Endovascular surgery: types of interventions

In the last decade, endovascular surgery is applicable and popular, but its ascent began in the 50s of the 20th century.

A bit of history

Swedish radiologist Sven Seldinger announced the idea of introducing a liquid into the vessel, that is, a contrast medium. The scientist's goal was to avoid a cut. Thus, he came to the technique of puncture the vessel with a special needle through the skin.

A needle entered the needle through the X-ray control, the needle was removed, and a catheter was inserted along the string. Contrast substance was fed into the catheter, then a picture was taken on X-ray film. Thus, the image of the vessel was obtained. The needle, guide, catheter are the basic tools in endovascular surgery and are used now. It is important to note that the quality of the tool is the key to the success of the operation. This is how the endovascular surgery of the internal carotid arteries was born.

The next stage of development dates back to 1964. Radiologist Charles Dotter introduced a method for dilating the narrowed vessel with an inflated balloon that was attached to the end of the catheter. This innovation was perfected by the Swiss cardiologist Andreas Grüntsig. He first made balloon angioplasty of the artery of the heart. In the next decade this area of medicine was overtaken by dynamics and development. It should be noted the contribution of domestic luminaries to vascular surgery, this: Serbinenko FA, Rabkin I. Kh., Savelyev VS, Zingerman LS and others.

Today, endovascular surgery has ceased to be experimental. Has firmly taken its place and is progressing.

About vascular surgery

Vascular surgery is an area of medicine that includes the treatment of the blood and lymphatic vessels. We apply the method of therapy as operable and intravascular surgical. Initially, the purpose of this area of surgery was diagnostic. Achievements and results of treatment allowed to establish a separate direction.

A minimally invasive species refers to modern vascular surgery. Effective operation inside the vessels is possible thanks to innovative technologies in medicine, thereby endovascular surgery is considered an independent, narrow profile specialization, which has taken its place and made an alternative to traditional surgery.

The term "endovascular", which means "intravascular", exactly corresponds to the specifics. This is a universal method, applicable for various pathologies of blood vessels and internal organ ducts.

Basic views

Endovascular surgery includes x-ray surgery, interventional cardiology, interventional radiology - these are the types of surgical interventions that are performed on the blood vessel through percutaneous access, controlled by radiation imaging.

The main advantage of intravascular surgery is interference through small punctures on the skin and x-ray monitoring of this manipulation.
Endovascular diagnosis and treatment are performed in the clinic and require several days of stay in the hospital. Benefits:

• On average, there is no need for general anesthesia.
• An order of magnitude lower risk in the absence of need for surgical intervention, as a consequence of lower pain syndrome, quick rehabilitation in comparison with classical surgery.
• Types of endovascular interventions are attractive budgetary pricing.

The often used endovascular procedure is diagnostic angiography. What does the endovascular surgery center do?

When the vessel is narrowed, it is dilated or stenting. With excessive blood supply to one of the organs (tumor, angiodysplasia and others) or pathological blood flow (arteriovenous shunt, varicocele), vascular embolization is used.
If a pathological dilatation of the vessel - an aneurysm is diagnosed, intravascular graft is used, which excludes an aneurysm from the blood flow area.

TIPS Methodology

In relation to patients diagnosed with portal hypertension (increased pressure in the portal vein due to difficulty in blood flow through the liver), the TIPS method is used - a bypass "channel" of blood flow from the portal to the hepatic vein is created. As a result, the pressure in the portal vein decreases, and the threat to life is prevented.

If there is a risk of detachment of the thrombus from the veins of the lower limb with further transport to the pulmonary artery, then cava filters are installed with a preventive purpose.

Regional Chemotherapy

The method of regional chemotherapy is used to target the drug in any organ, for example, infusion with acute pancreatitis, the chemotherapy of a malignant tumor (a catheter is inserted into the artery, then the drug is injected directly into the diseased organ). Introduction to the artery of chemotherapy drugs in a compartment with an oil contrast medium - chemoembabilization.

Thrombolysis

For thrombosis of the vessel, regional thrombolysis is used. Introduce the catheter into the thrombosis area, inject a substance that dissolves the thrombus (thrombolytic) directly into the thrombosis site. As a result, the thrombus partially or completely dissolves, thereby reducing the dose of the trambolic preparation.

The listed endovascular methods are not in full. The realities of the modern day are such that endovascular surgery is an innovative branch of medicine that develops in a geometric progression. The list of therapeutic different endovascular techniques is expanding.

What can I do with X-rays?

Investigation of blood vessels, arteries or veins allows to identify narrowing, blockage of the vessel, the focus, the size of the pathology of vessel enlargement, and also reveals internal bleeding, tumor process and many other things that it is not possible to reveal by another method.

The department of endovascular surgery is engaged in similar studies.
The order of the action is usually the following. For puncture of the artery or vein, use a special needle - in the groin, under the arm, under the collarbone or on the neck. A curved plastic tube - the catheter penetrates into the vessel. X-ray inspection helps to hold the catheter into the target vessel.

Then a contrast agent is introduced into the catheter, which is visible in X-ray radiation. Contrast substance, spreading along the considered vascular site, makes it visible to the x-ray. The result of the study fixes an X-ray or video. X-ray endovascular surgery reveals various pathologies of blood vessels, as well as internal organs and is an indispensable method of investigation.

In the hagiographic study, short-term pain of varying intensity in the study area is possible. Sometimes anesthesia therapy is required.

Samples of angiogram

So, how is endovascular carotid surgery performed? Narrowed or overlapped vessels are restored by the introduction of a special balloon, then inflate it in the lumen of the vessel. This procedure restores the patency of the vessel, does not need operative action, is universal, since it is applicable to any human vessels.

A catheter is introduced into the narrowed vessel, angiography is performed to reveal the level of narrowing of the vessel. Through a narrow or closed part of the vessel conduct a tool - a conductor. Then, a balloon catheter is brought in, which covers the narrowed section.

The balloon expands the narrowed section. The cause of constriction is a thrombus or plaque that spreads evenly over the highly stretched wall of the vessel. Then the balloon is blown off, thereby releasing the site of the vessel, which was restored for full blood flow.

The balloon removes, positive dynamics is monitored by repeated angiography. Endovascular surgery of the vertebral artery is also popular.

When the dilution is ineffective

Often after dilatation, residual stenosis is observed, which does not complicate the normal process of blood flow.

In case the dilatation is ineffective, a stent is recommended that supports the vessel from the inside and in the future does not allow it to narrow. A stent can have a different length and diameter, a different method of installation. The stent is selected individually. To date, all human vessels are available for endovascular stenirovaniya.

Conclusion

There are various indications when it is necessary to stop the blood flow through the vessel. To embolize the vessel, a catheter is inserted into it. It is important that the catheter should be placed so that the embolizing substances do not enter other vessels. By means of a catheter, an embolizing agent or device, such as a spiral, a plastic (gelatin) particle, a sclerosant is transported to the vessel.