What is Minimally Invasive Vascular Surgery?
Vascular surgery refers to a variety of different surgical procedures performed to treat disorders of the arteries, veins, and lymph vessels of the body, excluding those in the heart and brain.
Open vascular surgery is a surgical technique in which large incisions are made on the area of the defect to repair or unblock arteries and veins using standard instruments. Minimally invasive vascular surgery is a surgical technique that is performed under general or local anaesthesia and involves making smaller incisions to access the area of defect in the blood vessels and lymphatic system, without making larger incisions. Through these small incisions, tiny cameras and special instruments are used to magnify and project images of the veins and arteries onto a high-definition monitor and carry out the required repair more precisely.
Indications for Minimally Invasive Vascular Surgery
Minimally invasive vascular surgery is usually recommended when non-surgical treatments have failed to treat the diseases involving the arteries and veins. It is often performed to improve blood circulation to an area of the body where the blood vessels have been damaged or the blood flow has been obstructed, following injury, disease, or other conditions. Some of the common vascular conditions that may warrant minimally invasive vascular surgery include:
- Peripheral vascular disease: Peripheral vascular disease (PVD), also referred to as peripheral artery disease (PAD), is a common disease that occurs when the blood vessels that supply blood to the limbs and other organs of our body are partially or completely blocked due to plaque build-up, a condition called atherosclerosis.
- Deep vein thrombosis: The condition in which a blood clot forms in the deep veins of the body is referred to as Deep Vein Thrombosis (DVT). Clots form when blood thickens and clumps together. DVT occurs most often in the deep veins of the leg and thighs.
- Abdominal aortic aneurysm: Aortic aneurysm is a condition characterised by an abnormal bulging of a section of the large blood vessel called the aorta. The aorta is the major blood vessel that carries oxygenated blood from the heart to the different parts of the body. In an abdominal aortic aneurysm, the aneurysm occurs in the section of the aorta that passes through the abdomen.
- Carotid artery disease: Carotid artery disease occurs due to the deposition of plaque (fatty substances) inside the walls of your carotid (neck) arteries. These arteries supply oxygen-rich blood from the heart to your brain. Deposition of plaque causes the arteries to become narrower or even completely blocked, increasing your risk of having a stroke.
- Varicose veins: Varicose veins are enlarged veins caused due to weak or damaged valves in the veins. They appear twisted, bulged, and blue, red, or flesh-coloured. They are swollen and raised above the surface of the skin and are mostly found on the thighs, back of the calves, and inside of the leg.
- Pulmonary embolism: Pulmonary embolism is a sudden blockage of an artery in the lung. The blockage is due to a blood clot in the pulmonary artery that carries blood from the heart to the lungs.
Preparation for Minimally Invasive Vascular Surgery
Preoperative preparation for minimally invasive vascular surgery may involve the following steps:
- A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anaesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You may need to refrain from supplements or medications such as blood thinners or anti-inflammatories for a week or two prior to surgery.
- You should refrain from alcohol or tobacco at least a few days prior to surgery and several weeks after surgery.
- You should not consume solids or liquids at least 8 hours prior to surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Common Minimally Invasive Vascular Surgeries
Some of the common minimally invasive vascular procedures include:
- Angioplasty and stenting: Angioplasty and stenting is a procedure performed to open up narrowed or blocked blood vessels as a result of accumulation of fatty substance called plaque. During the procedure, a balloon catheter (thin tube) is inserted into the vessel and inflated at the site of the blockage to compress the plaque against the wall of the artery. Your surgeon may also insert a wire mesh tube called a stent along with the balloon catheter to help keep the artery open and prevent it from narrowing again.
- Carotid endarterectomy: Carotid endarterectomy is a surgical procedure performed to treat carotid artery disease. The surgery involves making a surgical cut in the neck area where the carotid arteries are located and removing fatty deposits that are narrowing the arteries and blocking the blood flow to the brain. The procedure reduces your risk of developing transient ischemic attacks (TIA) or stroke.
- Sclerotherapy: It is one of the common treatments for varicose veins. A sclerosing/irritant solution is injected to the target site where the varicose veins are present. The sclerosing solution irritates the lining of the blood vessel causing the vein to swell and stick together. Over time, the venous blemishes turn into scar tissue and may disappear.
- Phlebectomy: Phlebectomy is a minimally invasive procedure performed to remove superficial varicose veins of the leg. It is usually indicated for larger veins bulging from the surface of the skin and is rarely used on smaller veins. It involves the removal of varicose veins through small incisions made in the skin near the affected vein.
- Embolectomy: An embolus is a mass of fat, air, or other material carried by the blood circulation, which has the potential to clog or block a blood vessel and cause a life-threatening emergency. Embolectomy is a procedure performed to remove an embolus. The procedure is commonly performed to treat conditions such as pulmonary embolism (PE) - blood clot in the lung.
- Abdominal aortic aneurysm repair: During a minimally invasive abdominal aortic aneurysm repair, your surgeon makes a small incision in the groin region and guides a catheter (thin tube) through the blood vessel (femoral artery) to the site of the aortic aneurysm to deliver a stent-graft, a tube made of thin metal mesh. The stent-graft is opened in the area of the aneurysm and secured in place for blood to flow and to prevent the aneurysm from rupture.
- Peripheral angioplasty with stenting: This procedure is performed to widen the narrowed or blocked peripheral arteries in patients with peripheral arterial disease. The procedure involves passing a catheter (a small hollow tube) through a small incision into the blocked or narrowed section of the artery and inflating a small balloon located at the end of the catheter to push the plaque against the arterial walls to widen the vessel and improve blood flow. Peripheral angioplasty is often combined with the placement of a stent, a small tubular mesh, inside the artery. The stent maintains the patency of the artery and prevents it from future narrowing.
Following the surgical procedure, you may experience pain or discomfort for which your surgeon will prescribe medications. You may be allowed to go home after 2 to 3 days. You can usually resume normal activities and return to work within 2 to 4 weeks after the surgery. Refrain from strenuous activities and lifting heavy weights for a defined period. Keep your surgical site clean and dry. Instructions on surgical site care and bathing will be provided. You will be advised to take your prescribed medications and make a few lifestyle changes such as quitting smoking, exercising regularly, maintaining a healthy weight, and eating a healthy diet. A periodic follow-up appointment will be scheduled to monitor your progress.
Benefits of Minimally Invasive Vascular Surgery
Minimally invasive vascular surgery provides various benefits including:
- Smaller scars
- Decreased risk of infection
- Less bleeding
- Reduced requirement of transfusion
- Less post-operative pain
- Fast recovery
- Shorter hospital stays
- Quicker return to daily normal activities
Risks and Complications
Minimally invasive vascular surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Blood clots
- Allergic/anaesthetic reactions
- Damage to adjacent tissues or organs
- Heart attack