Endovascular therapy refers to minimally invasive procedures for the treatment of vascular diseases. The doctor uses a variety of aids, such as balloons, stents or stent prostheses, to ensure healthy blood flow and repair damage to the vessels. Minimally invasive means that no large incisions or surgical access routes are required to carry out the treatment.
Below you will find further information and specialists for endovascular therapy.
Endovascular (endo = inside, vascular = concerning vessels) therapy refers to all procedures in which diseased vessels are treated from the inside. In the case of circulatory disorders(e.g. intermittent claudication), constricted or blocked arteries can be widened or reopened.
On the other hand , injured vessels are closed in the event of bleeding or splinted from the inside with stent prostheses, which stops the bleeding.
The biggest advantage is certainly that the vessels to be treated do not have to be exposed over their entire length through large skin incisions. Instead, the treatment is carried out via a small access, usually in the groin.
From there, balloons, catheters and prostheses are advanced into the diseased vessel under X-ray control. All vessels in the body can be treated via the groin access, including cerebral arteries or the coronary arteries, for example.
In endovascular therapy , aids such as balloons and stents are used to ensure healthy blood flow @ Axel Kock /AdobeStock
The inguinal artery is punctured from the outside through the skin and is the preferred access vessel for endovascular therapy due to its superficial and easily accessible location. The procedure can therefore usually be performed under local anesthesia and therefore places little strain on the circulatory system.
This is a further advantage of endovascular therapy procedures, particularly for older people with pre-existing conditions and an increased risk of anesthesia.
Common indications for endovascular therapy procedures are
Intermittent claudication (peripheral arterial occlusive disease)
Here, constrictions or occlusions of leg arteries can be dilated and widened using balloons or stents. Blood flow to the lower leg and foot is then restored.
Protrusions of the aorta (aortic aneurysm)
Pathological dilatations of the aorta are closed from the inside with plastic-coated metal grids (stent prostheses), which can prevent the patient from bleeding to death if the vessel wall tears.
Protrusions of leg arteries (popliteal aneurysm)
Aneurysms of the knee joint artery are also a frequent indication for endovascular therapy procedures. In this case, a stent prosthesis is advanced into the dilated knee joint artery, which is then also closed from the inside.
The aim here is to prevent clots from being carried down from the dilated wall into the lower leg or foot and leading to critical circulatory disorders.
Myocardial infarction
A heart attack causes a sudden blockage of the coronary arteries, resulting in massive circulatory problems in the heart muscles and the resulting severe pain behind the breastbone. In most cases of acute myocardial infarction, the coronary arteries are dilated and supplied with stents.
This is carried out by internists (cardiologists). If this is not possible, a surgeon (heart surgeon) must expose the heart and its vessels as quickly as possible via a large incision in the chest and insert one or more bypasses. However, the risk of death during surgery is very high, which is why endovascular therapy is generally preferred.
Stroke
A stroke is an acute circulatory disorder in parts of the brain. The symptoms vary depending on which part of the brain is affected .
A stroke often manifests itself in the form of half-sided paralysis of the abdomen and/or legs, as well as loss of consciousness, speech or visual disturbances.
The cause is either narrowing of the carotid arteries, which can be widened by endovascular procedures and treated with a stent. Another common cause is clots carried into the brain, which often form in the heart due to cardiac arrhythmia.
These can be dissolved using special medication, which restores blood flow to the downstream brain tissue.
Depending on the size and duration of the circulatory disorder, the tissue can recover partially or completely so that, ideally, the stroke is no longer noticeable.
Varicose veins (varices) can also be treated using endovascular procedures. However, varicose veins are usually referred to as endoluminal therapy procedures, as they involve vessels of the low-pressure system (veins). In contrast, the term endovascular therapy is usually used for the treatment of arteries.
The principle of endoluminal varicose vein treatment is that special catheters are inserted into the vein from the outside and advanced to just below the groin.
The catheters have a special probe at the tip, which applies heat (laser or radio frequency energy) to the vein from the inside and then glues or obliterates it.
The advantages of these procedures are that no skin incisions are necessary again and the procedure can be performed under local anesthesia. For this reason, endoluminal varicose vein treatment is now almost exclusively carried out on an outpatient basis by registered vein specialists (phlebologists).
Endovascular therapy for an abdominal aortic aneurysm @ bilderzwerg /AdobeStockNo. For endovascular therapy, certain conditions must be met in order to be able to treat the vessel from the inside. This usually involves the accessibility of the vessel via the groin and its shape or course.
For example, a severely kinked abdominal aorta, in which the aneurysm also extends to important vascular outlets (e.g. renal arteries), cannot be treated endovascularly in some cases. Otherwise, the risk of the prosthesis not sitting properly and the aneurysm not being separated from the bloodstream, so to speak, would be very high.
In such cases, conventional treatment methods are usually used, namely open surgery with skin incisions. In contrast to endovascular therapy, the open procedure can be carried out almost without exception.
In many cases, open therapy procedures do not require follow-up checks. This is an advantage and applies in particular to the treatment of aortic aneurysms.
In contrast, close monitoring (computer tomography, later ultrasound) is recommended after endovascular treatment of aortic aneurysms.
The reason for this is that splinting from the inside is more susceptible to displacement of the prosthesis as it is not sutured in place.
The patient should definitely be informed about this before an endovascular aortic procedure so that they can then decide whether they prefer open therapy without subsequent close monitoring or endovascular therapy.
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