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 proclaimed the idea of introducing a liquid into the vessel, that is, a contrast agent. The goal of the scientist was to avoid a cut. Thus, he came to the technique of puncturing a vessel with a special needle through the skin.
A string was passed through the needle, penetrating into the vessel by X-ray control, the needle was removed, and a catheter was inserted along the string. A contrast agent was injected into the catheter, then a picture was taken on an x-ray film. Thus, an image of the vessel was obtained. Needle, conductor, catheter are the basic instruments 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 was born.
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 toend of the catheter. This innovation was perfected by the Swiss cardiologist Andreas Gruntzig. He was the first to perform 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, these are: Serbinenko F. A., Rabkin I. Kh., Savelyev V. S., Zingerman L. S. and others.
Today, endovascular surgery is no longer experimental. Has firmly taken its place and is progressing.
About vascular surgery
Vascular surgery is a field of medicine that includes the treatment of the blood and lymph vessels. We apply the method of therapy, both operable and intravascular surgical. The original purpose of this field of surgery was diagnostic. Achievements and results of treatment made it possible to establish a separate direction.
The minimally invasive look belongs to modern vascular surgery. Effective intravascular surgery 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 corresponds to the specifics. This is a universal method, applicable for various pathologies of blood vessels and intraorgan ducts.
Main species
Endovascular surgery includes X-ray surgery, interventional cardiology, interventional radiology are types of surgicalinterventions that are performed on a blood vessel through percutaneous access, controlled by radiation imaging.
The main advantage of intravascular surgery is the intervention through small punctures in the skin and x-ray control of this manipulation. Endovascular diagnosis and treatment is performed in the clinic and requires several days of hospital stay.
Benefits:
- No need for general anesthesia on average.
- An order of magnitude lower risk in the absence of the need for operable intervention, as a result, lower pain syndrome, faster rehabilitation compared to classical surgery.
- Types of endovascular interventions are attractive due to 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. In case of excessive blood supply to one of the organs (tumor, angiodysplasia, etc.) or pathological blood flow (arteriovenous shunt, varicocele), vascular embolization is used.
If a pathological expansion of the vessel is diagnosed - aneurysms use an intravascular graft, which excludes the aneurysm from the blood flow area.
TIPS Methodology
In relation to patients diagnosed with "portal hypertension" (increased pressure in the portal vein due toobstruction of blood flow through the liver), the TIPS technique is used - a bypass “channel” of blood flow is created from the portal to the hepatic vein. As a result, the pressure in the portal vein decreases, the threat to life is prevented.
If there is a risk of a blood clot detaching from the veins of the lower limb with their further transportation to the pulmonary artery, then cava filters are installed for prophylactic purposes.
Regional chemotherapy
The method of regional chemotherapy is used for the targeted administration of the drug into any organ, for example, infusion in acute pancreatitis, chemotherapy of a malignant tumor (a catheter is inserted into the artery, then the drug is injected directly into the diseased organ). The introduction of chemotherapy drugs into the artery in combination with an oily contrast agent - chemoembilization.
Thrombolysis
Regional thrombolysis is used for vascular thrombosis. A catheter is inserted into the area of thrombosis, a substance that dissolves the thrombus (thrombolytic) is injected directly into the focus of thrombosis. As a result, the thrombus partially or completely dissolves, thereby reducing the dose of the thrombolytic drug.
The listed endovascular techniques are not in full. The realities of the modern day are such that endovascular surgery is an innovative, exponentially developing branch of medicine. The list of various therapeutic endovascular techniques is expanding.
What can you do with X-rays?
Examination of vessels, arteries or veins reveals narrowing, blockage of the vessel, focus, sizepathology of vessel expansion, and also reveals internal bleeding, tumor process and much more, which cannot be detected by any other method.
The Department of Endovascular Surgery deals with 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 - the catheter penetrates into the vessel. Fluoroscopic guidance helps guide the catheter into the target vessel.
Then, a contrast agent is injected into the catheter, which is visible in X-rays. The contrast agent, spreading over the vascular area under consideration, makes it visible to the X-ray beam. 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.
During hagiographic examination, short-term pains of varying intensity in the study area are possible. Sometimes pain medication is 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 require prompt action, is universal, as it is applicable to any human vessels.
The catheter is brought into the narrowed vessel,angiography to determine the level of narrowing of the vessel. Through the narrow or closed part of the vessel, an instrument is passed - a conductor. Then a balloon-catheter is brought in, which covers the narrowed area.
The balloon expands the narrowed area. The cause of the narrowing is a thrombus or plaque, which evenly spreads along a highly stretched vessel wall. Next, the balloon is deflated, thereby freeing up a section of the vessel that has been restored for full blood flow.
The balloon is removed, positive dynamics is monitored by repeated angiography. Endovascular surgery of the vertebral artery is also popular.
If dilatation fails
Residual stenosis is often observed after dilatation, which does not impede the normal process of blood flow.
If dilation is ineffective, a stent is recommended, which supports the vessel from the inside and prevents it from narrowing in the future. The stent can have a different length and diameter, a different installation method. 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 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 embolic agents do not enter other vessels. Through a catheter, an embolizing substance or device, such as a coil, a plastic (gelatin) particle, a sclerosant, is transported into the vessel.
