Endovascular repair

Endovascular means “inside the blood vessel”. Instead of opening the body to reach a diseased artery, the surgeon passes fine wires, catheters (thin flexible tubes), balloons and stents into it through a needle puncture, usually in the groin or arm. Live X-ray images guide every step on a screen.

It is used to open narrowed or blocked arteries, reline an aneurysm with a stent-graft (a fabric-covered stent), remove clots, and block bleeding or abnormal vessels.

For many patients it replaces a long open operation with a procedure under local anaesthesia, a smaller wound and a much shorter recovery. It is not right for everyone, and sometimes open surgery is still the better choice.

Endovascular techniques are used for several conditions:

Narrowed or blocked leg arteries (peripheral arterial disease), causing pain on walking, rest pain or non-healing wounds

Abdominal aortic aneurysm, repaired with an EVAR stent-graft

A failing dialysis fistula or graft that has narrowed

Large clots in arteries or veins, removed or dissolved with a catheter (thrombectomy or thrombolysis)

Bleeding or abnormal vessels, closed from the inside (embolisation)

It is often a good option for patients who are at higher risk from open surgery, such as those with heart or lung disease. The underlying cause, such as smoking, diabetes or high blood pressure, still needs treating alongside the procedure.

Planning starts with imaging. A duplex Doppler scan, and often a CT angiogram (a CT scan with dye), show the exact size, length and position of the problem so the right equipment can be chosen.

You will usually have blood tests, including kidney function, because the X-ray dye is cleared by the kidneys. Tell the team if you have kidney disease or have ever reacted to X-ray dye or iodine.

Bring a full list of your medicines. Some, such as blood thinners and certain diabetes tablets, may need to be adjusted or paused for a short time; your doctor will tell you exactly what to do. You will be asked not to eat for a few hours beforehand. Bring previous scans and reports, and arrange for someone to take you home.

Most procedures take 1–3 hours. The area is numbed and a small tube (sheath) is placed in the artery through a needle. Depending on the problem, the surgeon may use:

Angioplasty: a balloon is inflated inside the narrowing to widen the artery.

Stenting: a metal mesh tube holds the artery open after the balloon.

EVAR stent-graft: a fabric-covered stent is placed inside an aortic aneurysm, so blood flows through the graft and no longer presses on the weak wall.

Thrombectomy or thrombolysis: a clot is pulled out with a catheter, or dissolved with a clot-busting medicine given directly into it.

Embolisation: tiny coils, plugs or special liquids are used to block a bleeding or abnormal vessel.

At the end, the puncture is closed with pressure or a small closure device.

You will usually lie fairly flat for a few hours so the puncture can seal. Depending on the procedure, you may go home the same day or stay one or two nights.

At home, expect a small bruise at the puncture site. For about a week, avoid heavy lifting and hard exercise, and keep the site clean and dry. Most people are back to normal daily activities within days rather than weeks.

You will usually be on medicines such as antiplatelets or blood thinners afterwards; do not stop them without advice. Follow-up visits with a Doppler or CT scan check that the treated vessel stays open or, after EVAR, that the stent-graft stays in the right place. After EVAR, scans are needed for life.

Ask about endovascular treatment if you have been told you have narrowed leg arteries, an aortic aneurysm or a failing dialysis access, or if you have been advised that open surgery is high risk for you.

After a procedure, contact the clinic the same day if:

The puncture site becomes red, hot, increasingly painful or leaks fluid

You develop a fever

Your original symptoms, such as pain on walking, come back

Seek emergency care if:

The puncture site suddenly swells or bleeds: lie flat, press firmly on it and call for help

The treated leg or arm becomes cold, pale, numb or very painful

You have sudden severe abdominal or back pain, or you feel faint