knee at adductor canal or Hunter's canal traversing the extent of the femur bone....
or a 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 X-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
or fluoroscopy
Fluoroscopy
Fluoroscopy is an imaging technique commonly used by physicians to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed...
. 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
Atherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...
, 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 Coronary artery bypass surgery
Coronary artery bypass surgery
Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease...
(CABG), carotid endarterectomy
Carotid endarterectomy
Carotid endarterectomy is a surgical procedure used to prevent stroke, by correcting stenosis in the common carotid artery...
and aneurysm clipping. Stents and coils are composed of fine wire materials such as platinum
Platinum
Platinum is a chemical element with the chemical symbol Pt and an atomic number of 78. Its name is derived from the Spanish term platina del Pinto, which is literally translated into "little silver of the Pinto River." It is a dense, malleable, ductile, precious, gray-white transition metal...
, 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, neurologist
Neurologist
A neurologist is a physician who specializes in neurology, and is trained to investigate, or diagnose and treat neurological disorders.Neurology is the medical specialty related to the human nervous system. The nervous system encompasses the brain, spinal cord, and peripheral nerves. A specialist...
s, 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, as shown by the Stenting vs. Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial, the complication rates for some endovascular procedures surpass those present after "aggressive medical management" (i.e., management without surgery). In the case of SAMMPRIS, the technique in question was intracranial arterial stenting with the use of the Wingspan stent system, with some resulting complications possibly due to "the fact that stenting of the intracranial vasculature is technically more challenging" than stenting of vessels elsewhere. Other trials examining the comparative effectiveness of endovascular procedures include the Carotid Revascularization Endarterectomy versus Stent Trial (CREST), and International Subarachnoid Aneurysm Trial
International Subarachnoid Aneurysm Trial
The International Subarachnoid Aneurysm Trial was a large multicentre, prospective randomised clinical medical trial, comparing the safety and efficacy of endovascular coil treatment and surgical clipping for the treatment of ruptured brain aneurysms. The study began in 1994...
(ISAT), among others.
A common and advanced form of endovascular surgery that is performed today is an EVAR, which was first reported by Nicholas Volodos and colleagues.
External links
- RSNA Interventional Radiology. Basics of endovascular techniques.
- http://www.endovascular.org/. The Endovascular Forum.