Aortic Stent Grafting is a new form of treatment for an abdominal aortic aneurysm. The medical term for this procedure is Endovascular Aneurysm Repair (EVAR) or Endovascular Stent Grafting and is preferred over open surgery as it is less invasive. In this procedure, a stent graft is used to protect the damaged area of the aorta from rupturing by reinforcing its walls.
The aorta, which is the largest blood vessel in the body, can be severely weakened by abdominal aortic aneurysms. With time, it can advance into a potentially life-threatening condition because if the aneurysm bursts it can be fatal as it causes acute internal bleeding.
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What is an Aortic Stent Graft?
An aortic stent graft is a tube supported by a tubular metal web that is placed inside an afflicted artery through a procedure which does not require the surgical opening of the surrounding tissue. The stent is placed to relieve pressure on an aneurysm (a disease that causes the artery to bulge due to the weakening of the artery walls) by creating a new path for the blood to flow.
Symptoms of Abdominal Aortic Aneurysm (AAA)
Abdominal Aortic Aneurysm almost shows no symptoms. However, one of the clearest signs of an AAA is mild to severe pain in the abdomen, back, and chest. Usually, an Abdominal Aortic Aneurysm is discovered while a routine examines such as CT scan or ultrasound for unrelated medical conditions. Some patients may experience an aneurysm as a throbbing mass in the abdomen.
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According to your doctor’s diagnosis, if there is a risk of an aortic aneurysm rupturing, he/ she may recommend various treatment options. The two options include:
- Open surgery: In this type of surgery, the surgeon makes a large cut in the abdomen to repair the aorta. The section of the aorta damaged or weakened by an aneurysm is replaced with a fabric graft and sewed into place to act as an artificial blood vessel. While the graft is placed, blood flow through the aorta is stopped. The surgery is carried out under general anesthesia and takes 3-4 hours to complete following which patients are kept under intensive care (ICU) for 1-2 days. They remain in the hospital at least for a week and require 2-3 months to recover.
- Aortic stent grafting or endovascular stent grafting: Aortic Stent Grafting is a minimally invasive procedure the does not require the surgical opening of the tissue surrounding the aneurysm. In this procedure, a stent graft is inserted into an aneurysm (aorta) using a catheter. The stent graft is designed in such a way that it bypasses an aneurysm and reduces the pressure and risk of rupture by creating a new path for the blood to flow.
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Before the procedure
Aortic Stent Grafting may be performed for the treatment of Abdominal Aortic Aneurysm (AAA) or thoracic aortic aneurysm. Before the procedure, your doctor will run imaging tests to evaluate and assess an aneurysm completely.
During the procedure
Once the doctor evaluates the size, location and severity of an aneurysm, you are given anesthesia. To prepare you for the stent grafting procedure, a small incision is made on both sides of the groin area. The next step is to find the area where the Abdominal Aortic Aneurysm is located, which is done by using fluoroscopy, which is an X-ray imaging technique that provides real-time moving images of the interiors of the body. After an aneurysm is located, a catheter and a tubular device are used to place the stent graft in the aorta. From the femoral artery (the blood vessel in the patient’s groin), the catheter is pushed along with the stent graft towards an aortic aneurysm in the abdomen.
After the stent graft is placed into the aorta, it is released allowing it to expand and snugly fit into the aorta. At this moment, the catheter is removed and stent graft is left inside the aorta permanently. Imaging techniques are used again to assess whether the stent graft has been placed properly or not.
After the procedure
After you recover from the Aortic Stent Grafting procedure, you will be advised by your doctor to remain flat on your back for at least 4-6 hours to allow the cuts to heal. You will experience mild discomfort at the wound area which will subdue in about 2 days. Side effects such as swelling, nausea, vomiting, and leg numbness, loss of appetite, fever and change in a bowel movement may be witnessed for 1-3 days after the stent grafting procedure.
Risks & Complications of Stent Grafting
There are some risks involved in aortic stent grafting as with any other grafting procedure. You should know about the risks and discuss them with your doctor before you go for the surgery. Below are some of the major risks related to endovascular stent grafting:
- Endoleaks: The leaking of blood from the graft into an aneurysm is called an endoleak, which is detected with a CT scan. Though most endoleaks do not require medical intervention, your doctor may decide depending on the severity.
- Stent graft displacement: Sometimes stent grafts can move from its original location in the body as time passes by. If your doctors see such a movement, he/she may decide whether you require a treatment.
- Aneurysm rupture: Since aortic stent grafting is done using a catheter, it carries the risk of tearing the blood vessels, especially when larger catheters are used.
- Device problems: In some occasions, the stent graft’s sutures or the metal portion may break causing problems. These issues can only be detected through imaging techniques.
- Arterial anomalies: Endovascular stent grafting may be responsible for forming an abnormal passage between veins and arteries.
- Bowel complications: Aortic stent grafting procedures for treating abdominal aortic aneurysm may result in bowel complications including the death of your bowel tissue which requires removal by surgery.
Other major complications related to aortic stent grafting include:
- Nausea and vomiting
- Groin area swelling
- Pain, inflammation and fever
- Liver and kidney problems
- Blood clots
- Infection of an aneurysm or grafting area
- Complications of the nervous system including total or partial paralysis
Benefits of Aortic Stent Grafting
Though there are risks that are usual with all forms of treatment and procedures, aortic stent grafting has many benefits for patients. Some of the major benefits include:
- Aortic or endovascular stent grafting is a minimally invasive procedure
- The stent grafting can be done under local anesthesia
- Compared to open surgery, aortic stent grafting has a lower complication rate
- There is a lesser possibility of losing a large amount of blood during the procedure
- It ensures short hospital stays and less time in the ICU
Follow-up consultations are an important part of recovery, healing and managing an aortic stent grafting. Regular visits to your doctor are important because most endovascular stent procedures rarely show any symptoms if there is a problem. Therefore, follow-up visits allow your doctor to check your stent graft and the condition of an aneurysm. Initially, these visits are a monthly affair but with time your doctor will ask you to come once a year for check-ups.
During follow-up consultation, your doctor will mostly do imaging tests such as CT scans, ultrasounds, X-rays, etc. If you have kidney issues, dyes used in these imaging procedures are harmful to your kidneys.