There is a revolution currently under way in vascular surgery and its name is endovascular surgery. More and more patients who were traditionally treated by open surgical methods are today benefiting from minimally invasive, endovascular approaches. Endovascular procedures are like operating on the arteries and veins from the inside. These procedures are performed through a small puncture wound or incision, as opposed to traditional open procedures, which require a larger incision and a longer recuperation time. Blockages in the arteries or veins can be treated with balloon angioplasty, placement of stents, and thrombolysis (the use of clot-dissolving drugs), all through a small puncture wound, usually in the groin.

With balloon angioplasty, a balloon is delivered to a site of critical arterial blockage via a small puncture wound. The deflated balloon catheter is threaded through the vascular tree, placed across the site of narrowing, and the balloon is inflated. This cracks open the atherosclerotic plaque or narrowing. The best candidates for balloon angioplasty procedures are patients with relatively short narrowings or even complete occlusions of the arteries, especially the larger, arteries in the abdomen. Balloon angioplasty has been used with greatest success in the iliac arteries that feed the legs and for some blockages in the arteries that feed the kidneys, but this technique can be applied to virtually any artery or vein in the body.

Above: From left, Dr. Weaver and Douglas B. Hood, M.D., Assistant Professor of Surgery, perform intraoperative percutaneous iliac angioplasty. Fluoroscopic image of arterial anatomy is displayed on monitors at left. (Inset) Pre-angioplasty aortogram demonstrating eccentric left common iliac artery lesion and tubular external iliac stenosis.

Stents are small metallic devices that are sometimes used in conjunction with balloon angioplasty. The stents are placed inside the artery or vein and act as a scaffold to hold the vessel open. For example, if a balloon can be inflated adequately but, because of elastic recoil, an artery does not remain open, a stent can be placed to serve as scaffolding to hold the artery open. There is some evidence that stents will prolong the benefits of balloon angioplasty in certain locations, namely in the iliac and renal arteries. Stents are placed through the same puncture that is used to perform balloon angioplasty.

Above: a) Collapsed stent placed through stenosis of artery. b, c) Balloon dilatation of stenosis with deployment of metallic stent.

Another technique that is sometimes used in the treatment of blocked vessels is thrombolysis, using clot-dissolving drugs to open the blockage. Thrombolytic therapy has an important, but limited, role in the treatment of long-standing blockages. It provides the best results for patients with relatively recent occlusions of the arteries and veins. Thrombolysis is also performed through a groin puncture, threading a catheter to the site of occlusion and delivering the clot-dissolving drug directly at that site. With this method, the highest concentration of the drug is given directly at the site where it is needed, while minimizing the effects of the drug on other parts of the body.

While endovascular procedures currently are not appropriate for all situations and all patients, as the technology continues to improve, this approach will be applicable to a wider range of patients. The strength of the USC Center for Vascular Disease program is that it offers physicians who are well trained, experienced, and current with the latest techniques of treatment. The only focus of the physicians is vascular disease. These physicians provide assessment and diagnosis of vascular problems, and, if invasive treatment is indicated, can perform either open or endovascular procedures, depending upon each patient's unique situation. We are not pigeonholed into one approach, but rather we can offer the full spectrum of options for both diagnosis and treatment.