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
The Swedish radiologist Sven Seldinger proclaimed the idea of introducing liquid, that is, a contrast agent, into the vessel. The scientist's goal was to avoid the cut. Thus, he came to the technique of puncture the vessel with a special needle through the skin.
A string entered the needle through the needle, penetrating the vessel through X-ray control, the needle was removed, and a catheter was inserted along the string. Contrast material was introduced into the catheter, then an X-ray film was taken. Thus, an image of the vessel was obtained. A needle, a guide, a 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 endovascular surgery of the internal carotid arteries originated.
The next stage of development dates back to 1964. Radiologist Charles Dotter introduced a method for expanding a narrowed vessel using an inflatable balloon that was attached to the end of the catheter. This innovation was improved by the Swiss cardiologist Andreas Grüntzig. He was the first to do balloon arterial angioplasty. 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, these are: Serbinenko F.A., Rabkin I.Kh., Savelyev V.S., Zingerman L.S. and others.
Today, endovascular surgery is no longer experimental. Firmly taken its place and progresses.
About vascular surgery
Vascular surgery is a field of medicine that includes the treatment of blood and lymph vessels. We apply the method of therapy both operable and intravascular surgical. The original goal of this area of surgery was diagnostic. Achievements and results of treatment allowed to establish a separate direction.
Minimally invasive species refers to modern vascular surgery. Effective surgery inside the vessels is possible thanks to innovative technologies in medicine, thus endovascular surgery is considered an independent, narrow-profile specialization, which has occupied its niche and constituted an alternative to traditional surgery.
The term "endovascular", which means "intravascular", exactly meets the specifics. This is a universal method, applicable to various pathologies of blood vessels and intraorgan ducts.
Main types
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, controlling radiation imaging.
The main advantage of intravascular surgery is the intervention through small punctures on the skin and x-ray control of this manipulation.
Endovascular diagnostics and medical intervention are performed in the clinic and require several days in hospital.
Benefits:
- On average, there is no need for general anesthesia.
- There is an order of magnitude lower risk in the absence of the need for an operable intervention, as a result of lower pain, quick rehabilitation compared with classical surgery.
- Types of endovascular interventions are attractive with budget pricing.
A commonly used endovascular procedure is diagnostic angiography. What does the endovascular surgery center do?
When the vessel is narrowed, it is dilated or stented. With excessive blood supply to one of the organs (tumor, angiodysplasia, etc.) or pathological blood flow (arteriovenous shunt, varicocele), vascular embolization is used.
If pathological vasodilation is diagnosed, aneurysms use an intravascular graft, which excludes aneurysm from the bloodstream.
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 technique is used - a bypass channel is created from the portal to the hepatic vein. As a result, the pressure in the portal vein is reduced, and the threat to life is prevented.
If there is a risk of a blood clot from the veins of the lower extremity with their further transport to the pulmonary artery, then establish cava filters for prophylactic purposes.
Regional Chemotherapy
The method of regional chemotherapy is used for targeted administration of the drug to an organ, for example, infusion for acute pancreatitis, chemotherapy for a malignant tumor (a catheter is inserted into the artery, then the drug is injected directly into the diseased organ). The introduction into the artery of chemotherapy along with an oil contrast medium is chemoembilization.
Thrombolysis
With vascular thrombosis, regional thrombolysis is used. A catheter is inserted into the area of thrombosis, a substance is introduced that dissolves the thrombus (thrombolytic) directly into the site of thrombosis. As a result, the thrombus partially or completely dissolves, thereby reducing the dose of the tramolytic drug.
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 is developing exponentially. The list of various endovascular treatments is expanding.
What can be done with x-rays?
Examination of blood vessels, arteries or veins reveals narrowing, clogging of the vessel, lesion, size of the pathology of expansion of the vessel, and also reveals internal bleeding, the tumor process, and much more that cannot be detected by another method.
The Department of Endovascular Surgery is engaged in similar studies.
The procedure is usually as follows. To puncture an artery or vein, a special needle is used - in the groin, under the arm, under the collarbone or on the neck. A curved plastic tube - a catheter penetrate a vessel. X-ray control helps guide the catheter into the target vessel.
Then, a contrast agent is introduced into the catheter, which is visible in x-ray radiation. Contrasting substance, spreading over the vascular site under consideration, makes it visible to the x-ray. The result of the study captures an x-ray or video. X-ray endovascular surgery reveals various pathologies of blood vessels, as well as internal organs and is an indispensable research method.
An hagiographic study may cause short-term pain of varying intensity in the study area. Pain medication is sometimes required.
Angiogram Samples
So, how is endovascular
carotid surgery performed
? Narrowed or blocked vessels are restored by introducing a special balloon, then inflate it in the lumen of the vessel. This procedure restores the patency of the vessel, does not need operational action, universal, as it is applicable to any human vessels.
A catheter is inserted into the narrowed vessel, angiography is done to reveal the level of narrowing of the vessel. An instrument - conductor is passed through a narrow or closed part of the vessel. Then a balloon catheter is brought in, which closes the narrowed section.
The cylinder expands the narrowed section. The cause of the narrowing is a blood clot or plaque, which evenly spreads along the greatly stretched wall of the vessel. Then the balloon is deflated, thereby liberating the portion of the vessel, which was restored for proper blood flow.
The balloon removes, positive dynamics are monitored by repeated angiography. Endovascular vertebral artery surgery is also popular.
In case of dilution inefficiency
Often after dilatation, residual stenosis is observed, which does not complicate the normal blood flow process.
In case dilatation is ineffective, a stent is recommended that supports the vessel from the inside and does not allow it to narrow further. A stent can have different lengths and diameters, different installation methods. The stent is selected individually. To date, all human vessels are available for endovascular stenosis.
Conclusion
There are various indications when you need to stop blood flow through the vessel. A catheter is inserted into the vessel to embolize the vessel. 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 substance or device, such as a spiral, a plastic (gelatinous) particle, and a sclerosant, is transported into the vessel.