Endovascular Procedures

What are endovascular procedures?

The term endovascular means inside the blood vessels. To perform these procedures generally vascular surgeons use special technology designed instruments. These procedures require only a small incision in an artery or vein. These procedures are used to treat problems affecting blood vessels such as an aneurysm and also for imaging the circulation or for treating vascular disorders from within the circulation, including angioplasty, the placement of stents in aneurysm, and emobolization.

These conditions were usually treated by open heart surgery, involving an incision in the side of the chest or breastbone. This means a longer recovery period. Patients generally stay in the hospital for seven to ten days following open heart surgery and recover completely after three months of rehabilitation program as suggested by Doctors. To overcome these glitches surgeons prefer endovascular procedures which have substantial advantages like :

  • Immediate recovery in short duration of time
  • Small incision
  • Fits the budget of many patients
  • Anasthesia administration may be general and local
  • Chances of survival and recovery more positive

Surgeons generally perform a full range of vascular and endovascular procedures, including :

Endovascular or open repair of abdominal aortic aneurysm, thoracic aortic aneurysm, thoracoabdominal aneurysms and fenestrated and branched stent grafts :

Open abdominal aortic aneurysm repair is a surgery to fix a widened part in aorta. This is called an aneurysm. Aorta is the large artery that carries blood to the torso region and the legs. Open surgery to repair an abdominal aortic aneurysm is sometimes done as an emergency procedure when there is bleeding inside the body from the aneurysm. Surgery for aortic aneurysm replacement may take two to three hours only and recover faster.

The aorta is the largest artery in our body, and it carries blood away from the heart to all the parts of the body. The part of aorta that runs through the chest is called thoracic aorta. When a weak portion of the thoracic aorta expands or bulges out, it is known as a thoracic aortic aneurysm. Approximately 25 percent of aortic aneurysms occur in the chest, and the rest occur in the abdominal aorta. Thoracic aortic aneurysms are serious health risks because they can burst or rupture at any point of time. A ruptured aneurysm may cause internal bleeding, which may rapidly lead to shock or death.

Instead of open aneurysm repair, your vascular surgeon may consider promising newer procedure called an endovascular stent graft. The treatment is performed inside the body using long, thin tubes called catheters.

Aneurysms that coexist in both segments of the aorta thoracic and abdominal are termed thoracoabdominal aneurysms. They are also at risk for rupture at any point of time. Surgical repair may involve endovascular stent grafting (in suitable candidates) or traditional open surgical repair.

Open surgery for complex aneurysm of the abdominal aorta, including thoracoabdominal aortic aneurysms has greatly developed during the past decades to provide patients adequate management with good functional results and reduced morbidity and mortality post operation significantly. Endovascular aneurysm repair has been shown to be effective in treating uncomplicated infrarental and thoracic aneurysms in both elective and urgent circumstances, yet there is limited experience with this technology in complex conditions. Fenestrated and branched endografts have been developed as a minimally invasive, totally endovascular alternative for the treatment of complex aortic aneurysms in highrisk patients.

1.  Open surgical reconstructions and balloon angioplasty and stenting in all vascular areas :

Interventional cardiologists perform angioplasty, which opens narrowed or blocked arteries. They use a long, thin tube called a catheter that is fit with a small balloon on its tip. They inflate the balloon at the blockage site in the artery to flatten or compress the plaque against the artery wall. Angioplasty is also called percutaneous transluminal coronary angioplasty.

A stent is a small mesh like device made of metal content. When a stent is placed inside of a coronary artery, it acts as a support or scaffold, keeping the vessel open, by keeping the vessel open the stent helps to improve blood flow to the heart muscle and reduce the pain and pressure on the angina. Stent procedures are usually used along with balloon angioplasty. Stent procedures are now widely used in carotid arteries too.

2. Carotid endarterectomy and carotid artery stenting :

Carotid artery stenting is a procedure involves the vascular surgeons inserting a slender non metal-mesh tube called a stent, which expands inside the carotid artery to increase blood supply in areas blocked by plaque.

A stent inserted as an alternative to surgical removal of the plaque is known as carotid endarterectomy. During the carotid stenting procedure the physician inserts a stent into the carotid artery after performing angioplasty. In angioplasty a balloon is inflated in the narrowed part of the artery to flatten the plaque and open the artery. The stent holds the artery open by holding flattened plaque like scaffolding in a mineshaft.

