Intraluminal Treatment Methods
Endoluminal surgical methods (colloquially known as “stent” or “balloon”) include a wide range of techniques that correct a vessel lesion from its interior (its lumen). They are also called minimally invasive methods because with very small incisions in easily accessible sections of vessels, lesions are corrected even in areas where surgical access to the vessels is laborious. This achieves faster mobilization of the patient and faster discharge from the clinic. Although they are not applicable in all cases, endoluminal methods provide a solution to many vascular diseases.
1. Treatment of Abdominal Aortic Aneurysm
With the advent of Stentgrafts in the treatment of aortic aneurysms about 35 years ago, new horizons were opened in their treatment. Although not all aneurysms can be treated endoluminally, this method has allowed many patients who previously could not undergo the classic surgical method with opening the abdomen (see classic surgical methods) , to find a life-saving solution for this condition. We are now able to insert large-caliber grafts (Stentgrafts) into the lumen of the aneurysm – under continuous fluoroscopy – through two small surgical incisions in the groin area in order to completely cover the “weak” area of the vessel and to exclude the aneurysm from the rest of the circulation. In some cases of more complex aneurysms (thoracic/abdominal aorta and iliac arteries) that were previously considered inoperable, we can today provide minimally invasive solutions , with specially constructed grafts with windows or branches "cut and sewn" to the anatomy of each patient's vessels individually (custom-made)
2. Management of Peripheral Arterial Occlusive Disease (PAOD)
Since the first application of the so-called “balloon” almost 60 years ago in RA, this disease has also been the main field of endovascular methods in arterial diseases.
The usual endovascular method is angioplasty of the arteries with special catheters and balloons, as well as the placement of stents made of wire mesh coated or not with a synthetic graft, the so-called stents or stentgrafts. The latter can be infiltrated with a special drug that increases the performance of the stentgraft over time.
Recently, newer methods have appeared, such as the removal of atheromatous plaque with special rotating catheters in the form of a "mill" (Rotationsatherectomy) as well as the disruption and absorption of atheromatous plaque with special balloons that emit radiofrequency shock pulses (shockwave).
In cases of embolism, there are suction catheters that help remove clots, without the need for a surgical incision, as well as the possibility of placing catheters for injecting thrombolytic drugs targeted at the area of obstruction.
3. Management of Carotid Artery Disease
Although it is not the gold standard for the treatment of carotid disease, the endoluminal method of treating internal 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, there is the possibility of stent placement either through the inguinal and femoral arteries, or transcervically through the common carotid artery.
A main contraindication for this method, which increases the risk of intraoperative stroke, is the presence of a thrombus in the atherosclerotic plaque.
The success rates are comparable to those of the open classical method (see classical surgical methods).
4. Management of Varicose Veins
In the treatment of varicose veins, endoluminal methods have largely replaced the classic surgical method of saphenectomy. In these cases, a catheter is inserted into the vein and with thermal energy coming from either a laseror a radiofrequency catheter ,the inner wall of the saphenous vein is destroyed, resulting in its therapeutic occlusion. In this case, the endoluminal method is not always indicated. Contraindications are the strongly curved course of the vein, its large diameter and its short distance from the skin. Laser is also used to treat varicose veins by burning the small veins from the outside.
5. Management of Deep Vein Thrombosis
Endoluminal methods in the treatment of deep vein thrombosis are rarely applied and only in specialized cases, when the clinical picture requires an invasive approach. Such cases include, for example, chronic occlusions of the iliac veins or May-Thurner syndrome where stents are placed using a technique similar to that in the case of PAD . In this way, chronic post-thrombotic syndromes are treated, especially in young patients. In cases of recent deep vein thrombosis, mainly of the iliac veins, there is also the possibility of placing catheters for injecting thrombolytic drugs with enhanced action through ultrasound pulses. Also, in special cases and for protection against pulmonary embolism, special filters can be placed in the inferior vena cava that open like an “umbrella” inside the vessel and prevent the transfer of small clots to the lung.