New developments in the treatment of aneurysms and stenosis

Minimally invasive arterial surgery or endovascular techniques (TEV) is a procedure developed at the end of the last century that consists of treating both narrowing (stenosis and/or occlusions) and dilatations (aneurysms) of the arteries.

What is minimally invasive arterial surgery or Endovascular Techniques (TEV)?

The technique consists of puncturing an artery distal to the affected artery and introducing catheters through which, in the case of stenosis, balloons (which dilate the stenosed arteries) and/or stents (a type of spring that prevents the artery from narrowing again) are used. In the case of dilatations or aneurysms, stents coated with different materials such as dacron, goretex, etc., are used for their treatment, thus covering these dilatations on the inside and preventing their rupture.

For which patient is it intended?

The indications for TEVs have varied over time, but in general it can be said that in the case of stenosis they are used in patients with “favorable” lesions and when the clinic puts the viability of the affected organ or limb at risk. In the case of aneurysms when they are large, increase rapidly in size or produce some complication such as rupture.

What advantages and disadvantages do they offer compared to other techniques?

The alternative technique to TEVs is conventional or open surgery. The advantages of VTE are that it is less invasive, since it is performed through a simple puncture, and the hospital stay is shorter, in some cases the patient can be discharged the following day. The disadvantages are that in many cases the technique must be repeated and the long-term results are inferior to conventional surgery.

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What risks are involved?

Intraoperative risks, i.e., those that may arise during the VTE procedure, are rare, but in some cases significant. They can be classified as intraoperative or local, at the puncture site, such as rupture of the artery, which can lead to dilatation or thrombosis, sometimes requiring emergency surgery.

Intraoperative risks at a distance depend on the technique used. In the case of stenosis, lesions of the artery wall (dissection) or even thrombosis may occur, which would require a new procedure or conversion to conventional surgery. In the treatment of aneurysms complications can be poor implantation which would produce “leaks”. The long-term risks of these techniques are usually a consequence of the deterioration of the materials, although at present these materials have advanced considerably in their safety.

What does the postoperative period consist of?

If lesions of the extremities or visceral arteries are treated, the postoperative period is usually short, the first hours of rest, but within 24 hours the patient can be discharged. In the case of treating more complex lesions, such as carotid arteries or aortic aneurysms, the postoperative period is the same, although discharge is usually extended for another day.

What kind of care should the patient take before and after the procedure?

Before the intervention, patients, if they are not medicated by their Angiologist and Vascular Surgeon, their only treatment is the control of cardiovascular risk factors: tobacco, diabetes, hypertension, obesity, etc. In the postoperative period the recommendations are the same, regardless of the medication prescribed by your doctor.

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