Endovascular

Endovascular refers to medical procedures performed within the blood vessels using minimally invasive catheters and intravascular devices. Endovascular therapy treats arterial and venous diseases through percutaneous access, guided by imaging, with tools such as guidewires, balloons, stents, thrombolytic or embolic agents, and retrieval devices. Common goals include widening narrowed arteries, sealing leaks, removing clots, or excluding aneurysms, while avoiding open surgery.

Historically, endovascular techniques emerged in the mid-20th century, with early percutaneous methods and the development of balloon angioplasty in the 1970s, followed by the widespread use of stents in the late 1980s. The field expanded from coronary and peripheral arteries to neurovascular, venous, and complex aortic repairs, driven by advances in imaging, device technology, and catheter design.

Key procedures include percutaneous transluminal angioplasty with or without stenting for arterial disease; endovascular aneurysm repair for abdominal or thoracic aneurysms; carotid, renal, mesenteric, and iliac vessel stenting; endovascular thrombectomy and thrombolysis for acute occlusion; atherectomy and embolization for malformations or hemorrhage; and specialized neuroendovascular techniques such as coil embolization and flow-diverting stents for intracranial aneurysms.

Imaging and guidance rely on real-time fluoroscopy and angiography, often supplemented by intravascular ultrasound (IVUS) or optical coherence tomography (OCT) for vessel assessment and device sizing.

Outcomes and advantages include reduced invasiveness, shorter hospital stays, and quicker recovery compared with open surgery. Limitations include not being suitable for all lesions, potential need for lifelong antithrombotic therapy, radiation exposure, contrast-related risks, and possible restenosis or device-related complications.

Practitioners typically come from interventional radiology, vascular surgery, or interventional cardiology, with neurointerventional specialists handling cerebrovascular cases. Training and certification vary by country.