Endovascular procedures offer a modern, minimally invasive approach to treating narrowed or blocked blood vessels. Specialists access the vascular system through small entry points, navigating specialized tools to affected areas from inside the body. This restores proper blood flow and resolves vascular problems without extensive open surgery.
Primary Endovascular Procedures
Several primary endovascular procedures are commonly employed to reopen narrowed blood vessels, each designed to address specific types of blockages. Angioplasty, often referred to as balloon angioplasty, involves using a tiny balloon to expand a constricted vessel. This technique is frequently combined with the placement of a stent.
Stenting involves inserting a small, expandable mesh tube into the artery to provide structural support and maintain the vessel’s widened state after angioplasty. These stents can be bare metal or drug-eluting, with the latter releasing medication to prevent future narrowing. Atherectomy is another procedure that directly removes plaque buildup from the arterial walls. This method physically clears the obstruction, restoring blood flow.
Mechanism of Action
The detailed mechanics of these procedures involve precise deployment of specialized instruments within the vascular system. During angioplasty, a deflated balloon attached to a catheter is guided to the narrowed segment of the blood vessel, typically over a guidewire. Once in position, the balloon is inflated to a fixed size, compressing the plaque against the artery walls and expanding the vessel lumen.
Following angioplasty, a stent, often collapsed over a balloon, is delivered to the treated area. The balloon is then inflated, expanding the mesh stent to embed it into the artery wall, thereby holding the vessel open. Atherectomy procedures utilize various tools to remove plaque. Rotational atherectomy employs a diamond-encrusted burr that rotates at high speeds to ablate calcified plaque, while orbital atherectomy uses an eccentrically mounted diamond-coated crown to sand away plaque. Laser atherectomy uses pulsatile ultraviolet laser energy to vaporize plaque tissue.
Conditions Addressed
Endovascular procedures address a range of medical conditions characterized by narrowed blood vessels, primarily caused by atherosclerosis. Atherosclerosis involves the buildup of plaque, composed of cholesterol, fats, and other substances, on the inner walls of arteries, which restricts blood flow.
Peripheral Artery Disease (PAD) is a common condition treated, where plaque narrows arteries supplying blood to the limbs, often leading to pain or tissue loss. Coronary Artery Disease (CAD) involves narrowing of the arteries that supply blood to the heart muscle, potentially causing chest pain or heart attacks. Carotid Artery Disease refers to the narrowing of the carotid arteries in the neck, which supply blood to the brain, increasing the risk of stroke.
Advantages of Endovascular Approaches
Endovascular approaches offer several advantages over traditional open surgery for treating narrowed blood vessels. These minimally invasive procedures typically involve only small punctures or incisions, often in the groin or wrist, rather than large surgical cuts.
This reduced invasiveness generally leads to less trauma to surrounding tissues, resulting in reduced postoperative discomfort and quicker healing. Patients often experience shorter hospital stays, with many able to return home the same day or within a brief period. The smaller incisions also contribute to a lower likelihood of infection and less blood loss.