Endovascular Repair (Abdominal)

A aortic aneurysm, an abnormal bulge in a weakened wall of the aorta, can cause a variety of symptoms and often life-threatening complications upon rupture. Due to the serious risks it presents, timely diagnosis and treatment of aortic aneurysm are critical.

 

The standard surgical treatment for abdominal aortic aneurysms is open aneurysm repair, but McAllen Heart Surgeons is now able to treat many abdominal aneurysms with a minimally invasive procedure called an endovascular stent graft.

 

What is an endovascular stent graft?

Endovascular means that surgery is performed inside your aorta using thin, long tubes called catheters. Through small incisions in the groin, the catheters are used to guide and deliver a stent-graft through the blood vessels to the site of the aneurysm. The stent graft is then deployed in the diseased segment of the aorta and "relines" the aorta like a sleeve to divert blood flow away from the aneurysm.

 

An endovascular stent graft is a fabric tube supported by metal wire stents (also called a scaffold) that reinforces the weak spot in the aorta. By sealing the area tightly with your artery above and below the aortic aneurysm, the graft allows blood to pass through it without pushing on the aneurysm.

 

What are the benefits of endovascular repair?

Endovascular repair of thoracic aneurysms is generally less painful and has a lower risk of complications than traditional surgery because the incisions are smaller. Endovascular aorta aneurysm procedures also allow you to leave the hospital sooner and recover more quickly after your aorta repair.

 

Who is a candidate for endovascular repair of a thoracic aneurysm?

You may be eligible for endovascular stent grafting if your abdominal aneurysm has not ruptured and the aneurysm is 5 centimeters or more in size.

Your physician can determine if aortic aneurysm repair is the best treatment by performing one or a combination of imaging studies, which may include:

  • High resolution, computed tomography (CT) scan
  • Angiography (an x-ray of the blood vessels)

 

Physical characteristics of the aorta and the aortic aneurysm itself are very important in determining if endovascular aorta repair is the best treatment.

 

What happens during endovascular stent grafting?

Your surgeon will make small incisions in the skin above the femoral artery (the large artery that supplies blood to each leg) in the groin. A guide wire is threaded through the artery beyond the area of the thoracic aneurysm.

heart surgery

By using x-ray guidance, your surgeon inserts the device over the guide wire. The stent-graft device is constrained within a catheter to make it easier to deliver the stent-graft through your blood vessels. Once the graft is guided to the aneurysm site, the catheter is withdrawn, exposing the stent-graft in place. The stent-graft then expands like a spring to fit against the walls of the aorta on either side of the aneurysm, and delivers blood flow through the weakened section.

 

Once the stent-graft is in place, the blood flows through the graft, avoiding the aneurysm. Over time, the aneurysm typically shrinks due to the blood pressure being diverted away from the aneurysm.

 

Digital CT showing endovascular stenting of an abdominal aortic aneurysm with bilateral iliac aneurysms, using a techniques that perserves flow into both internal iliac arteries (purple arrows).