3. Bypass surgery and endovascular therapy for peripheral artery disease and gangrene of the limbs :

Peripheral arterial disease is one of the manifestations of systemic and progressive atherosclerosis. The prevalence of peripheral arterial disease increases with the age of the population. It is important to remember the significant association of coincident coronary artery disease, which is the major cause of mortality in such patients. Remarkable technological advancements in the past decade, along with patient preference have shifted revascularization strategies from traditional open surgical approaches toward lower-morbidity based percutaneous endovascular treatments. The availability of stents has the growth of catheter based procedures by improving the safety, durability and predictability of percutaneous revascularization.

4. Endovascular and open surgical treatment for peripheral artery aneurysms :

Aneurismal degeneration of peripheral arteries may occur less frequently than aortic aneurysm. While rupture is the most common complication of aortic aneurysms, peripheral aneurysms frequently cause thrombosis or embolozation of the involved vessels. It has generally been accepted that most peripheral aneurysms in good risk patients should be repaired to avoid the ischemic complications of thrombosis. Endovascular repair of abdominal aneurysms has revolutionized the treatment of aortic aneurysms. Endovascular techniques have been used to treat peripheral artery aneurysms with varying success. Thrombosis of stent grafts has been a significant problem which has limited the success of this treatment. At present endovascular treatment of peripheral aneurysms must be reserved for selective instances, in very high risk patients.

5. Endovascular surgical intervention such as angioplasty and stenting, in all vascular areas :

Endovascular angioplasty with stenting is an option for patients with carotid stenosis who are at high risk for carotid endarterectomy or who cannot undergo a surgery due to their prognosis. Carotid angioplasty with stenting is a minimally invasive procedure in which a very small hollow tube, or catheter is advanced from blood vessel present in the groin to the carotid arteries. Once the catheter is in the desired place, a balloon may be inflated to open the artery and a stent is placed. A stent is a cylinder like tube made of thin metal mesh framework used to hold the artery open and prevent it from closing in.

6. Endovascular laser therapy treatment, radiofrequency ablation or subfascial endoscopic perforator surgery for varicose vein and venous ulcers :

Varicose vein treatment also known as endovenous ablation uses radiofrequency or laser energy to cauterize and close varicose veins in the legs. Endovenous ablation is safe, less invasive than conventional surgery, and virtually no scars appear.

7. Endovascular and open surgical reconstruction for deep vein occlusions :

Deep vein thrombosis is a blood clot that forms in any vein deep in the body. Blood clots occur when blood thickens or clumps or stiffens together. Most deep vein blood clots occur in the lower leg or thigh. They also can occur in other parts of the body. Treatment consists of immediate anticoagulation as well as other options depending on the patient’s condition. Vascular surgeons treat this disease with medications or minimally invasive procedures.

8. Haemodialysis access :

A vascular access is a haemodialysis patient’s lifeline peripheral. A vascular access makes life saving haemodialysis treatments actually possible. Haemodialysis is a sought after treatment for kidney failure that uses a machine to send the patient’s blood through a filter, called a dialyzer, outside the body. The access is a surgically created vein used to remove and return blood supply during haemodialysis. A vascular access lets large amounts of blood flow continuously during haemodialysis treatments to filter as much blood as possible per treatment. About a pint of blood flows through the machine every minute. A vascular access should be in pace weeks or months before the first haemodialysis treatment. Two types of vascular access designed for long term use include the arteriovenous fistula and the AV graft. The venous catheter is for short time use only.

9. Treatment of vascular malformations, median arcuate ligament and nutcracker syndromes, lymphedema, and chylous effusions.

Vascular malformation is a general term that includes congenital vascular anomalies of only veins, only lymph vessels or both veins and lymph vessels, or both arteries and veins. Although surgery is sometimes beneficial it is usually difficult for surgeons to completely remove vascular malformations, which will return if not removed completely. A nonsurgical method of closing down the blood or lymph flow into the malformation is done by interventional radiologists, who treat patients with image guided procedures. Vascular malformations are treated by embolization procedures.

 Why choose KIMS :

At KIMS, surgeons have expertise and experience in diagnosing and treating common, complex and rare vascular diseases. Surgeons use technically developed and new minimally invasive endovascular procedures to treat patients. Our state of the art Heart centre is one in its kind in Asia. Our success rate and patient testimonies speaks for itself.



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