Endovascular surgery is a rapidly developing branch of vascular surgery. It evolved from the diagnostic techniques used to investigate damage to blood vessels caused by atherosclerosis or injury.

Endovascular surgery is highly skilled and complex. Two main procedures are used:

  • Angioplasty with stenting: this is the main technique used to treat blockages in arteries caused by the build up of fatty plaques due to atherosclerosis. The technique can be applied to any of the main arteries such as leg artery angioplasty with stenting.
  • Endovascular aneurysm repair (EVAR): the endovascular method is used to repair aneurysms. The technique can be applied to any aneurysm whether it affects the main aorta or one of the other main arteries.
    Thoracic endovascular aortic repair (TEVAR) is a subtype of EVAR: this is used to repair an aneurysm that develops in the thoracic aorta in the chest. This is the part of the aorta that leads upwards from the heart before curving down to form the abdominal aorta.

Leg artery angioplasty with stenting

Endovascular surgeons use angioplasty with stenting to open up blockages in the arteries that supply blood to the legs and other parts of the body. Blocked arteries in the legs cause pain in the muscles on walking, a condition called intermittent claudication.

The endovascular technique used to treat intermittent claudication involves introducing a catheter into the femoral artery in the groin and then manipulating it through the blood vessels into the artery that is blocked. 

Once in place, a small balloon at the end of the catheter is expanded to open up the blocked part of the artery so blood can flow freely through it. A stent, which is a fine, spring-like metal cage, may be left in place to support the artery wall to prevent the lumen of the blood vessel narrowing again. Similar techniques may be used to treat carotid arteries, which provide the blood supply to the brain. 

Endovascular aneurysm repair (EVAR) in the abdominal aorta

The aorta is the main artery that carries blood from the heart to all parts of the body. Our blood is pressurised just like air in a car tyre – this is what is measured when our blood pressure is taken. An aortic aneurysm is a bulge in the wall of the aorta, like a bulge in a car tyre. Unless it is fixed, the pressure inside it may cause it to burst which can be fatal.

Endovascular treatment of this condition uses catheters introduced into the abdominal aorta through the femoral artery in the groin. Images from live X-rays guide the endovascular surgeon to be able to place the catheters into the aneurysm, the point where the wall of the artery is bulging out.

A special catheter, called an introducer sheath, carries with it an endovascular stent graft, or endograft. This is a tube made from a fabric-like material that is reinforced by a scaffold of metal springs or stents. The stents, which are compressed within the introducer sheath, open up as the endograft is deployed to form the tube. 

Once in place, the top and bottom of the endograft make a seal with the normal aorta above and below the aneurysm. This forms an inner tube through which the blood flows and blood can no longer enter the aneurysm. This stops the wall bulging any further and eliminates the risk of rupture.