Is endovascular surgery right for you?

by Edward Woo, MD, Director, MedStar Vascular Program
August 28, 2017

 The trend in surgery today is to use the least-invasive procedures possible. The reasoning is simple: It’s usually better for patients to return home and get back to their normal lives faster than for them to spend long periods recovering in the hospital.  

In the field of vascular surgery, which deals with conditions of the blood vessels, we refer to minimally invasive surgery as endovascular surgery. Endovascular surgery involves small punctures, usually in the groin area, as opposed to the large incisions on the abdomen or chest that open surgery for blood vessels requires.

This type of surgery has seen a huge surge in the past few decades. That’s because it’s often safer and better for patients. But endovascular surgery isn’t the best option in all cases. Below, I’ll discuss when we use endovascular surgery, why it’s beneficial, when the traditional open approach might be better and what’s to come for this area of surgery.  

When we use endovascular surgery

We can use these surgical techniques for virtually the entire range of vascular treatments. These include:

The field of vascular surgery started seeing a surge in less-invasive surgical techniques in the early 1990s. Since then, endovascular surgery has grown from something reserved for simple cases to being used for complex issues today. Our rule of thumb is this: If a vascular surgery can be done with an endovascular technique, that’s probably the way to go.  

A vascular surgeon’s work now consists of about 75 percent endovascular surgery and perhaps 25 percent open surgery. That’s almost the opposite of the way it was just a few decades ago.  Using less-invasive techniques involves a much different skillset for vascular surgeons. I must be able to clearly see the area where I’m operating on an X-ray screen, rather than operating on the patient and looking directly. Advanced imaging technology, like what we use in our Hybrid Suite, can make this easier for vascular surgeons.  

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How endovascular surgery benefits patients

The main benefit of endovascular surgery is that it’s less invasive. Open surgery for blood vessels can involve large incisions, major scarring and long recovery periods. But less-invasive techniques are all done through a small puncture or incision, usually in the groin area. We can thread our tools through the blood vessels to access the area where we’re working with the use of catheters—thin, flexible tubes we insert into this small incision.

Many patients who have this type of surgery go home the same day. Some have short stays in the hospital afterward, but it’s a huge improvement over those who have open vascular surgery. Endovascular surgery can make a big difference in patients’ recovery and quality of life.  

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A great example is surgery to treat aortic disease. Traditionally, correcting it involved an open surgery with a large incision and long recovery period. Patients were usually in the hospital for seven to 10 days, and they usually took three to four months to fully recover. But with an endovascular surgical procedure, these patients go home the next day, and they’re usually back to themselves within four to five days.

Limitations of less-invasive blood vessel surgery

While there’s been tremendous growth in this area of surgery, it does have a few limitations. One example is if we can’t reach an area through a minimally invasive approach. Because we thread our surgical tools from the groin to the area where we operate, we must make sure we can access the blood vessels we need to treat and that blood continues to flow to the body’s organs and tissues during surgery. With an open approach, we can directly access the area where we need to work, which can be easier in some cases.

A patient’s age and overall health also can factor into the decision on whether to use a less-invasive technique or an open surgical technique. Though endovascular surgeries can be easier on patients, some patients find that the results don’t last as long as the results after open vascular surgery. So we may have to weigh a patient’s particular options when we decide which approach is better. For a 75-year-old who’s a smoker, I probably would choose a less-invasive approach to be easier on the patient. For a 35-year-old who’s in otherwise excellent health, it may make sense to perform an open surgical procedure that will last a lifetime.

New treatments on the horizon

Researchers hope to make endovascular surgery a good option for treating even more cases of blood vessel conditions. It’s a constant process of changes and improvements to make this possible.

As of January 2017, we have initiated a clinical trial for a new device to treat aortic aneurysms in the aortic arch, which is the area of the aorta that curves between the ascending aorta (which carries blood up from the heart) and descending aorta (which carries blood down through the chest and abdomen). The aortic arch has three blood vessels that branch off of it to carry blood to the arms and brain.

Traditionally, we haven’t been able to put a stent (a device used to hold blood vessels open) there, because it would cover those branching arteries. But we’ll be testing a new device that allows us to maintain this circulation with a minimally invasive approach.

We’re also involved in the clinical testing of different balloons used to treat peripheral artery disease. During a procedure called angioplasty, we use a balloon to push arterial blockages aside to improve blood flow. But these blockages may come back over time. We helped test a balloon coated with a medication to prevent blockages from reforming in treated blood vessels.

And we’re about to help test another type of angioplasty balloon called a lithotripsy device. This balloon uses sound waves to break up blockages that have hardened because they have calcium in them, similar to a process used to treat kidney stones.

Endovascular surgery is a great option in many cases. And as technology and techniques continue to improve, I’m looking forward to it being an option for even more conditions and patients.

Category: Healthy Living     Tags: Dr. Edward WooDr. Wooendovascularperipheral artery diseasevascularvascular surgeonvascular surgery