Risks and Complications of Endovascular Surgery

Endovascular surgery has transformed how we treat vascular diseases, offering a minimally invasive alternative to traditional open procedures. It is widely used for conditions like aneurysms, peripheral artery disease (PAD), deep vein thrombosis (DVT), and carotid artery stenosis. While this approach is generally safe and effective, like any surgical procedure, it carries certain risks and potential complications.

Understanding these risks helps patients make informed decisions, prepare better for the procedure, and know when to seek help during recovery. 

What Is Endovascular Surgery?

Endovascular surgery is a minimally invasive technique used to treat vascular conditions from inside the blood vessels using catheters, balloons, stents, coils, and other devices. It’s typically performed through small incisions in the groin, wrist, or arm, and guided by real-time imaging (such as fluoroscopy or ultrasound).

Compared to open surgery, it:

• Requires smaller incisions
• Results in less pain and scarring
• Allows for quicker recovery
• Is often suitable for high-risk patients
  

Despite these advantages, there are specific risks associated with endovascular techniques due to the complexity of the vascular system and the tools involved.

Common Risks and Complications of Endovascular Surgery

1. Bleeding at the Access Site

One of the most common complications is bleeding or hematoma (blood collection under the skin) at the catheter insertion site.

Causes:

• Accidental injury to the artery or vein
  
• Poor clotting
  
• Use of blood thinners
  

Symptoms:

• Swelling
  
• Bruising
  
• Pain or warmth at the puncture site
  

Prevention & Management:

• Proper pressure dressing post-procedure
  
• Monitoring during recovery
  
• Avoiding heavy activity
  
• In severe cases, surgical drainage or repair may be needed
  

2. Infection

Though rare, infection can occur at the puncture site or inside the blood vessel (endovascular infection).

Causes:

• Contamination during the procedure
  
• Poor wound care post-operatively
  
• Weakened immune system
  

Symptoms:

• Redness, warmth, or pus at the incision
  
• Fever
  
• Chills or fatigue
  

Prevention & Management:

• Use of sterile techniques
  
• Antibiotics before or after surgery
  
• Immediate medical attention if signs of infection develop
  

3. Allergic Reaction to Contrast Dye

Endovascular surgery often uses contrast dye to visualize blood vessels. Some people may react to the dye, especially those with a history of allergies or kidney disease.

Symptoms:

• Itching, hives, or rash
  
• Nausea
  
• Breathing difficulty
  
• Anaphylaxis (rare but severe)
  

Prevention & Management:

• Pre-procedure screening for allergies
  
• Use of non-iodinated or low-allergy contrast agents
  
• Antihistamines or steroids before the procedure (for at-risk patients)
  

4. Damage to Blood Vessels

During the procedure, catheters and wires are maneuvered through delicate vessels. Sometimes, this can lead to:

• Vessel perforation
• Dissection (tearing of the vessel wall)
• Pseudoaneurysm formation
  

Symptoms:

• Sudden pain
  
• Drop in blood pressure
  
• Swelling or internal bleeding
  

Prevention & Management:

• Skilled surgical technique
  
• Immediate imaging and repair
  
• Emergency conversion to open surgery in rare cases
  

5. Blood Clot Formation (Thrombosis)

Endovascular procedures may disturb the lining of the vessel or alter blood flow, increasing the risk of clot formation.

Potential Complications:

• Stroke (in carotid artery procedures)
  
• Heart attack
• Pulmonary embolism
• Blocked stent or graft
  

Symptoms:

• Sudden numbness or weakness
  
• Chest pain or shortness of breath
  
• Pain, swelling, or coldness in a limb
  

Prevention & Management:

• Use of blood thinners (anticoagulants)
  
• Early mobilization after surgery
  
• Regular follow-up imaging
  

6. Stent or Device Malfunction

Devices like stents or grafts can sometimes move, collapse, or fail to work as intended.

Causes:

• Improper placement
  
• Artery size mismatch
  
• Patient movement during recovery
  

Symptoms:

• Recurrence of symptoms (e.g., leg pain)
  
• Reduced blood flow in the treated area
  

Prevention & Management:

• Accurate imaging and pre-planning
  
• Use of appropriate device sizes
  
• In some cases, revision surgery may be necessary
  

7. Kidney Damage (Contrast-Induced Nephropathy)

The contrast dye used during the procedure can affect kidney function, particularly in patients with pre-existing chronic kidney disease (CKD) or diabetes.

Symptoms:

• Decreased urine output
  
• Fatigue
  
• Swelling in legs
  

Prevention & Management:

• Preoperative kidney function testing
  
• Hydration before and after the procedure
  
• Limiting contrast exposure
  

8. Radiation Exposure

Fluoroscopy (X-ray imaging) is used to guide the surgery. While the exposure is usually minimal, long or complex procedures may involve significant radiation, increasing lifetime exposure risk.

Prevention:

• Use of modern, low-radiation equipment
  
• Minimizing procedure time
  
• Protective lead shielding
  

9. Re-stenosis (Re-narrowing of the Vessel)

Even after successful angioplasty or stent placement, the treated artery may narrow again over time.

Causes:

• Scar tissue formation
  
• Continued plaque buildup
  
• Smoking or uncontrolled diabetes
  

Prevention:

• Lifestyle changes (diet, exercise, quitting smoking)
  
• Regular follow-up scans (e.g., Doppler ultrasound)
  
• Medications like statins or antiplatelets
  

10. Incomplete Treatment or Recurrence

Sometimes, the full goal of the surgery isn’t achieved due to:

• Complex anatomy
  
• Severe disease
  
• Technical limitations
  

In such cases, repeat procedures or a conversion to open surgery may be required.

When to Seek Medical Attention

After endovascular surgery, it’s important to monitor for warning signs. Contact your doctor immediately if you experience:

• Heavy bleeding from the puncture site
  
• Fever, chills, or signs of infection
  
• Chest pain or shortness of breath
  
• Numbness, weakness, or confusion
  
• Pain, coldness, or color change in limbs
  

Prompt care can prevent serious complications.

Reducing the Risks: What You Can Do

You can lower your risk of complications by:

• Choosing a qualified vascular surgeon
• Following all preoperative instructions
• Disclosing all allergies and health conditions
• Sticking to prescribed medications and follow-ups
• Adopting a heart-healthy lifestyle
  

Conclusion

While endovascular surgery is a highly effective and less invasive alternative to open surgery, it’s not entirely free of risks. Complications, though uncommon, can range from mild bruising to more serious issues like blood clots, infection, or organ damage.

The good news is that with proper preparation, skilled surgeons, and vigilant post-operative care, most complications can be prevented or managed successfully.

If you or a loved one is considering endovascular surgery, be sure to discuss your personal risks, benefits, and alternatives with your doctor. Informed patients make safer, healthier choices.