Open & Endovascular Abdominal Aneurysm Repair
What is an abdominal aneurysm?
The aorta is a major artery which carries oxygenated (oxygen-rich) blood from the heart to all parts of your body. The section of the aorta which runs down into the abdominal region is called the abdominal aorta. This large artery supplies blood to the lower part of your body.
An abdominal aortic aneurysm (AAA) is a condition where the inner walls of the aorta weaken and bulge out due to the pressure of the blood exerted on the walls of the vessel. This dilation may increase in size over time and cause the aorta to burst, causing life threatening internal bleeding. High blood pressure, smoking , high cholesterol levels and a family history of aneurysms are some of the risk factors that can contribute to the development of an aneurysm.
What is an abdominal aneurysm repair?
Abdominal aneurysm repair is performed to prevent the aneurysm from rupturing and can be accomplished by two different ways. It can be treated by open surgical repair, in which a bypass is created for the blood to flow around the aneurysm, or by a less invasive endovascular procedure where an artificial stent graft is introduced to replace the region of the weakened abdominal aorta.
What are the indications for an abdominal aneurysm repair?
Abdominal aneurysm repair is indicated under the following situations:
- Urgent abdominal aneurysm repair is performed for the treatment of symptomatic or ruptured aneurysms (pain in abdomen, lower back and groin area).
- Endovascular abdominal aneurysm repair is a minimally invasive procedure that can be performed to treat a symptomatic aneurysm (irrespective of the size of enlargement) or an asymptomatic abdominal aortic aneurysm (when the aorta is larger than 5-5.5cm; or if the rate at which it is growing is >0.5 cm in six months ).
How is open abdominal aneurysm repair performed?
Open abdominal aneurysm repair is performed under general anesthesia. During the repair, your surgeon makes an incision on the abdomen. The graft to be used is made of a strong, durable fabric and designed to fit the size and shape of the healthy aorta. Clamps are placed at either end of the weakened section of the artery to temporarily stop the flow of blood through the affected region. Your doctor opens up the artery at the region of the aneurysm and removes any clots or debris. Your surgeon then sutures both ends of the artificial graft to the aorta. The clamps are removed, and the opened region of the aneurysm is wrapped over the graft and sutured. The graft can also be placed in such a way that a “Y” graft is used and sutured to each end of the iliac artery (which supplies blood to each leg). You may have to stay in the hospital for 1-2 weeks , and may need about 6 weeks to 6 months to completely recover.
How is endovascular abdominal aneurysm repair performed?
The endovascular stent graft repair is the preferred method to treat AAA’s in most people. It is a minimally invasive method of treating abdominal aortic aneurysms. With the patient under general , spinal or local anesthesia , your surgeon makes a small incision in the groin region and guides a catheter (thin tube) through the blood vessels (femoral arteries). The doctor uses live X-ray images to guide a stent-graft (narrow mesh tube with a synthetic graft attached) to the site of the aneurysm. Using a spring-mechanism, your surgeon opens the stent and attaches it to the walls of the aorta. The graft makes your artery stronger and prevents it from rupturing by restoring the blood flow without putting pressure on the region of the aneurysm. In time, the aneurysm may shrink around the stent-graft.
What can you expect after abdominal aneurysm repair?
The recovery time for an endovascular stent graft repair is less than open surgical aneurysm repair. You may be required to stay in the hospital for about 1 to 2 days. The procedure will require follow-up visits, during which a CT scan may be necessary to ensure optimal functioning and placement of the graft.
Are there any complications of the abdominal aneurysm repair?
Like all surgical procedures, both open and endovascular repair may be associated with certain complications that may include, but are not limited to:
- Heart attack
- Arrhythmias (irregular heart rhythms)
- Injury to the intestines
- Limb ischemia (loss of flow of blood to legs/feet)
- Clot formation in other parts of the body
- Graft infection
- Lung problems
- Spinal cord injury and paralysis
- Kidney damage
What are the advantages of an endovascular abdominal aneurysm repair over open surgery?
Endovascular repair involves a smaller incision and is associated with a shorter hospital stay and faster recovery when compared to open surgical repair. However, most literature does not show a long-term survival advantage with endovascular repair.
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