[Minimally invasive and intraoperative endoluminal vascular surgery. Critical overlapping and differentiation]

There are only four therapeutic options in minimally invasive vascular surgery. Combined open and endoluminal vascular repair is used most often to minimize surgical trauma. This procedure carries the risk of unfavorable long-term results, which must be hazarded in most elderly and critically ill patients. These new therapeutic procedures require a new generation of vascular surgeons. Besides endovascular surgery there is a new and interesting use of laparoscopic aortic surgery, which competes with endovascular surgery. Also endoscopic vein harvesting for bypass surgery is an interesting procedure to minimize surgical trauma. Minimally invasive procedures for varicose vein disease must be considered fashionable surgery and not aimed at minimizing surgical trauma since cosmetic aspects play an important role.

Minimally invasive surgery does not yet play a major part in vascular surgery. Only combined open and endoluminal vascular repair is on the advance in vascular departments. Because of the increases in the incidence of vascular diseases and the use of new expensive therapeutic procedures that drain health care resources on the one hand and because of the controversy involved in allocating patients to different vascular specialists on the other hand, there is a large amount of dynamite in vascular politics that gives us a thrill for the future!