Endovascular methods
Endovascular surgical methods include a wide range of techniques that repair damage to blood vessels from the inside (within the lumen). These are also called minimally invasive methods, as they require only small incisions in easily accessible vessels, allowing the treatment of lesions even in areas where traditional vascular surgery would be challenging. This results in faster patient mobilization and a quicker discharge from the clinic. Although not suitable for all cases, endovascular methods offer effective treatment options for many vascular diseases.
1. Abdominal Aneurysm Treatment
The introduction of stent-grafts in the treatment of aortic aneurysms approximately 35 years ago marked a significant advancement in vascular surgery, opening new therapeutic horizons. Although not all aneurysms are amenable to endovascular repair, this technique has provided a life-saving alternative for many patients who, due to high surgical risk or anatomical complexity, were previously deemed unsuitable for open surgical repair via laparotomy (see traditional open surgical techniques).Currently, it is possible—through two small incisions in the femoral region—to deploy large-caliber stent-grafts under continuous fluoroscopic guidance. These devices are positioned within the aneurysmal segment to fully cover the weakened area of the vessel wall, effectively excluding the aneurysm from systemic circulation and thereby preventing rupture.Furthermore, advances in custom-made and branched stent-grafts have extended the applicability of endovascular repair to complex aneurysms involving the thoracic and abdominal aorta, as well as their branch vessels. Cases that were once considered inoperable can now be approached using minimally invasive techniques, employing individually tailored grafts that are designed and fabricated on a patient-specific basis—achievements that were deemed unattainable just a few decades ago.
2. Peripheral Artery Disease (PAD) Treatment
Since the first time the so-called "balloon" was applied to the PAD almost 60 years ago,
this disease is the main field of endovascular methods in arterial diseases. The common endovascular method is the angioplasty of the arteries with special catheters and balloons, as well as the placement of stents, which are wire-mesh scaffolds covered or not with a synthetic graft, so-called stentgrafts . The latter may be filled with a special drug that increases the performance of the stentgraft over time. New methods have emerged recently, such as removing the atherosclerotic plaque with special rotating catheters in the form of "
Rotationsather CTOM y) as well as the breakdown and absorption of the atherosclerotic plaque with special balloons that emit impact pulses (Shockwave) .
In cases of embolism there are suction catheters that help remove the clots, without the necessary surgical incision as well as the ability to install thrombolying drug catheters targeted at the area of obstruction.
3. Carotid Disease Treatment
Although not the golden rule of carotid disease , the endovascular method of treating inner carotid stenosis has its place in a specific field of indications, which the patient should discuss with the vascular surgeon. In the treatment of carotid arteries it is possible to place stent either through the groin and the femoral artery, or perforated through the common carotid artery.
A basic contraindication for this method, which increases the risk of stroke, is the presence of an eagerness on the atherosclerotic plaque.
Success rates are comparable to those of the open classical method (see classic surgical methods ).
4. Varicose Veins Treatment
In the treatment of varicose veins , endovascular methods have largely replaced the classic surgical method of clearly. , a catheter is inserted inside the vein and with thermal energy either from a laser or radiofrequency destroying the inner wall of the clear vein resulting in therapeutic obstruction. In this case too, the endovascular method is not always appropriate. The contraindication is the intense curved course of the vein, its large diameter as well as its short distance from the skin. The laser is also used to treat the spider veins by burning the small veins from the outside.
5. Deep in depths of venous thrombosis
Endovascular methods in the treatment of deep venous thrombosis are rarely applied only in specialized cases when the clinical picture imposes an invasive approach. Such cases are, for example, the chronic blockages of the veins or the May-Thurner syndrome where stents with a technique similar as in the case of the RDP . In this way, chronic postthromic syndromes are cured, especially in new patients.
In cases of recent venous thrombosis mainly in the veins, there is also the possibility of placing a thrombolytic drug catheter with enhancing its action through ultrasound pulses.
Finally, in special cases and for the protection against pulmonary embolism, special filters in the lower concave vein that open as an "umbrella" in the vessel can be installed and prevent the transfer of small clots to the lung.