Vascular & Endovascular Surgery
POSTED BY Dr. Sumit Kapadia | Jun 17, 2024

Vascular vs. Endovascular Surgery

When it comes to treating diseases of the blood vessels, patients often encounter two primary options: vascular surgery and endovascular surgery. Both play pivotal roles in modern medicine, each with its own set of advantages, challenges, and patient considerations. Understanding the differences between these surgical disciplines can help patients make informed decisions about their treatment options.

In this blog, I will explore these differences, delve into the specifics of each surgery type, and provide insights based on my experiences and knowledge as a vascular and endovascular surgeon.

What is Vascular Surgery?

Vascular surgery involves surgical interventions performed on the blood vessels outside the heart and brain. This type of surgery addresses a variety of conditions, including aneurysms, blockages, and varicose veins, among others. 

As a vascular surgeon, I use open surgical techniques, often involving large incisions to directly access and repair the affected vessels. Research indicates that vascular surgery has been effective in reducing symptoms and preventing complications from vascular diseases. For example, studies have found that surgical intervention significantly reduces the risk of aneurysm rupture in patients with abdominal aortic aneurysms.

What is Endovascular Surgery?

Endovascular surgery, on the other hand, is a minimally invasive procedure that involves accessing the blood vessels through small incisions or needle punctures, typically in the groin or arm. This technique uses catheters and specialized instruments to treat vascular diseases without requiring large incisions. 

The focus is on repairing or replacing blood vessels from within the lumen (interior) of the vessel. Endovascular procedures have become increasingly popular due to their ability to treat complex vascular conditions with reduced invasiveness. According to research, the number of endovascular procedures has been rising steadily, indicating their effectiveness and patient preference for minimally invasive treatments. In our current practice, we have noted that we are able to treat more than 80% of vascular patients with these minimally invasive techniques.

Key Differences Between Vascular and Endovascular Surgery

Surgical Approach

Vascular surgery typically requires open surgery, where I make large incisions to directly access the affected blood vessels. This approach provides a clear view and direct access to the problem area, allowing for extensive repair. A meta-analysis published in the Cochrane Database of Systematic Reviews found that open surgery is effective for treating certain vascular conditions, particularly when complex repairs are necessary.

Endovascular surgery, however, is characterized by its minimally invasive nature. I access the vessels via small punctures, using imaging techniques to guide the instruments to the problem area. This approach often involves the use of a catheter-based system to navigate and treat the vascular issues internally. Studies have shown that endovascular techniques offer lower perioperative risks and quicker recovery times compared to traditional open surgeries.

Tools and Techniques

Vascular surgery utilizes a variety of traditional surgical tools and techniques, including scalpels, forceps, needle holders, sutures, and clamps. These are essential for the direct repair ofof the blood vessels and surrounding tissues. A report from the Society for Vascular Surgery indicates that traditional surgical methods are well-established and effective for many types of vascular interventions.

Endovascular surgery employs advanced imaging technologies, such as fluoroscopy (cath Lab), and uses specialized wires, catheters, stents, and balloons. These tools allow me to navigate through the blood vessels and repair them without extensive tissue disruption. The adoption of endovascular techniques has been supported by research demonstrating their effectiveness in treating vascular diseases with fewer complications and shorter recovery times.

Recovery Time and Hospital Stay

The recovery time for vascular surgery is generally longer due to the invasive nature of the procedure. Patients often require a longer hospital stay and a more extended period of recuperation to recover from the surgery and heal from the incisions. According to a study in the Journal of Vascular Surgery, patients undergoing open surgery typically have longer hospital stays and recovery periods compared to those undergoing endovascular procedures.

Endovascular surgery typically offers a quicker recovery period. The minimally invasive nature of the procedure means less tissue damage, which often translates to shorter hospital stays and a faster return to normal activities. Research published in Endovascular Today has shown that patients undergoing endovascular procedures often experience faster recovery and fewer complications.

Indications for Vascular vs. Endovascular Surgery

The choice between vascular and endovascular surgery often depends on the specific condition being treated, the patient’s overall health, and the location of the problem within the vascular system.

Vascular Surgery is often indicated for complex cases where extensive repair is needed, such as large aneurysms or severe or extensive arterial blockages that are not amenable to endovascular techniques. Studies have found that open surgery is necessary for large aneurysms due to the complexity and risk involved in repairing such structures endovascularly.

Endovascular Surgery is frequently used for less complex issues that can be treated through the catheter-based approach, such as small aneurysms, short-segment artery blockages, and varicose veins. Research has supported the effectiveness of endovascular techniques in treating these conditions with less risk and shorter recovery times.

Advantages and Disadvantages of Vascular and Endovascular Surgery

Vascular Surgery (Benefits and Drawbacks)

Benefits:

  • Direct access and clear visibility for surgeons
  • Suitable for complex cases requiring extensive repair
  • Well-established techniques with a long track record of success
  • Durable results

Drawbacks:

  • Longer recovery times
  • Higher risk of complications from larger incisions as well as Anesthesia
  • Requires a more significant hospital stay

Endovascular Surgery (Benefits and Drawbacks)

Benefits:

  • Minimally invasive with smaller incisions
  • Faster recovery and shorter hospital stays
  • Reduced risk of complications related to large surgical wounds
  • Growing body of evidence supporting efficacy and safety

Drawbacks:

  • Limited access to some areas of the vascular system
  • May not be suitable for all patients or all conditions
  • Requires specialized skills and equipment
  • Less durable. So repeat interventions may often be required

Expert Insights from Vascular and Endovascular Surgeon Dr. Sumit Kapadia

In my experience as a vascular and endovascular surgeon, the decision between vascular and endovascular surgery depends on multiple factors including but not limited to the patient’s condition as well as overall health, the anatomy of the blood vessels, the complexity of the blockage and cost factorst. Endovascular techniques offer less invasive options that can significantly reduce recovery times and hospital stays. However, in cases where more extensive repair is needed, traditional vascular surgery remains essential.

 My expertise highlights the importance of tailored treatment plans based on individual patient needs and the specific characteristics of their vascular conditions.

Conclusion

Understanding the differences between vascular and endovascular surgery is crucial for patients facing vascular health issues. While both surgical approaches aim to treat diseases of the blood vessels, they differ significantly in terms of the techniques used, the recovery process, and the specific indications for each procedure.

By consulting with a vascular and endovascular surgeon, patients can gain a better understanding of their options and make informed decisions about their treatment. Whether through traditional open surgery or advanced endovascular techniques, the goal remains the same: to restore health and improve the quality of life for patients dealing with vascular conditions.

FAQs

Endovascular surgery is a minimally invasive procedure used to treat problems within the blood vessels. It involves inserting catheters and sleek instruments like wires, balloons and stents through small incisions or needle punctures, typically in the groin or arm.

Another name for endovascular is “minimally invasive vascular.”

A vascular surgeon performs traditional open surgeries on blood vessels, while an endovascular surgeon specializes in minimally invasive procedures using catheters and imaging techniques.Many are trained in both and hence they are termed as vascular & endovascular surgeons. This is different from interventional vascular radiologists who are not trained in surgery.

An example of endovascular treatment is the placement of a stent to open a narrowed artery or the repair of an aneurysm using a stent graft.

The life expectancy after endovascular surgery varies based on the condition treated and the patient’s overall health, but studies generally show comparable or better long-term outcomes compared to open surgery, particularly for aneurysm repair.

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  • Vascular and Endovascular Surgeon,
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