Endovascular Surgery

What is endovascular surgery?

Endovascular surgery treats conditions affecting your blood vessels (vascular system) without making large incisions. Surgeons repair these vessels and remove blood clots to restore blood flow and prevent damage to your brain, heart, limbs and lungs.

What is the difference between endovascular and open vascular surgery?

Both endovascular surgery and open vascular surgery are procedures to access and repair blood vessels damaged by vascular disease or injury. The difference is in how the surgeon accesses the blood vessels.

Endovascular surgery, or an endovascular procedure, uses a minimally invasive approach. Surgeons make punctures into the artery with a needle and then thread small flexible tubes called catheters through the blood vessels to reach the damaged area. The lack of an incision results in less blood loss and faster recovery.

In open (traditional) vascular surgery, surgeons make incisions to reach the blood vessels.

What conditions do healthcare providers treat with endovascular surgery?

Healthcare providers use endovascular procedures to treat many conditions involving blood vessels and heart vessels. These conditions include:

• Aneurysm: A bulging or weak area forms in a blood vessel. Aneurysms can happen in the aorta (abdominal aortic aneurysm and thoracic aortic aneurysm) and in other blood vessels in your body.
• Atherosclerosis: Plaque builds up in your arteries. Atherosclerosis keeps your blood from flowing as it should.
• Carotid artery disease: This narrowing of the carotid arteries happens when plaque builds up. Carotid artery disease raises your risk of stroke.
• Deep vein thrombosis: Blood clots form in veins deep inside your body. Deep vein thrombosis (DVT) can cause complications when clots break off and travel through your bloodstream.
• Peripheral artery disease: Blockages form in the limbs, often the legs. Peripheral artery disease can cause poor circulation.

How common is vascular disease?

Between eight and 12 million Americans have peripheral artery disease. Healthcare providers diagnose almost 200,000 Americans with abdominal aortic aneurysms each year. Vascular disease also contributes to heart attack and stroke.

What happens before endovascular surgery?

Your healthcare provider talks with you about your condition and health history. They do a physical examination and may order tests such as:

• Ultrasound.
• Angiography.
• Ankle-brachial index.
• CT scan.
• MRI.
• Stress test.
• X-ray.
• Echocardiogram.
• Electrocardiogram.

What happens during endovascular surgery procedures?

You may have sedation or general anesthesia. Your surgeon makes a puncture, usually in an artery in your groin. They use real-time X-ray images to guide them in threading a covered (sheathed) catheter through the incision to reach and repair the diseased blood vessel.

What endovascular surgery procedures do healthcare providers perform?

Your vascular condition and overall health determine what type of endovascular procedure you have. You might have:

• Angioplasty. Surgeons insert a catheter with a balloon on the end into a blocked or narrow blood vessel. Once the balloon is in place, they inflate it to open the blood vessel. Then, they deflate the balloon and remove it.
• Atherectomy. This procedure physically removes plaque from the inside of blood vessels or arteries.
• Stent. A small tube typically made of metal or plastic mesh, a stent keeps your coronary arteries open and reduces your risk for heart attack.
• Stent grafting. An endovascular stent graft is a fabric tube supported by wire mesh. It helps to reinforce an aneurysm — a weak spot in an artery. Once in place, the stent graft allows blood to pass through it without placing pressure on the weak area.
• Clot removal or thrombectomy. This is the surgical removal of a blood clot.
• Sometimes called fibrinolytic therapy, thrombolysis uses medication to break up blood clots inside veins and arteries.
• Embolization or blockage of vessels. Sometimes your healthcare provider might need to block a blood vessel — to stop bleeding or to block blood flow to a tumor, for instance. With embolization, your surgeon places tiny beads or sponges to block a blood vessel.
• Valve repair or replacement. A diseased or faulty heart valve is either repaired or replaced with a synthetic one.

What happens after endovascular surgery?

Before you leave the hospital, your healthcare provider discusses your follow-up plan with you. You see your provider for follow-up visits and imaging tests. During these visits, your healthcare provider makes sure blood vessels are healing properly.

What are the advantages of endovascular procedures?

With endovascular procedures, you’ll likely spend less time in the hospital than if you had an open procedure. Because surgeons don’t use large incisions, your body can heal faster.

However, while endovascular surgery has advantages, it might not be the right procedure for your needs. Your surgeon has your long-term outcome in mind when deciding whether endovascular surgery or open surgery is best for you.

What are the risks or complications of endovascular surgery?

Possible complications include:

• Bleeding.
• Blood vessel damage.
• Dissection.
• Thrombosis.

What is the recovery time for endovascular surgery?

Endovascular surgery recovery times vary by procedure type. You might be able to leave the hospital on the same day, known as outpatient surgery. If the procedure is more complicated or if you need monitoring, you may stay in the hospital for a day or two.

When can I resume my regular activities after endovascular surgery?

Talk with your healthcare provider about when you can go back to work, drive, be physically active and resume sexual activity. Many people can return to regular activities in about a month.

When should I see my healthcare provider after endovascular surgery?

Be sure to keep all scheduled follow-up appointments with your healthcare provider after your procedure. Let your provider know right away if you develop:

• Abdominal pain, chest pain or pain in your back or groin.
• Bleeding.
• Leg or arm pain or swelling.
• Dizziness or fainting.
• Numbness or tingling.
• Weakness or fatigue.
• Redness around the tiny incisions or drainage.
• Fever.

A note from Cleveland Clinic

Endovascular surgery includes minimally invasive treatments for vascular disease, coronary disease and blood vessels in the brain. Surgeons use tiny incisions, catheters and stents to repair damage to blood vessels and break up blood clots. These smaller incisions help reduce the time it takes your body to heal so you can get back to your daily activities sooner.