Endovascular Procedures

Peripheral arterial stents are usually inserted in conjunction with a peripheral artery balloon angioplasty, to treat peripheral artery disease in the arms or legs. The stent is a metal mesh tube that reinforces the artery walls. It holds the artery open and ensures that blood continues to flow through to the leg muscles. The stent is left in place permanently. In certain cases, specialised stents called drug-eluting stents (DES) are used. These stents are coated in medication that prevents plaque from re-accumulating at the same site, preventing future blockages. The procedure is performed while the patient is awake but sedated. The procedure is minimally-invasive, and hence all the instruments are inserted through a microincision in the leg. The entire procedure is performed under X-ray fluoroscopy.

An inferior vena cava (IVC) filter is a small biomedical implant that stops blood clots from travelling to the lungs. It is surgically implanted in the inferior vena cava, a large vein that carries blood from the lower body to the heart. Blood clots from the legs or pelvis can travel up to the heart and lungs through the inferior vena cava and cause a pulmonary embolism or blockage in the lungs. The IVC filter’s main function is to prevent this. It is recommended for patients who cannot be given blood thinners. The IVC filter does not prevent the formation of blood clots in the leg; it only prevents them from reaching the heart and lungs and causing dangerous complications. During the procedure, the surgeon inserts a flexible catheter into a small incision in the neck or groin and manoeuvres it into the inferior vena cava. The filter is then placed in position, where it expands and attaches itself to the walls of the inferior vena cava. The IVC filter can be left in permanently or removed after a period of time.

An arteriovenous (AV) malformation is an abnormal connection between an artery and vein. AV malformations are the ideal access-site for long-term haemodialysis treatment. An AV fistulaplasty is a surgical procedure to relieve blockages in the haemodialysis access site. The procedure is performed by an interventional radiologist, under X-ray fluoroscopy guidance with a contrast dye to visualise the blood vessels in the arm. The procedure is performed under local anaesthesia or mild sedation. An inflatable balloon catheter is inserted into the AV malformation and inflated to stretch the narrowed portion.

An endovascular aneurysm is a stretched, bulging section of the artery wall, typically the aorta. An aneurysm in the aorta can rupture and cause internal bleeding. Endovascular aneurysm repair (EVAR) is a minimally-invasive procedure, to insert a stent-graft to divert blood flow from the aneurysm to decrease the pressure on it.. The procedure is performed using X-ray fluoroscopy to guide specialised instruments to the aneurysm through small incisions in the groin. Endovascular aneurysm repair is effective in treating abdominal aortic aneurysms and descending thoracic aortic aneurysms. The procedure may be performed under general or local anaesthesia, at the physician’s discretion. After the procedure, the patient may require follow-up scans to check for leaks in the stent-graft.

An atherectomy is a procedure to treat plaque build-up in the arteries. The arteries may be narrowed or blocked, stopping blood from flowing through normally and causing muscular cramps and loss of strength in the lower legs. The procedure uses a catheter with a sharp scalpel on the end to cut and remove the plaque build-up from the artery walls. The catheter has a suction tool that removes the dislodged plaque. The procedure is performed under local anaesthesia. The surgeon may need to pass the catheter through the artery multiple times to remove a majority of the plaque. The atherectomy procedure provides immediate relief from atherosclerosis (build-up of plaque in the arteries); however, the patient will have to maintain a healthy lifestyle to reduce the chances of recurrence.