Endovascular surgery is a form of minimally invasive
surgery that is designed to remove blocks in major blood vessels, using balloons and stents. Basic techniques involve introduction of a catheter
percutaneously into a large blood vessel (Seldinger technique). Typically the blood vessel chosen is the femoral artery or a vein found in the groin
or the brachial artery at the elbow. A needle is inserted into the artery and a wire is passed inside. A small catheter is then passed over the wire
and negotiated to the artery to be studied. 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, it images the blocks in the vessel and the circulation beyond the block. This serves as a road map to plan further treatment. View more
In recent years, however, the development of intravascular balloons,
stents and coils have allowed for new therapies as alternatives to traditional surgeries such as arterial bypass surgery (CABG), carotid endarterectomy and
aneurysm repair. Stents and coils are composed of fine wire materials such as nitinol, that can be inserted through a thin catheter and expanded into a
predetermined shape once they are guided into place.
In balloon angioplasty, the balloon is positioned across the block or narrowed artery and
dilated. This causes the plaque (fatty material deposited in the wall) to compress and the arterial wall is stretched. Majority of the blocks to the limb
vessels can be opened by balloon angioplasty. In some cases the block is hard and the artery collapses after the balloon is removed. In these cases a metal
mesh (stent) is kept inside to prevent the wall from collapsing. Stent may also come covered with a thin fabric so that a smooth lining can be achieved for
the arterial wall. These stent grafts are used for treating aneurysms (abnormal dilatation of the artery).
Nowadays angioplasty is offered as the treatment of choice for treating limb ischemia. Advantages of angioplasty include:
Advantages of angioplasty include
It can be done without anesthesia.
There is no long incision and wound-related issues.
Patient can be mobilised early.
Patient can be discharged after a day or two.
It can be repeated if the block comes back.
The disadvantages are that it is less durable than a bypass and the block tends to recur.