Is endovascular surgery right for you?

 The trend in surgery today is to use the least-invasive procedures possible. The reasoning is simple: It’s usually better for patients to return home and get back to their normal lives faster than for them to spend long periods recovering in the hospital.  

In the field of vascular surgery, which deals with conditions of the blood vessels, we refer to minimally invasive surgery as endovascular surgery. Endovascular surgery involves small punctures, usually in the groin area, as opposed to the large incisions on the abdomen or chest that open surgery for blood vessels requires.

This type of surgery has seen a huge surge in the past few decades. That’s because it’s often safer and better for patients. But endovascular surgery isn’t the best option in all cases. Below, I’ll discuss when we use endovascular surgery, why it’s beneficial, when the traditional open approach might be better and what’s to come for this area of surgery.  

When we use endovascular surgery

We can use these surgical techniques for virtually the entire range of vascular treatments. These include:

The field of vascular surgery started seeing a surge in less-invasive surgical techniques in the early 1990s. Since then, endovascular surgery has grown from something reserved for simple cases to being used for complex issues today. Our rule of thumb is this: If a vascular surgery can be done with an endovascular technique, that’s probably the way to go.  

A vascular surgeon’s work now consists of about 75 percent endovascular surgery and perhaps 25 percent open surgery. That’s almost the opposite of the way it was just a few decades ago.  Using less-invasive techniques involves a much different skillset for vascular surgeons. I must be able to clearly see the area where I’m operating on an X-ray screen, rather than operating on the patient and looking directly. Advanced imaging technology, like what we use in our Hybrid Suite, can make this easier for vascular surgeons.  

Request an appointment with one of our doctors to learn if endovascular surgery might be an option to treat your vascular condition.

How endovascular surgery benefits patients

The main benefit of endovascular surgery is that it’s less invasive. Open surgery for blood vessels can involve large incisions, major scarring and long recovery periods. But less-invasive techniques are all done through a small puncture or incision, usually in the groin area. We can thread our tools through the blood vessels to access the area where we’re working with the use of catheters—thin, flexible tubes we insert into this small incision.

Many patients who have this type of surgery go home the same day. Some have short stays in the hospital afterward, but it’s a huge improvement over those who have open vascular surgery. Endovascular surgery can make a big difference in patients’ recovery and quality of life.  

#Endovascular surgery can make a big difference in patients’ recovery and quality of life. via @MedStarWHC

A great example is surgery to treat aortic disease. Traditionally, correcting it involved an open surgery with a large incision and long recovery period. Patients were usually in the hospital for seven to 10 days, and they usually took three to four months to fully recover. But with an endovascular surgical procedure, these patients go home the next day, and they’re usually back to themselves within four to five days.

Limitations of less-invasive blood vessel surgery

While there’s been tremendous growth in this area of surgery, it does have a few limitations. One example is if we can’t reach an area through a minimally invasive approach. Because we thread our surgical tools from the groin to the area where we operate, we must make sure we can access the blood vessels we need to treat and that blood continues to flow to the body’s organs and tissues during surgery. With an open approach, we can directly access the area where we need to work, which can be easier in some cases.

A patient’s age and overall health also can factor into the decision on whether to use a less-invasive technique or an open surgical technique. Though endovascular surgeries can be easier on patients, some patients find that the results don’t last as long as the results after open vascular surgery. So we may have to weigh a patient’s particular options when we decide which approach is better. For a 75-year-old who’s a smoker, I probably would choose a less-invasive approach to be easier on the patient. For a 35-year-old who’s in otherwise excellent health, it may make sense to perform an open surgical procedure that will last a lifetime.

New treatments on the horizon

Researchers hope to make endovascular surgery a good option for treating even more cases of blood vessel conditions. It’s a constant process of changes and improvements to make this possible.

As of January 2017, we have initiated a clinical trial for a new device to treat aortic aneurysms in the aortic arch, which is the area of the aorta that curves between the ascending aorta (which carries blood up from the heart) and descending aorta (which carries blood down through the chest and abdomen). The aortic arch has three blood vessels that branch off of it to carry blood to the arms and brain.

Traditionally, we haven’t been able to put a stent (a device used to hold blood vessels open) there, because it would cover those branching arteries. But we’ll be testing a new device that allows us to maintain this circulation with a minimally invasive approach.

We’re also involved in the clinical testing of different balloons used to treat peripheral artery disease. During a procedure called angioplasty, we use a balloon to push arterial blockages aside to improve blood flow. But these blockages may come back over time. We helped test a balloon coated with a medication to prevent blockages from reforming in treated blood vessels.

