What is endovascular surgery? Endovascular surgery involves the use of special tools that match the inside of a blood vessel. For this, the surgeon inserts a catheter into a large blood vessel, usually in the arm or leg, and then pushes it forward a little bit until it reaches the area of the vessel that needs to be repaired. Next, special tools and devices are placed through the catheter to reopen the blocked vessel, lining it, or even sealing it. During the procedure, the surgeon uses x-rays or ultrasound to see where the catheter and device are placed. Some of the most common tools and devices used in endovascular surgery and their roles are described below: Balloon catheter – An uninflated balloon catheter is inserted into a vessel and then inflated to help widen a vessel that is too narrow, known as an “angioplasty. A balloon is used to widen an artery that is too narrow, such as an artery in the leg. Stents – A stent is a metal mesh catheter that is left in place and holds the vessel open (Figure 2) for a variety of vessels, including: arm or leg arteries brain supply arteries intestinal supply arteries Stent-type grafts – These are catheters made of special materials, often reinforced with metal mesh. This device can repair “aneurysms” in large blood vessels, which occur when the vessel wall thins and begins to bulge. The surgeon inserts a folded graft, unfolds it when it reaches the aneurysm, and expands the graft against the vessel wall to act as a liner. Blood will flow through the graft just as it does through the vessel itself. A properly placed graft helps to share the pressure on the vessel so that it does not burst. Spring coils or other devices – Doctors sometimes place small spring-loaded steel coils or other devices in balloon aneurysms to seal the aneurysm and prevent it from bursting, especially in small aneurysms such as those in the brain or spleen. Such devices are also used to stop bleeding of damaged vessels. Heated guidewires are sometimes used by physicians to seal diseased veins by heating (Figure 4). Umbrella device – A vena cava filter is an umbrella-shaped device that can be placed in the large intra-abdominal vein, the vena cava, to capture blood clots that may be dislodged from the leg veins and prevent them from entering the heart. The doctor will place the device in the closed position and then open it. Why choose an endovascular procedure over an open procedure? Open surgery means that the skin is cut open to perform the procedure. Post-operative healing is usually easier with endovascular surgery than with open surgery. This is because: It usually leaves only a small wound at the placement site and does not require a large incision. There is no need to expose the interior of the body as in open surgery. The degree of organ movement is much less than in open surgery. However, it is important to understand that endovascular surgery is still surgery. Patients do experience some pain, often require stitches, and can develop infections or other problems as a result of the procedure. Is it up to the patient to decide whether or not to have an endovascular procedure? Not necessarily. If the procedure is both endovascular and open, the patient can sometimes, but not always, help make the decision. The decision to operate depends on whether the device is suitable. For example, endovascular surgery is sometimes difficult to perform because the size or shape of the vessel is not compatible with the device. The reason for the procedure Whether there is an experienced surgeon nearby and, if not, whether he or she is willing to treat elsewhere Even if the endovascular approach is started, it may not always be used. Sometimes a surgeon starts an endovascular procedure and then finds that it needs to be converted to an open procedure. This does not mean that the surgeon made any mistakes, but is simply a situation that may arise after the procedure has begun. If you are going to undergo an endovascular procedure, be prepared to wake up and find out that you are undergoing an open procedure. There are many reasons for this, such as: the surgeon finds something unanticipated after the procedure has begun, the surgeon is unable to adequately see or treat the target area properly, there is bleeding that needs to be controlled, and some procedures can only be performed endovascularly, so if there is a problem, an open procedure cannot be performed. Sometimes the surgeon may try an alternative endovascular approach, such as inserting a catheter into another vessel. If this is not possible, the procedure may be stopped. Keep in mind that if the surgeon switches to another procedure or is forced to stop the procedure, it is usually to ensure safety.