Endovascular surgery

Endovascular surgery is a minimally invasive subspecialty within vascular surgery that has become an essential part of modern treatment for diseases of the arteries, veins, and aneurysms.^[1] Unlike traditional open vascular surgery, endovascular techniques are often performed through small percutaneous punctures and are discussed separately in many textbooks and clinical guidelines, highlighting their importance as a distinct field within vascular surgery.^[2]

Access to the vascular system is typically obtained through a small percutaneous puncture, most commonly in the femoral or radial artery. Through this access, guidewires, catheters, balloons, stents, and other devices can be advanced under imaging guidance to diagnose or treat vascular disease.^[3]

Endovascular procedures are used to treat a wide range of vascular conditions, including aneurysms, arterial stenoses, and certain venous disorders such as varicose veins. Common interventions include angioplasty, stent placement, endovascular aneurysm repair (EVAR), and endovenous treatments for venous reflux such as endovenous laser treatment (EVLT), sclerotherapy and radiofrequency ablation. These procedures are typically performed using fluoroscopic or ultrasound guidance.

Compared with conventional open vascular surgery, endovascular approaches usually involve smaller puncture sites, less surgical trauma, and shorter recovery times.^[4][5][6] Many procedures can be performed under local or regional anaesthesia and are commonly carried out in outpatient or short-stay settings.^[7] For this reason, endovascular techniques have become an important component of modern vascular surgery and are increasingly used as first-line treatment for many vascular diseases.^[8] Current clinical guidelines from organizations such as the Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society recommend endovenous thermal ablation as a first-line treatment for symptomatic great saphenous vein reflux, in preference to high ligation and stripping (phlebectomy).^[9] Similarly, the European Society for Vascular Surgery endorses endovenous thermal techniques, including endovenous laser therapy, as first-line management in appropriate patients.^[10]

Endovascular surgery is practiced by specialists in vascular surgery, interventional radiology, and interventional cardiology, depending on the vascular territory being treated.