And we’re about to help test another type of angioplasty balloon called a lithotripsy device. This balloon uses sound waves to break up blockages that have hardened because they have calcium in them, similar to a process used to treat kidney stones.

Endovascular surgery is a great option in many cases. And as technology and techniques continue to improve, I’m looking forward to it being an option for even more conditions and patients.

Leg pain: A potential sign of peripheral artery disease

A little leg pain or soreness with exercise usually is normal. But severe pain, especially pain that appears when you’re only walking a short distance, may be a sign of a condition called peripheral artery disease. This condition, also known as peripheral vascular disease, can make even simple actions like walking across the room a challenge. As the Centers for Disease Control and Prevention reports, about 8.5 million Americans have peripheral artery disease, including 12 to 20 percent of people older than 60.  

Peripheral artery disease doesn’t have to slow you down. Our diagnostic tools and treatment options let us identify and address the causes of your leg pain to get you back on your feet.  

The warning signs of peripheral artery disease

Peripheral artery disease involves the narrowing or blockage of blood vessels. The main cause of the disease is a process called atherosclerosis, in which fatty deposits build up in the blood vessels. Peripheral artery disease can occur in any of the body’s blood vessels, but it’s more common in the legs than the arms.  

The classic and most common symptom of peripheral artery disease is leg pain. This may appear as pain in a specific area of the leg, such as in the calf or thigh—anywhere from the buttock and hip down to the foot. Weakness and leg cramps often go along with the pain.  

You may especially notice these problems when you walk, though they can appear while resting as well. Everyone’s experience is different. I’ve had patients who could walk for a mile or so before they had to rest, while others experienced intense leg pain and cramps just walking to the mailbox. The pain, weakness and cramping are signs of poor circulation in the legs. Resting can improve circulation temporarily and relieve these symptoms.  

Other common peripheral artery disease symptoms can include:

  • Changes in the color or temperature of the legs
  • Numbness or tingling in the legs
  • Toenails that become thick or opaque (unable to be seen through)  

It’s possible for people with peripheral artery disease to develop ulcers in the toes or feet. This is because the narrowed blood vessels in the legs restrict blood flow to the feet, which makes it harder for the body to heal cuts, sores and other minor injuries.  

As peripheral artery disease progresses, the symptoms get worse. Without treatment, peripheral artery disease can lead to serious consequences, including gangrene or even amputation of a leg. Peripheral artery disease also can increase your risk for having a heart attack or stroke without proper care. 

#Peripheralarterydisease can lead to serious consequences, including #gangrene or even #amputation of a leg. via @MedStarWHC

What to do if you have these symptoms

One of the big problems with peripheral artery disease is that people often don’t get help for it. They think it’s just a part of getting older, or maybe it’s their arthritis acting up. People with diabetes can mistake the pain of peripheral artery disease with diabetic neuropathy, a burning or painful feeling in the legs.  

Don’t ignore these symptoms. Request an appointment with one of our doctors if you have leg pain while walking.

How we treat peripheral artery disease

If we catch peripheral artery disease early enough, it’s often possible to treat it through changes in your lifestyle. This can include creating a plan for healthy eating and exercise, both of which can improve poor circulation and slow blockages from forming in the arteries.  

One major lifestyle factor we recommend is to quit smoking if you smoke. We offer smoking cessation services through our Pulmonary Services team if you need help to quit smoking.  

These lifestyle changes are important. But they may not be enough to treat advanced cases of peripheral artery disease. In these cases, we may have to take action to restore the blood flow to the legs. We usually can do this through endovascular surgery, which involves minimally invasive procedures.  

We treat peripheral artery disease with the following procedures:

  • Angioplasty: We insert a thin, flexible tube called a catheter and thread it to the blocked artery. Then we inflate a special balloon inside the artery that pushes the blockage aside and restores proper blood flow. We also may implant a stent, a device to help keep the artery open, during this procedure.
  • Atherectomy: Similar to an angioplasty, this also involves using a catheter. We use catheters with special cutting tools to cut blockages out of arteries. Wealso may implant a stent during this procedure.
  • Bypass graft: If we can’t remove a blockage, we may be able to go around it. A bypass graft involves using either a blood vessel from elsewhere in your body or a synthetic vessel to go around, or bypass, the blocked artery.  

Related reading: Debilitating Leg Pain Gone After Minimally Invasive Peripheral Vascular Surgery

Leg pain isn’t just a part of getting older. It can be a sign of serious, potentially life-threatening problems. But with the right diagnosis and treatment, leg pain can be something you look back on—not something you just have to live with.