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Endovascular Surgery

Last updated April 3, 2019

Approved by: Maulik P. Purohit MD MPH

Endovascular Surgery is a procedure that uses a special graft to repair, narrow or enlarged arteries.


Background Information:

What are the other Names for the Procedure?

  • Endovascular Repair

What is the Endovascular Surgery surgical procedure?

Endovascular Surgery is a procedure that uses a special graft to repair, narrow or enlarged arteries.

What part of the Body does the Procedure involve?

An Endovascular Surgery may involve any of the several arteries within the body.

Why is the Endovascular Surgery surgical procedure Performed?

An Endovascular Surgery is performed for the following reasons:

  • Prevent an aneurysm rupture, which frequently results in a massive internal bleeding and potentially cause death
  • Improve blood flow within a narrowed artery

What are some Alternative Choices for the Procedure?

Open surgical repair is an alternative treatment approach.

What are the Recent Advances in the Procedure?

The use of different types of stents and stent-deploying devices has been some of the recent advances in the procedure.

What is the Cost of performing the Endovascular Surgery surgical procedure?

The cost of Endovascular Surgery depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding Endovascular Surgery and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.ucsfhealth.org/treatments/endovascular_surgery/

http://www.vascularweb.org/vascularhealth/Pages/endovascular-stent-graft.aspx

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

Prior to Endovascular Surgery surgical procedure:

How is the Endovascular Surgery surgical procedure Performed?

  • An Endovascular Surgery is a less invasive procedure, performed with the help of X-ray imaging
  • It involves the insertion of a catheter through the artery
  • Graft (a metal mesh stent) is deployed in the aneurysm with the help of the catheter
  • It is guided through the artery with the aid of x-ray imaging (fluoroscopy) and a radio contrast solution, injected in the blood
  • Once the stent is placed on the arterial wall with the support of hooks, the catheter is withdrawn. The skin is then closed and bandaged
  • The stent acts as an artificial lumen (hollow inside space in an artery) for blood to flow, and not into the surrounding aneurysm sac
  • Thus, the chance of aneurysm expansion and rupture is decreased significantly

Where is the Procedure Performed?

An Endovascular Surgery is performed in a hospital.

Who Performs the Procedure?

An Endovascular Surgery is performed by a vascular surgeon, a cardiothoracic surgeon, interventional radiologist, interventional cardiologist, or a general surgeon, with assistance from an anesthesiologist.

How long will the Procedure take?

The procedure may take anywhere between 2-3 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc. 

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
  • A physician will request your consent for the Endovascular surgical procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Endovascular Surgery using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Endovascular Surgery surgical procedure?

Prior to an Endovascular Surgery, the physician may recommend any of the following tests:

  • Routine blood test
  • CT scan
  • Electrocardiogram (EKG)

The physician may suggest further tests depending on the health of the patient and their medical history.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is an Endovascular Surgery?
  • Why is this procedure necessary?  How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • How long will it take to recover? When can I resume normal work?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • How many such procedures have you (the physician) performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • What are the costs involved?

During the Endovascular Surgery surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the procedure the patient is administered, local anesthesia with sedation, or general anesthesia.

How much Blood will you lose, during the Procedure?

Endovascular Surgery is a less invasive procedure and so the blood loss is minimal.

What are the possible Risks and Complications during the Endovascular Surgery surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

  • Obesity: Generally greater the degree of obesity, greater is the surgical risk
  • Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Long standing illness, such as autoimmune disorders, chronic infections, etc.
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

  • Infection
  • Excessive bleeding surrounding the endovascular graft
  • Fracture of the endovascular graft
  • Disruption of blood flow in the graft
  • Inability to place the endovascular graft into its proper position

What Post-Operative Care is needed at the Healthcare Facility after the Endovascular Surgery surgical procedure?

  • After the surgical procedure, patients will be sent to an area of the hospital called, postoperative recovery area (PACU)
  • The patient’s blood pressure, heart rate, and respiration cycle, shall be closely monitored
  • Any additional pain associated with the procedure, will also be treated
  • Patients are usually discharged from the hospital, 1-2 days after surgery

After the Endovascular Surgery surgical procedure:

What are the possible Risks and Complications after the Endovascular Surgery surgical procedure?

Post Endovascular Surgery, the following complications may arise:

  • Excessive bleeding in the groin, if catheter is advanced through the groin blood vessel
  • Kidney failure
  • Decreased circulation of blood to the intestines, which may result in gangrene
  • Excessive bleeding or rupture of the aorta
  • Kinking of the stent
  • Migration of the stent
  • Endoleak

Endoleak: An endoleak is a condition where blood leaks into the aneurysm sac. It is seen after an Endovascular Repair. Five types of endoleaks exist:

Type I - Perigraft leakage at the upper or lower graft attachment sites

Type II - Retrograde flow from branches of the aorta

Type III - Leakage between overlapping parts of the stent

Type IV - Leakage through the graft wall

Type V - Leakage from an unknown origin

What is the Prognosis after the Surgery?

Individuals should expect a complete recovery in 2-3 weeks after the procedure. 

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Increase in pain
  • Bleeding or fluid drainage around the surgical wound
  • Abnormal bleeding or swelling
  • Nauseous
  • Signs of an infection
  • Headache
  • Muscle aches
  • Fever
  • Dizziness
  • Feeling sick
  • Constipation that occurs over a prolonged time period
  • Cold, numb, or painful sensation, within the legs
  • Complications associated with prescription medications used for the treatment

What Post-Operative Care is needed at Home after the Endovascular Surgery surgical procedure?

At home, the following post-operative care is recommended, after an Endovascular Surgery:

  • Resume regular/daily activities, as early as possible (under advice by the physician). This aids in a faster recovery
  • Use heat pad or warm compress to relieve pain due to the incision
  • Keep the wound clean and dry
  • Avoid sex till complete healing has taken place (under advise by the physician)
  • Avoid all activities that are physically strenuous for 2-3 weeks
  • Complete the course of prescribed medication
  • Individuals may take nonprescription medications, such as acetaminophen, if required. Ask your physician, if ibuprofen or aspirin are acceptable

How long does it normally take to fully recover, from the Procedure?

Individuals should expect a complete recovery within 2-3 weeks of the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Endovascular Surgery surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital
  • An anesthesiologist (if anesthesia was administered)
  • An cardiothoracic surgeon, interventional radiologist, interventional cardiologist, or a vascular surgeon

The patient is advised to inquire and confirm the type of billing, before the Endovascular Surgery is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: July 5, 2013
Last updated: April 3, 2019