In recent years there has been a rapid development and diffusion of a new type of approach to the treatment of diseases of the arteries which has joined the conventional vascular surgery.

Endovascular surgery represents a "minimally invasive" method. The correction of stenosis, aneurysmal dilations, dissections, anastomotic pseudoaneurysms, does not take place from the outside, as in traditional surgery, but through the endoluminal route, using the lumen of the artery itself for access to the lesions, achieved through the cannulation of a peripheral artery, accessible under local anesthesia, with a transcutaneous puncture or with a minincision (femoral or axillary artery), through which the catheters, guides, instruments and even the prostheses (stent / endoprosthesis) are inserted which are pushed to backwards under radiographic control until reaching the site of the disease from inside the vessel.

However, there are still some limitations related to the application of stents. Often, for example, endovascular treatment is not practicable both for the tortuosity of the vessels and for the presence of thrombotic material inside them, or for lesions of the walls of the vessels that make access difficult. Another problem related to the use of stents consists in the proliferation of cellular tissue within the stent itself and therefore the increased risk of 'restenosis' (for this reason, the use of medicated or drug-eluting stents is being evaluated' anti proliferation 'also for the treatment of carotid lesions, as a coronary benefit has been demonstrated).

For the choice of the type of treatment, traditional or endovascular surgical, the specialist must be based on the evaluation of a series of factors including for example the anatomy of the stenotic vessel, the characteristics of the stenosis and the general condition of the patient. Only by carefully studying the single "case" is it possible to choose the best therapeutic strategy, which will not necessarily have to be endovascular, except in those carefully selected circumstances in which this method can be decisive.

Traditional vascular intervention and minimally invasive endovascular intervention represent two valid complementary tools available to the Vascular Surgeon, who continues to be the only Specialist who, given his in-depth knowledge of both traditional and endovascular pathology and techniques, has in his hand the tools to be able to decide which is the best treatment for arterial pathology on the basis of scientific evidence and the type of paintings addressed.