Endovascular Surgery

Endovascular Surgery

What is endovascular surgery?

Endovascular surgery is an innovative, minimally invasive procedure that is performed inside of blood vessels. It is used to treat aneurysms, a swelling or "ballooning" of an artery, and other problems affecting blood vessels.

The surgery involves making a small incision near each hip to access the blood vessels. An endovascular graft, a special fabric tube device with stainless steel, self-expanding stents, is inserted through the arteries in a catheter, and positioned inside the aorta. Once in place, the graft expands and seals off the aneurysm, preventing blood from flowing into it. Following the procedure, the graft stays inside the aorta permanently.

How does endovascular surgery compare to vascular surgery?

In the past, conditions affecting the blood vessels were treated by vascular surgery, which is an open surgical procedure. Vascular surgery involves making an incision in the side of the chest or breastbone. This procedure typically requires a long recovery period. Patients generally stay in the hospital for seven to 10 days following open surgery and undergo a three-month recovery.

An alternative to open surgery, endovascular surgery offers many advantages, including:

• A shorter recovery period
• Less discomfort
• Local or regional anesthesia instead of general anesthesia
• Smaller incisions
• Less stress on the heart
• Fewer risks for patients with other medical conditions

Our approach to endovascular surgery

UCSF Health is a pioneer in endovascular surgery, performing more than 150 endovascular aneurysm repairs annually – more than any other medical center on the West Coast. Our team of experts have developed and tested groundbreaking endovascular surgical technologies and techniques.

In some cases, standard endovascular repair is not an option. Sometimes the aneurysm is too close to important branches of the aorta, or the arteries are too narrow or too complicated to insert the catheter. Vascular surgeons at UCSF Health have developed new procedures and technologies, using endovascular techniques for complex conditions. These advanced techniques are not available at other medical centers. They may be used for thoracoabdominal aortic aneurysms (TAAA), which involve vital arteries to the abdominal organs, or arch aortic aneurysms, involving vital arteries to the brain.

Evaluation for endovascular surgery

Before endovascular surgery, you will meet with your doctor who will take your medical history and conduct a thorough physical exam. You also may have tests to determine the health of your heart, such as a stress test and an electrocardiogram (ECG), which records the electrical activity of the heart.

To determine whether your aneurysm can be treated with endovascular surgery, you will have additional tests done. These tests include a CT scan and angiography, which allow your doctor to assess your aorta and blood vessels. These tests also allow the doctor to select the appropriate size graft for your treatment.

During this time, your doctor will discuss endovascular surgery with you and answer any questions you may have.

Procedure for endovascular surgery

Before your endovascular surgery begins, you will be put under anesthesia. This will be either a sedative and regional anesthesia to make you more comfortable and numb the area of operation, though sometimes we may use general anesthesia to put you to sleep completely.

The area of insertion will be cleaned and shaven to prevent infections. Next, your doctor will make a small incision around your hip, near the crease between the hip and thigh, to access your blood vessels. Then, a guide wire will be inserted through the incision and pushed through a blood vessel to the aneurysm.

Special X-rays will be taken so your doctor can see the exact location of the aneurysm. At that point, they will insert a catheter – a long, flexible narrow tube – over the guide wire. This catheter will carry the graft through your blood vessels to the aorta above the aneurysm. Once in place, the graft is released from the catheter and expanded, blocking the flow of blood to the aneurysm, which will shrink the aneurysm over time.

Before the procedure is finished, X-rays will be taken to confirm that blood in the aorta is flowing through the graft, not through the aneurysm. Then, the incisions near your hip will be closed with sutures (stitches).

Recovery from endovascular surgery

After your endovascular surgery, you will be closely monitored and cared for by our team of experts. Most patients spend two to three days in the hospital. The first day following your surgery you will be allowed to walk and to eat. However, most patients will experience reduced energy and appetite for approximately two weeks after the operation.

Once you go home, you may take sponge baths. You should not soak the area around your incision until it has completely healed. Most patients return to their normal activities within four to six weeks after surgery.

Follow-up after endovascular surgery

One to two weeks after surgery, you will have a follow-up appointment with your doctor to check the progress of your recovery. You will have imaging tests one month after your surgery, and again at the six-month mark. These tests are done to check that your graft is working properly. After the first year, you will have annual imaging tests to assess your aneurysm and graft.

Complications after endovascular surgery

Endovascular surgery does have potential complications, which may include:

• Blockage of the blood flow through the graft
• Fever and an increase in white blood cell count shortly after the surgery
• Graft fracturing
• Infection
• Leaking of blood around the graft
• Movement of the graft away from the targeted position

Other complications that are rare, but serious may include:

• Blocked blood flow to the abdomen or lower body
• Burst artery
• Delayed rupture of the aneurysm
• Injury to kidneys
• Paralysis