Endovascular surgery is an exciting field in which rapid advances are currently being made. It is very different to open vascular surgery, and a different set of assisting skills and techniques is required. Highly specialised equipment is also necessary, so procedures usually take place either in an angiography suite (sometimes known as a ‘cath-lab’), or in a custom-built endovascular theatre. It is essential to work in these areas to gain the required skills. For all these reasons, it is beyond the scope of this chapter to provide a definitive guide on how to assist at all such procedures. Instead, it is intended to give the reader an overview of endovascular procedures and how they are performed, together with some of the general principles of assisting at these procedures.

Introduction

Procedures may be broadly categorised into purely diagnostic studies (angiography) and therapeutic (‘interventional’) procedures. Most procedures take place under local anaesthetic.

A variety of specialists perform endovascular procedures including vascular surgeons, interventional radiologists and cardiologists. Often for complex procedures, two specialists may work together.

Because X-ray radiation is used during the procedures, knowledge about radiation safety is essential. A lead gown and a cumulative-radiation exposure tag are required when present at these procedures. It is important to remember that the further from the source of the X-ray beam, the less radiation exposure received. This is due to the ‘inverse square rule’, which means, for example, by being positioned 2 m from the radiation source, instead of 1 m, the radiation exposure is quartered.