Endovascular surgery: types of interventions
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 announcedidea to introduce a liquid into the vessel, that is, a contrast agent. The scientist's goal was to avoid a cut. So he came to the technique of puncture the vessel with a special needle through the skin.
Through the needle came a string penetrating into the vesselby means of X-ray control, the needle was removed and a catheter was inserted along the string. Contrast substance was fed into the catheter, then a picture was taken on X-ray film. Thus, the image of the vessel was obtained. The needle, guide, catheter are the basic tools 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 the 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 dilating the narrowed vessel with an inflated balloon that was attached to the end of the catheter. This innovation was perfected by the Swiss cardiologist Andreas Grüntsig. He first made 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, this: Serbinenko FA, Rabkin I. Kh., Savelyev VS, Zingerman LS and others.
Today, endovascular surgery has ceased to be experimental. Has firmly taken its place and is progressing.
About vascular surgery
Vascular surgery is an area of medicine thatincludes treatment of the blood and lymphatic vessels. We apply the method of therapy as operable and intravascular surgical. Initially, the purpose of this area of surgery was diagnostic. Achievements and results of treatment allowed to establish a separate direction.
Minimally invasive species refers to moderncardiovascular surgery. Effective operation inside the vessels is possible thanks to innovative technologies in medicine, thus endovascular surgery is considered an independent, narrow profile specialization that has taken its niche and made 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 internal organ ducts.
Basic views
Endovascular surgery includesroentgenosurgery, interventional cardiology, interventional radiology are types of surgical interventions that are performed on a blood vessel through percutaneous access, controlled by radiation imaging.
The main advantage of intravascular surgery is intervention through small punctures on the skin and x-ray monitoring of this manipulation.
Endovascular diagnosis and treatment are performed in the clinic and require several days of stay in the hospital.
- On average, there is no need for general anesthesia.
- An order of magnitude lower risk in the absence of need for surgical intervention, as a consequence of lower pain syndrome, quick rehabilitation in comparison with classical surgery.
- Types of endovascular interventions are attractive budgetary pricing.
The often used endovascular procedure is diagnostic angiography. What does the endovascular surgery center do?
When the vessel is narrowed, it is dilated orstenting. With excess blood supply of one of the organs (tumor, angiodysplasia and others) or pathological blood flow (arteriovenous shunt, varicocele), vascular embolization is used.
TIPS Methodology
In relation to patients with a diagnosis of "portalhypertension "(increased pressure in the portal vein due to the difficulty of blood flow through the liver), the TIPS technique is used - a bypass" bloodstream "from the portal to the hepatic vein is created, which reduces the pressure in the portal vein and prevents the threat of life.
If there is a risk of separation of the thrombus from the veins of the lower limb with further transport to the pulmonary artery, then cava filters are installed with a preventive purpose.
Regional Chemotherapy
The method of regional chemotherapy is used fortargeted administration of the drug to any organ, for example, infusion with acute pancreatitis, the chemotherapy of a malignant tumor (a catheter is inserted into the artery, then the drug is injected directly into the diseased organ). Introduction to the artery of chemotherapy in a compartment with an oil contrast medium - chemoembabilization.
Thrombolysis
The listed endovascular methods are notfull volume. The realities of the modern day are such that endovascular surgery is an innovative branch of medicine that develops in a geometric progression. The list of therapeutic different endovascular methods is expanding.
What can I do with X-rays?
Investigation of blood vessels, arteries or veins allowsto reveal narrowing, blockage of the vessel, the focus, the size of the pathology of the vessel widening, and also reveals internal bleeding, the tumor process and many other things that it is not possible to reveal by another method.
The department of endovascular surgery is engaged in similar studies.
The order of the action is usually the following. For puncture of the artery or vein, use a special needle - in the groin, under the arm, under the collarbone or on the neck. A curved plastic tube - the catheter penetrates into the vessel. X-ray inspection helps to hold the catheter into the target vessel.
Then a contrast agent is fed into the catheter,which is seen in x-ray radiation. Contrast substance, spreading along the considered vascular site, makes it visible to the x-ray. The result of the study fixes an x-ray image or video. X-ray-endovascular surgery reveals various pathologies of blood vessels, as well as internal organs and is an indispensable method of investigation.
When hagiographic study possible short-term pain of varying intensity in the study area. Sometimes pain therapy is required.
Samples of angiograms
A catheter is fed into the constricted vessel;angiography to reveal the level of vasoconstriction. Through the narrow or closed part of the vessel conduct tool - conductor. Then bring the balloon-catheter, which overlaps the narrowed area.
The balloon expands the constricted area. The reason for the contraction is a blood clot or plaque that evenly spreads over the highly stretched wall of the vessel. Next, the balloon is blown off, thereby freeing a portion of the vessel, which was restored for full blood flow.
The balloon is removed, the positive dynamics is monitored by repeated angiography. Endovascular surgery of the vertebral artery is also popular.
With the inefficiency of the dilation
Often, after dilation, residual stenosis is observed, which does not impede the normal blood flow process.
If the dilatation is ineffective,A stent is recommended that supports the vessel from the inside and further does not allow it to narrow. The stent can have a different length and diameter, a different method of installation. The stent is selected individually. To date, all human vessels are available for endovascular steenia.
Conclusion
There are various indications when you need to stopblood flow through the vessel. A catheter is inserted into the vessel for embolization. It is important that the catheter should be placed so that embolizing substances do not enter other vessels. An embolizing agent or device, such as a spiral, a plastic (gelatin) particle, or a sclerosant is transported into the vessel by means of a catheter.
