Open Surgery
Open surgery, also known as traditional or conventional surgery, involves making a large incision in the skin and tissue to access the surgical site directly. This approach provides the surgeon with a clear view of the anatomy and allows for more extensive interventions. Open surgery has been the standard method for many years and is still widely used for various medical procedures. Some key points about open surgery include:
- Large Incision: Surgeons create a sizable opening to access the targeted area, which allows for direct visualization and manipulation of tissues and organs.
- Direct Access: The surgeon has direct contact with the organs and structures, which can be beneficial for complex surgeries that require precise manipulation.
- Longer Recovery: Recovery time is generally longer due to the larger incision and the need for healing of deeper tissues.
- Complications from Anesthesia: Anesthesia is generally considered safe for the majority of patients, but it does carry some potential risks and complications. Some patients are not candidates for open surgery due to complications that could come from anesthesia.
Endovascular Surgery
Endovascular surgery, also known as minimally invasive surgery or interventional radiology, involves accessing the surgical site through small incisions or natural body openings, such as blood vessels. This approach relies on specialized tools and imaging guidance, such as fluoroscopy (a type of real-time X-ray), to perform procedures without the need for a large incision. Some key points about endovascular surgery include:
- Small/Scarless Incisions: The surgeon uses small incisions, often just a few millimeters in size, to insert catheters, wires, and other tools into the body.
- Guided Imaging: Procedures are guided by real-time imaging, allowing the surgeon to navigate and perform the surgery within blood vessels or other hollow structures.
- Reduced Trauma: Since the surgical site is accessed through small openings, there is less trauma to surrounding tissues. This typically results in shorter hospital stays and quicker recovery times.
- Outpatient/ ASC: Endovascular procedures can be done in an outpatient setting called an Outpatient Surgery Center or an Ambulatory Surgery Center (ASC). Having your procedure completed in a surgery center has advantages with cost, convenience and individual nursing care.
- Less Invasive: Endovascular procedures are considered less invasive than open surgery and generally result in less pain and scarring.
Examples of endovascular procedures include angioplasty (widening of narrowed blood vessels), stent placement (insertion of a mesh-like tube to support blood vessels), and embolization (blocking blood flow to treat certain conditions).
Hybrid Surgery
A hybrid surgery is a specialized approach that combines elements of both open surgery and endovascular surgery to treat complex medical conditions, particularly those involving blood vessels and the cardiovascular system. It’s a collaborative effort that brings together surgeons and interventional radiologists or cardiologists to provide the most effective and tailored treatment for patients.
- In a hybrid surgery, the medical team can leverage the advantages of both open and endovascular techniques to optimize patient outcomes. The decision to perform a hybrid procedure is typically made based on factors such as the complexity of the condition, the patient’s overall health, and the availability of specialized equipment and expertise.
- Hybrid surgeries are often used to treat conditions such as aortic aneurysms, aortic dissections, and peripheral arterial disease. The goal of a hybrid procedure is to capitalize on the strengths of both open and endovascular techniques, minimizing invasiveness and optimizing patient outcomes.
- It’s important to note that not all surgical procedures can be performed using a hybrid approach. The decision to pursue a hybrid surgery is based on careful evaluation by the medical team and is tailored to the specific needs of each patient.
In summary, the main difference between open surgery and endovascular surgery lies in their approaches to accessing and treating medical conditions. Open surgery involves larger incisions and direct manipulation of tissues, while endovascular surgery is minimally invasive and relies on small incisions and guided imaging for precise interventions. The choice between the two approaches depends on factors such as the nature of the condition, the patient’s health, and the surgeon’s expertise.
Sammy Eghbalieh, MD, FACS, DFSVS, RPVI
Why Choose a Vascular Surgeon for your Endovascular Repair?
Many physicians claim to be interventionalists who perform vascular surgeries. These may include vein procedures, lower extremity interventions, fistula procedures and more. While many of these physicians perform these procedures, not all are vascular surgeons and did not complete extensive training or education on the subtle nuisances of these procedures. Many of these physicians may even be still learning how to best perform these procedures due to lack of training.
When you choose a vascular surgeon, you know you are getting a specialist who has dedicated years of training to these specific disease states and are the experts in this field. No other specialty can provide the full package of treatment options and therefore has the ability to make these procedures as safe and appropriate as possible. The Society for Vascular Surgery (SVS) released a statement in response to a recent New York Times article on this topic. SVS states in their response that, “there is only one primary specialty in medicine comprehensively educated, trained and tested to provide the full spectrum of evidence-based care to vascular patients, ranging from medical management to minimally invasive procedures, to open surgery; that specialty is vascular surgery.”
By performing minimally invasive endovascular procedures, Drs Eghbalieh and Abi-Chaker are able to minimize blood loss, days admitted to the hospital, risk of infection, heart or lung complications, and minimize surgical scars. These options also provide faster return to normal activities and recovery. When endovascular options are no longer available or are not ideal, open or hybrid procedures allow for more durable results. This is what separates a trained vascular surgeon from other specialists. Vascular surgeons can provide alternative solutions to your vascular condition.
At SCMSC our vascular physicians are dual certified on both open surgical repair and endovascular repair. This means they can make a decision based on the best outcome for the patient not based on where their expertise is. For example, a radiologist or cardiologist can only offer endovascular repair options, they are not trained or certified to perform open surgical or hybrid procedures. Although, endovascular surgery has made great advances in the number of procedures we are able to do using this minimally invasive technique, sometimes open surgical repair is the better option based on longevity and outcomes.
Even still, not all vascular surgeons are created equal. What separates Drs. Eghbalieh and Abi-Chaker from the rest, is their experience and training with straightforward and common disease states, but more importantly their experience with complex cases. They are highly motivated surgeons who are constantly at the forefront of new technology, procedures, and techniques in vascular surgery which has driven them to provide all vascular options including not operating if you don’t need it. Our doctors will work with the patients to determine the best treatment options and come to a decision together, not limit the options because of incomplete training or financial benefit. In our state-of-the-art lab and with the use of cutting-edge technology and procedures, our physicians are able to provide a quality of care that is unmatched in the area. When you are making a decision to have a surgical repair, always research the credentials of the physician and make sure you are fully informed of the risks and benefits of all your options. Contact our office for an evaluation if you need a vascular surgical repair (818) 900-6480.
