Endovascular Surgery is a minimally invasive procedure used to treat vascular diseases by operating within the blood vessels themselves. Instead of large incisions, endovascular surgery involves small punctures through which catheters are inserted to reach the target area inside the blood vessels. Here's an overview of its techniques, types, and indications:


Techniques:

  • Angioplasty: Involves the inflation of a balloon within a narrow or blocked blood vessel to open it up, improving blood flow.

  • Atherectomy: This procedure removes plaque from the inside of arteries using specialized catheters.

  • Stent Placement: A stent, a small mesh tube, is placed to keep an artery open post-angioplasty. Stents can be bare metal or drug-eluting, the latter designed to minimize restenosis.

  • Stent Grafting: Used particularly for aneurysms, where a fabric tube supported by a metal frame is placed to reinforce the weakened artery wall.

  • Thrombectomy: This involves the removal or dissolution of blood clots to restore blood flow, often used in cases of acute stroke or deep vein thrombosis.


Types:

  • Endovascular Aneurysm Repair (EVAR): Treats aneurysms, especially in the aorta, by inserting a stent graft to prevent rupture.

  • Carotid Artery Stenting: An alternative to carotid endarterectomy for treating carotid artery disease, particularly in high-risk surgical candidates.

  • Endovenous Ablation: Used for treating varicose veins by sealing off the affected veins through catheter techniques.


Indications:

  • Aneurysms: Particularly abdominal aortic aneurysms (AAA) or thoracic aortic aneurysms where the risk of rupture is high.

  • Atherosclerosis: When narrowing or blockage of arteries leads to conditions like peripheral artery disease (PAD), coronary artery disease, or carotid artery disease.

  • Acute Ischemic Stroke: For clot removal in large vessel occlusions to restore cerebral blood flow.

  • Chronic Limb-Threatening Ischemia (CLTI): To improve blood flow to limbs at risk of amputation due to severe PAD.

  • Venous Disorders: Including deep vein thrombosis or chronic venous insufficiency where intervention can alleviate symptoms or prevent complications.

  • Renal Artery Stenosis: To treat hypertension or kidney dysfunction caused by narrowed renal arteries.


Endovascular surgery has become preferred due to its reduced recovery time, lower risk of complications, and less pain compared to traditional open surgery methods. However, the choice between endovascular and open surgery depends on the specific condition, the patient's overall health, and the anatomy of the vascular issue.