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Endovascular Surgery Grows as Treatment Option for Variety of Vascular Diseases
Minimally invasive techniques have revolutionized vascular surgery in recent years, and endovascular surgery is one of the ultimate minimally invasive surgeries. By utilizing this technique, surgeons can access the vessel through the skin (percutaneously) to treat vascular diseases from inside the vessel. One of the benefits of endovascular surgery over open surgery is a faster recovery for patients. Today surgeons offer endovascular surgery to treat a wide variety of vascular diseases including peripheral arterial disease, aortic aneurysm, and varicose veins.
Peripheral Arterial Disease
Peripheral arterial disease arises from poor circulation of the leg/foot due to the obstruction of the artery with aging, arteriosclerosis, diabetes, etc. Open surgical bypass was the “gold standard” to release these obstructions and to improve circulation of the affected tissue 1. Unfortunately, this surgery is associated with significant morbidity and mortality, especially for elderly patients.
Endovascular surgery for the lower extremity can offer reduced morbidity and mortality with improved quality of life 2. Basically, the surgeon will access the vessel from the groin or arm and release the obstruction of the artery from inside using balloon, stent, and/or other devices. By using advanced endovascular techniques, surgeons can offer endovascular surgery to a broad range of the patients, even with challenging anatomy 2.
Here are examples of endovascular surgery for lower extremity:
Although endovascular treatment requires more re-intervention than conventional open bypass, these minimally invasive approaches started to be recognized as a first-line choice for the patient with lower extremity vascular disease 3.
Endovascular aneurysm repair (EVAR) has become an established treatment option for abdominal aortic aneurysm and most thoracic aortic aneurysm. With recent advancements in the devices and techniques, EVAR surpassed open aneurysm repair. Currently, 80% or more cases are done by EVAR 4 5 6 7.
Recently, more and more complex aneurysm with challenging anatomy can also be done by EVAR by utilizing “fenestrated” or “branched” EVAR techniques. Although the feasibility of these advanced techniques compared to conventional open repair for complex aneurysm is still controversial, some of the patients who are not a good candidate for the open procedure due to the limited general status will benefit from these procedures. EVAR benefits include:
Prevalence of the varicose vein in the United States is high, especially among women. The prevalence of varicose veins was reported to be around 57% in men and 77% in women aged older than 70 years 10. Conventionally, varicose veins have been treated by a “stripping” operation. Stripping is usually performed under general anesthesia to remove the vein with “leaky valve” surgically. Recent advances in endovenous catheters enable surgeons to treat varicose veins endovascularly. Instead of removing the vein, surgeons can close the vein by utilizing thermal ablation catheters (laser ablation catheter or radiofrequency catheter) with equivalent effectiveness compared to open vein surgery 8 9 10.
When combined with minimally invasive “stub” incision (5-10mm) phlebectomy, surgeons can apply this minimally invasive surgery for most of the varicose veins in the lower extremity. There also is a small-diameter laser catheter which can go through the regular needle. This laser catheter enables surgeons to perform ablation of the veins even underneath the dermatitis or ulcerated lesion and avoid wound complications. Thermal ablation therapy for varicose veins is as effective as open venous surgery 9. Small varicose veins, spider veins and reticular veins can even be treated by injection-based therapy (sclerotherapy) 11.
For More Information
To learn more about vascular disease and endovascular surgery treatments, visit UW Health’s Heart, Vascular and Thoracic Care. If you would like to speak with a vascular surgeon or refer a patient, call the Vascular Surgery Clinic at (608) 263-8915.
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11 Coleridge Smith P. Sclerotherapy and foam sclerotherapy for varicose veins. Phlebology. 2009;24:260-269