ABSTRACT
Deciding who gets what can be a challenge. Wrong choices are usually revealed only after the damage is done. When intervention is indicated, the choice of endovascular or open surgery is based upon the clinician’s understanding of the balance in a given patient between medical comorbidities (perioperative risk) and lesion severity (likelihood of endovascular success). This is represented in a stylized graphical version in Fig. 1. Endovascular therapy is most beneficial in patients with more severe medical comorbidities or with lesser forms of vascular disease. Open surgery is more successful when the risk is low and when the disease is severe enough that the results of surgery are likely to be durable in comparison to endovascular intervention. Theoretically, every patient can be placed somewhere on this graph. There is an enlarging group of patients in the middle who could be considered for either type of treatment. Advancing technology and patient demand for less invasive procedures is pushing the curve downward toward a decrease in open surgery and an increase in endovascular surgery.
