Minimally Invasive Vascular Surgery
Minimally invasive procedures to treat problems in the arteries and veins, such as aneurysms and narrowings, are now available. Cooper surgeons use endovascular surgery, other catheter-based methods, and other minimally invasive methods in vascular surgery.
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| Jeffrey P. Carpenter, M.D., Department Chief and Vascular Surgeon, talks about the Cooper Vascular Center and discusses surgery for PAD, carotid blockages and aneurysms. |
Endovascular surgery is done from within the blood vessel. It is used to treat the two major problems that can develop in blood vessels: an aneurysm and a narrowing (also called occlusion or stenosis). The surgeon reaches the aneurysm or narrowing by inserting a catheter (a long hollow tube) into a smaller artery and using x-ray imaging to advance it into the aneurysm or narrowing. Usually, the catheter is placed into the femoral artery in the groin.
To repair an aneurysm, the surgeon pushes a hollow tube (a graft with metal attachments) through the catheter to the aneurysm and anchors it in place. To open a narrowing, the surgeon does an angioplasty with stenting. In angioplasty, a balloon is inserted and advanced to the narrowing. The balloon is then inflated, and a stent (a small, mesh-like stainless steel tube) is moved to the narrowing. The balloon is deflated and removed, and the stent expands and presses against the inner walls of the artery, keeping it open.
Endovascular surgery may be done under local anesthesia. Most patients stay in the hospital for only one night.
Other minimally invasive methods are used to treat other vascular problems, such as to relieve blockages in the carotid arteries in the neck, provide access for hemodialysis in patients with kidney failure, and for varicose vein surgery.
Minimally invasive vascular surgery isn’t appropriate for all vascular patients. Before any surgery, the Cooper surgeon will discuss the procedure, including whether to use a minimally invasive or traditional procedure, with the patient in detail.
Endovascular Surgery
Aortic Aneurysm Surgery
An aortic aneurysm occurs when the wall of the aorta becomes stretched out from hardening or deterioration of the arteries. When the arterial wall stretches, this weakens the artery, which may rupture or break. A ruptured aneurysm may cause hemorrhaging (excessive bleeding) which can be fatal.
Cooper surgeons can use endovascular surgery to treat aortic aneurysms. A stent or graft is placed within the blood vessel to relieve the pressure of the aneurysm. (See Cook Zentih Flex aortic aneurysm graft at right)
CLICK ON THE LINK BELOW FOR ANIMATED VIDEO OF AORTIC STENT PLACEMENT:
http://www.youtube.com/watch?v=9OWIh3zyfek
Revascularization: Balloons and Stents
The build-up of fatty deposits (plaque) in the arteries produces a progressive blockage of the arteries, which reduces or cuts off blood flow. When this happens in the carotid artery and blood flow to the brain is cut off, a stroke results. An interruption in the circulation of arteries to the legs is called peripheral vascular disease, which is usually associated with blockages in the arteries that supply blood to the legs.
Cooper surgeons can use endovascular surgery to open blocked arteries using balloons and stents. In balloon angioplasty, a catheter is inserted into the blocked vessel. A balloon is introduced through the catheter and inflated. This unblocks the blood vessel; the balloon is then deflated and removed. After balloon angioplasty, a stent can be placed in the blood vessel to keep it open. A blocked artery can also be treated with a bypass graft. The bypass graft is a vein or plastic tube that replaces the blocked blood vesselsp.
Other Minimally Invasive Procedures
Carotid Surgery
The build-up of fatty deposits (plaque) in the carotid artery produces a progressive blockage of the arteries, which reduces or cuts off blood flow. When blood flow to the brain is cut off, the result is a stroke.
Cooper surgeons perform carotid endarterectomy to open a blocked carotid artery (see illustration at right). This can be done under either local or general anesthesia. After making an incision along the side of the neck, the surgeon opens the carotid artery and removes the plaque, and then closes the artery.
Dialysis Access
In patients with kidney failure who need dialysis, Cooper surgeons use minimally invasive techniques to implant a catheter, which provides the necessary access to the blood vessels for dialysis. This is called a central venous access catheter and it helps avoid repeated needlesticks. Surgeons can also use angioplasty to open blocked grafts for hemodialysis.
Varicose Vein Surgery
Cooper surgeons use minimally invasive, laser powered techniques to treat large veins with leaking valves that can be the cause of troublesome varicose veins. Under local anesthesia in the office a laser fiber is placed through a 2 – 3 mm hole in the skin. The laser fiber is threaded into the leaking vein which is then permanently collapsed using laser energy. Patients are typically back to full activity within a few days.
If the only veins that need treating are large varicose veins under the skin, these can be removed in the office under local anesthesia. Small “spider” veins may be treated in the office by injection of a chemical that cause them to seal off and be subsequently resorbed by the body. The specific techniques used are tailored to the individual findings and needs of each patient.
Aortic Endograft
To treat an aneurysm, Cooper surgeons reinforce the ruptured or ballooning section of the artery with a fabric-wrapped stent, which patches the blood vessel. This procedure is called an endograft or a stent-graft.
Drs. Carpenter (L) and Lombardi insert stent graft into patient's aortic aneurysm to prevent rupturing.
Doctors Who Perform These Minimally Invasive Procedures
For more information or to schedule an appointment with a Cooper University Physician at an office near you, call 1-800-8-COOPER (800-826-6737).