Abdominal Aneurysm Repair

The aorta is the main artery from the heart to the body. An aneurysm is a weak spot that balloons out from the wall of a blood vessel. Aneurysms can burst and cause internal bleeding, in which case there is a high risk of death and emergency surgery may be required. We now have minimally invasive techniques using an endovascular approach to repair the aneurysm by using catheters guided within the arteries eliminating the need to cut the patient open.

What Is the Current Treatment Used for Repair of Abdominal Aortic Aneurysms?

Abdominal Aortic Aneurysm

An abdominal aortic aneurysm is treated if the doctor feels there is a risk that the aneurysm will burst (or rupture).

Repair is usually considered for aneurysms larger than 5 cm in diameter. Smaller aneurysms may just be monitored closely. Currently, the standard treatment is conventional surgery. The surgeon accesses the aneurysm through an incision in the abdomen. The aneurysmal portion of the vessel is excluded (shut off from the main part) or sometimes replaced with a synthetic graft, which is sewn into place. The surgical procedure is performed under general anesthesia and takes about three to four hours to complete. Patients typically spend one or two nights in an intensive care unit and remain in the hospital for an additional five to seven days.

Is There an Alternative Treatment to Conventional Surgery?

Abdominal incision - Open Surgical Repair

Yes, there is an alternative treatment known as "endovascular stent grafting." Endovascular stent grafting is a procedure where a stent graft, which is a woven polyester tube (graft) covered by a tubular metal web (stent), is placed inside of a diseased (aneurysmal) vesselwithout surgically opening the tissue surrounding the diseased vessel. The stent graft, therefore, excludes the aneurysm from the normal blood flow.

The AneuRx Stent Graft

The long-term risks of the stent graft implant are not yet known, so you will have to be monitored at least once a year, for the duration of your life, with imaging devices such as computed tomography (also known as a CAT scan or CT). You may need to have more frequent exams and images taken if your physician feels that there is a problem with the implant. This frequency and type of monitoring is generally not required after the standard treatment.

There are also risks and benefits associated with conventional surgery.

How is the Procedure Performed?

The AneuRx stent graft procedure is performed using either regional or general anesthesia. Prior to the procedure, a number of diagnostic tests are performed. These diagnostic tests allow the doctor to visualize the aneurysm and the surrounding area. To prepare for the procedure, a small incision is made in each upper thigh area. Using fluoroscopy (X-rays) for visual guidance, the delivery catheter is advanced through the large vessel in your thigh (iliac vessel) to the aneurysm site in your abdomen (see Fig. 1).

Fig. 1 The delivery catheter is inserted through the vessel in your leg and into the aneurysm

When the delivery catheter is properly positioned inside the aneurysm, the AneuRx Stent Graft is slowly released from the delivery catheter into the blood vessel. When the stent graft comes into contact with blood, it expands to a preset size. After expansion of the stent graft, the delivery catheter is withdrawn and removed, leaving the stent graft within the vessel. Depending on the shape and size of your aneurysm, additional stent grafts may be placed to ensure that the aneurysm is completely excluded. X-rays and/or intravascular ultrasound imaging procedures are performed to allow the doctor to verify that the stent graft is properly placed within the aneurysm (see Fig. 2).

Fig. 2 Placement of the AneuRx Stent Graft

The procedure typically takes between two to four hours to complete.If you are in need of surgeon and think you might be a candidate for Aneurysm Repair contact our office for an appointment. If you are considering having your heart surgery at St. Luke’s, Methodist, or Memorial Hermann, please contact us [link].