Sunita Srivastava, MD, FACS

Frequently Asked Questions

Video by Sunita Srivastava, MD, FACS

Staff Surgeon in the Cleveland Clinic Department of Vascular Surgery

Specialties: Minimally invasive and open cerebrovascular and vertebral disease, minimally invasive varicose vein surgery.

Hello. I’m Dr. Sunita Srivastava, vascular surgeon in The Miller Family Heart & Vascular Institute. Today, I’m going to explain endovascular treatments – what they are and how they can be used to treat peripheral artery disease.

Endovascular treatments are minimally invasive procedures that are done inside the blood vessels and can be used to treat peripheral arterial disease, or PAD, which is a common type of vascular problem in the leg, aorta or carotid. PAD occurs when these blood vessels become narrowed or blocked with plaque over time – a condition known as atherosclerosis.

Interventional treatment becomes necessary for PAD when patients’ symptoms, such as pain or tissue loss, develop due to the loss of circulation. Typically endovascular treatments are used after patients have failed conservative therapy, such as medication and supervised exercise, and are experiencing a limitation in lifestyle due to their disease, such as being unable to work.

An endovascular procedure is performed inside your artery using a thin, long tube called a catheter. Through a small incision in the groin, the catheter is then guided by the surgeon to the blocked area in the blood vessel.

From there, the surgeon will perform an endovascular treatment, such as balloon angioplasty or stenting. In balloon angioplasty, the blocked artery is opened by pressing plaque against the vessel wall with a balloon inserted with a catheter. A stent, or mesh wire tubes, may also be placed in the artery following angioplasty to support the cleared vessel and keep it open.

Such endovascular approaches are advantageous for many groups of patients. They help younger patients who want the quickest recovery and fastest return to work. A minimally invasive approach can allow qualifying patients to get back to work in two weeks at the most vs. six to eight weeks with an open surgery.

Endovascular treatments also are a good alternative for patients who have had prior open procedures and have been told that they have are too high a risk for another open procedure.

At Cleveland Clinic, our first option is typically the least invasive, if at all possible. The chance is that we have a minimally invasive approach that works available.

In addition to vast experience, Cleveland Clinic surgeons also are investigating new technologies. For example, we are currently involved in several clinical trials of patients who are at high-risk for carotid surgery using new stents that have a built-in filter that captures any debris that may be released from the blood vessel, which could potentially go to the brain and cause a stroke. Experts are also examining biodegradable stents that disappear over time.

Here at Cleveland Clinic, our vascular surgeons work with patients on a case by case basis to determine whether an endovascular treatment approach is the best option for them. We assess the risk and benefits of each therapy, taking into account the patient’s arteries, his or her physical condition, and how comfortable the patient and the physician feel with the various options.

Together, we help patients find the treatment that will result in the best possible outcome. Thank you.

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