Patient education: Endovascular surgery (The Basics)

What is endovascular surgery? — This is surgery that is done on blood vessels. Blood vessels carry blood around the body. There are 2 main types of blood vessels, called "arteries" and "veins."

Endovascular surgery is a type of "minimally invasive surgery." This means that instead of making large cuts ("incisions"), a surgeon can make very small incisions instead. Then, they use special tools to do the surgery.

You might need endovascular surgery to:

●Open up a clogged blood vessel

●Widen a blood vessel that is too narrow

●Strengthen a weak blood vessel

●Seal off a blood vessel

How is endovascular surgery done? — The surgeon uses special tools that are small enough to fit inside blood vessels. They also use imaging, such as a CT scan, during the surgery to see where the tools are. (Imaging creates pictures of the inside of the body).

First, the surgeon makes a very small incision in the skin near a large blood vessel. This is usually in the groin area, or sometimes, in the arm. Then, the surgeon inserts a thin tube called a "catheter" into the blood vessel. The surgeon pushes the catheter into the blood vessel until it reaches the part that needs to be fixed (figure 1). Next, the surgeon passes special tools and devices through the catheter to do the repair.

Here are some examples of the most common tools and devices used in endovascular surgery and what they do:

●A balloon catheter – This is used for a type of endovascular surgery called "angioplasty." Angioplasty is used to widen blood vessels that are too narrow or blocked. A balloon catheter has a deflated balloon on the end. When the catheter reaches the blocked part of the blood vessel, the surgeon inflates the balloon. This helps widen the blood vessel.

●A stent – This is a tube made of fine metal mesh that is placed in a blood vessel. It can be used to help hold open a blood vessel (figure 2). Sometimes, the stent is coated with medicine to help keep the blood vessel open.

●A stent-graft – This is a tube made of special fabric and metal mesh. Stent-grafts are usually used to fix a problem called an "aneurysm" in a large blood vessel. An aneurysm is when the walls of the blood vessel become weak and start to bulge out (figure 3). The stent-graft takes pressure off of the walls of the blood vessel. This can keep it from bursting or fix an aneurysm that has already burst. Stent-grafts are also used to fix vessels that are injured or have a "dissection." A dissection is when the wall of a blood vessel splits or tears.

●Embolization coils, beads, or glue – Embolization coils are used to seal off certain types of aneurysms. This stops blood from flowing to it. With coils, the surgeon feeds a very thin metal wire through a catheter and into the aneurysm. Many coils are usually needed to fill up the aneurysm.

Coils, beads, or special glue can be used to help stop bleeding from injured blood vessels. Embolization beads or glue are injected through the catheter to stop the flow of blood.

●A wire that heats up – Surgeons sometimes use heat to seal off a diseased vein (figure 4). They move the wire through the catheter until it reaches the right part of the vein. Then, the wire is heated up to seal off the vein.

●A filter – This is a small metal device that looks like a folded-up umbrella when it is closed. Filters are most often placed in a large vein in the belly called the "inferior vena cava." The filter catches blood clots that might form in veins in the legs and keeps them from going to the heart and lungs. Surgeons insert filters into blood vessels while they are closed. Then, when they get to the part of the blood vessel where they want to use the filter, they open it.

Why might I get endovascular surgery instead of open surgery? — "Open" surgery is when the surgeon cuts open your skin to do the procedure. In general, but not always, recovery is easier after endovascular surgery than after open surgery. That's because:

●You have a small incision where the catheter goes in, instead of a large incision from open surgery – Small incisions usually heal faster than large ones.

●The inside of the body does not get as exposed as it would with open surgery.

●The organs don't get moved around like they might with open surgery.

Still, it's important to know that endovascular surgery is still surgery. You will still have some pain, might need stitches, and could get an infection or have other problems just like with open surgery.

Can I choose to have endovascular surgery instead of open surgery? — It depends. For procedures that can be done either way, you might help make the decision. But you do not always get to choose what type of surgery to have.

Whether you can have endovascular surgery depends on:

●If an endovascular device will work with your body – For example, the size or shape of your blood vessels can sometimes make endovascular surgery more difficult.

●Why you need surgery

●Your other health problems

●If there is an endovascular surgeon with enough experience nearby, and if not, if you are willing to travel for treatment

Surgeons sometimes start doing endovascular surgery, but then realize they need to switch to open surgery. This could happen for a few different reasons, such as:

●The surgeon found something unexpected after starting.

●The surgeon couldn't see well enough with imaging.

●The surgeon couldn't properly treat the blood vessel they were trying to operate on.

●You had bleeding that needed to be controlled.

Switching to open surgery doesn't mean that the surgeon did anything wrong. It's just something that can happen after a surgery starts.

Some repairs can only be done with endovascular surgery. In these cases, if there is a problem, switching to open surgery is not an option. Sometimes, the surgeon can try inserting the catheter into a different blood vessel. If this is not possible, they might decide to stop the surgery.

The important thing to remember is that if your surgeon switches to a different kind of surgery, or has to stop the surgery, it is usually for your safety.

More on this topic

Patient education: Angioplasty and stents for peripheral artery disease (The Basics)
Patient education: Minimally invasive surgery (The Basics)
Patient education: Questions to ask if you are having surgery or a procedure (The Basics)