Endovascular treatment

What is endovascular treatment?

Endovascular treatment covers a range of procedures that repair or reopen blood vessels from the inside, without a large surgical cut. Your surgeon reaches the affected vessel through a small puncture, usually in the groin, guided by X-ray images.

What conditions does endovascular treatment help with?

Endovascular techniques can be used for:

• an abdominal or thoracic aortic aneurysm (a bulge or weak spot in the body's main artery)
• narrowed or blocked arteries (atherosclerosis), including peripheral artery disease affecting the legs
• carotid artery disease (narrowing of the arteries that supply the brain)
• blood clots, such as deep vein thrombosis
• varicose veins (enlarged, twisted veins, most often in the legs).

What are the benefits of endovascular treatment?

Compared with open surgery, endovascular treatment uses much smaller cuts, so there's usually less blood loss and a quicker recovery.

Many procedures can be done as day cases or with only a short hospital stay, and most people return to their normal activities sooner than they would after open surgery.

For an aortic aneurysm specifically, repairing it lowers the chance of it bursting (rupturing), which can be life-threatening.

Are there different types of endovascular treatment?

Endovascular treatment covers several distinct procedures, chosen according to the problem being treated:

• Angioplasty and stenting: a balloon widens a narrowed artery, sometimes followed by a small mesh tube (a stent) left in place to hold it open.
• Stent grafting, used for aneurysm repair: a fabric-covered tube reinforces a weakened section of artery from within.
• Atherectomy: clearing away a build-up of plaque from inside a blood vessel.
• Thrombectomy or thrombolysis: physically removing a blood clot, or using medicine to break it down.
• Embolization: deliberately blocking a blood vessel, for example to stop bleeding.
• Endovenous ablation (radiofrequency or laser): closing off a faulty vein, commonly used to treat varicose veins.

For an aortic aneurysm, this approach is usually called endovascular aneurysm repair (EVAR). A specialised version, fenestrated EVAR (FEVAR), is used for more complex aneurysms close to other important arteries.

What happens before endovascular treatment?

Preparation usually includes:

• a physical examination and a discussion of your medical history
• imaging tests, such as an ultrasound, CT scan, MRI or angiogram, to assess the affected blood vessel
• heart tests, such as an ECG, echocardiogram or exercise stress test
• blood tests.

You'll be told whether to fast beforehand, and whether you'll need someone to accompany you home afterwards.

What happens during endovascular treatment?

1. You're given sedation, a local or regional anaesthetic, or a general anaesthetic, depending on the procedure.
2. Your surgeon makes a small puncture or cut, usually in your groin, to reach a blood vessel.
3. Guided by real-time X-ray images, they thread a thin, flexible tube (a catheter) through your blood vessels to the area that needs treatment.
4. Depending on what’s being treated, they may widen a narrowed vessel with a balloon, place a stent or stent-graft, clear a blockage, remove or dissolve a clot, or seal off a faulty vein.
5. Once treatment is complete, the catheter is withdrawn and the small entry point is closed.

What does recovery look like?

How long you stay in hospital depends on the procedure. Some, such as varicose vein treatment, are done as day cases, so you go home the same day. Others, such as aortic aneurysm repair, usually mean a short stay of around 1 to 2 days.

Most people can return to work and normal activities within a few weeks, though getting back to normal fully after aortic aneurysm repair can take up to a month. You'll have follow-up appointments and imaging tests afterwards to check the repair is working as it should.

What are the risks and complications?

As with any procedure, endovascular treatment carries some risk, including:

• bleeding
• damage to the blood vessel
• infection
• a blood clot forming (thrombosis).

For aortic aneurysm repair specifically, the physical stress of surgery can occasionally trigger a heart attack, which is why your heart gets a thorough check and, where needed, some fine-tuning beforehand. There's also a small chance the stent-graft can shift out of position, sometimes needing a further procedure to correct it.

For varicose vein treatment, risks tend to be more minor and can include skin burns or temporary discomfort from nearby nerves, along with bruising and swelling that usually clears up over a week or two.

Contact your care team if you notice pain in your abdomen, chest, back or groin, bleeding, a swollen or painful limb, feeling light-headed or passing out, pins and needles or a loss of feeling, or redness and discharge where the catheter went in.