25 Questions and Answers
Endovascular treatment is the general term for minimally invasive surgical techniques performed from inside the blood vessel. "Endo" means inside and "vascular" refers to vessels. Instead of large incisions, access is gained through the groin or arm artery. Catheters are used to repair aneurysms and place stents or grafts. Compared to open surgery, it offers less pain, a shorter hospital stay, and lower complication rates.
It is used for aortic aneurysms (EVAR, TEVAR), aortic dissections, peripheral arterial occlusions, carotid artery stenosis (carotid stenting), renal and leg arterial blockages, and heart valve disease (TAVI). It is a safe alternative to open surgery especially in high-risk or elderly patients.
EVAR (EndoVascular Aneurysm Repair) is the repair of an abdominal aortic aneurysm via access through the groin artery. A metal scaffold called a stent-graft is placed inside the aneurysm to support the weakened vessel from within, eliminating the risk of rupture.
TEVAR (Thoracic EndoVascular Aneurysm Repair) is the endovascular treatment of thoracic aortic aneurysms. A stent-graft delivered through the groin artery seals the dilated segment and restores normal blood flow. Mortality is lower and recovery is faster than with open surgery.
TAVI (Transcatheter Aortic Valve Implantation) is valve replacement for aortic stenosis without opening the chest. A new biological valve is delivered via a catheter through the groin artery to the heart. It is a life-saving alternative particularly for elderly patients and those at high surgical risk.
Many endovascular procedures can be performed under sedation or local anaesthesia. Some procedures such as TAVI may use light general anaesthesia. This reduces surgical stress and allows early mobilisation.
No. Access is typically through a 3–5 mm puncture in the groin or sometimes the arm. There are no large incisions, sutures, or chest opening. This greatly reduces the risk of pain and infection.
Blood loss, infection, and complication rates are lower than with open surgery. Patients are typically discharged within 2–3 days. It is a safe option for elderly individuals and those with coexisting medical conditions.
Modern stent-grafts last over 10–15 years. The material does not degrade, but annual CT or MRI monitoring is required. Minor additional procedures can provide support if needed.
Yes. The new biological valve is placed inside the old narrowed valve. The procedure is completed without stopping the heart. In most patients, exercise capacity improves noticeably the very next day.
Patients are usually up and walking within 2–3 days and discharged within a few days. Recovery is 4 times faster than after open valve surgery.
In experienced centres, the mortality rate is around 1–2%. This is significantly lower than for open surgery. The difference is most pronounced in aortic dissection cases and elderly patients.
Yes. The stent or graft integrates into the vessel wall and functions for many years. However, conditions such as endoleak or re-narrowing must be monitored with regular check-ups.
An endoleak is a small amount of blood seeping around the edges or through holes in the stent-graft. Most are small and harmless, but large leaks may require additional intervention. They are detected early through regular CT monitoring.
EVAR and TEVAR typically take 1–2 hours; TAVI takes 60–90 minutes. Both are significantly shorter than open surgery.
An average of 2–4 days, compared to 7–10 days for open surgery. Patients can return to daily life within 1 week of discharge.
In most patients, no. Blood loss is minimal. This is an important advantage for patients who prefer bloodless surgery or have blood disorders.
Rarely. However, due to changes in vascular anatomy, new aneurysms or narrowings may develop in some patients. Annual imaging is therefore essential.
Yes, but light walking should begin only after 1–2 weeks of rest. Heavy lifting and sudden exertion should be avoided.
No. It is performed under local anaesthesia and light sedation. After the procedure, only mild groin discomfort may occur, which typically resolves within 24 hours.
Yes. Smoking weakens the vessel wall, reduces stent patency, and increases the risk of re-narrowing. It must be stopped completely after treatment.
The primary target group is elderly, high-risk patients. However, in recent years TAVI has also been performed in younger, intermediate-risk patients. Long-term durability studies are promising.
In approximately 5–10% of patients, the cardiac conduction system may be affected by the new valve placement. In such cases, a permanent pacemaker may need to be implanted.
Yes, in the classical sense — no chest or abdominal opening is required. However, they are considered "catheter-based surgery" and are therefore performed under sterile operating theatre conditions.
Technology is advancing rapidly. Next-generation stent-grafts, smaller catheter systems, and robot-assisted interventions are expected to replace a large proportion of open surgeries in the coming years, allowing patients to be treated with minimal risk in a much shorter time.
