Comprehensive Overview of Stent-Graft Abdominal Aortic Aneurysm Repair


Anyone who is or had an abdominal aortic aneurysm surgery and lived to tell about should consider themselves lucky, the abdominal aortic aneurysm open repair surgery has a high mortality rate and comes down to how fast acting the surgeon is who is treating the condition. Some of the common risk factors for developing this aneurysm include people who smoke, according to some reports over 90% of people who develop the aortic aneurysm disorder have a history of smoking.

If you have completed the surgery you are still at risk of having another one which is where lifestyle changes become a priority, you need to reduce the amount of fat in your diet and if you suffer from hypertension it would be prudent to get medical help to bring it under control. The biggest thing is to stop smoking! While tobacco cessation is not easy it could make the difference between life and death for you.

Stent-Graft Abdominal Aortic Aneurysm Repair

Abdominal aortic aneurysm stent-grafts have emerged as a promising new catheter-based method to the repair of aneurysm health condition (AAA).

The stent-graft is designed to fit tightly into the blood vessel, creating a pressure seal that prevents flow around the stent-graft into the aneurysm. Early experience suggests that in carefully selected patients stent-graft abdominal aortic aneurysm repair is safe and effective and has a lower morbidity than conventional surgery.

The Appearance of Stent-Graft Technology
The idea of stent-grafts for treatment of aortic aneurysms was received with enthusiasm when the first trials in humans were reported by Parodi in 1991. In the intervening years, stent-grafts have become widely available, especially in Europe. There are a number of devices in clinical trials in the United States and two devices have FDA approval.

The stent-graft device is an outgrowth of three existing technologies — metal stents, vascular graft materials, and catheters. When compressed and fitted onto a catheter, the stent-graft can be inserted through a small femoral arteriotomy, or possibly percutaneously. When released from the catheter, the stent-graft expands to a predetermined size and shape. Some devices have small barbs that help anchor the stent-graft in position.

Results
In approximately 70 percent to 80 percent of cases, the excluded abdominal aortic aneurysm sac around the stent-graft thromboses completely within hours of the procedure. In the remaining 20 percent to 30 per-cent of patients, an endoleak may occur when a portion of the abdominal aneurysm sac remains incompletely thrombosed due to retrograde flow through lum-bar arteries, the inferior mesenteric artery or the internal iliac artery.

animation of stent-graft abdominal aortic aneurysm repair

Approximately half of these aneurysms will thrombose completely after several months. With thrombosis of the abdominal aneurysm, some shrinkage of the sac is usually observed over time.

Comparison with Open Surgical Abdominal Aortic Aneurysm Repair

Stent-graft repair of abdominal aortic aneurysm differs from traditional surgical aneurysmectomy in several ways. A successful abdominal aortic aneurysm stent-graft procedure is highly dependent upon careful, detailed imaging for both treatment planning and execution. Selection of the correct stent-graft for a patient is based upon imaging studies, not direct observation of the aorta as in open repair. Similarly, deployment of the stent-graft in the proper location relies on correct interpretation of high quality intraprocedural imaging. The stent-graft is secured in the aorta primarily by pressing against the wall of the blood vessel. In surgery, the graft is secured with sutures. Following stent-graft repair, the abdominal aortic aneurysm is thrombosed but still present. In contrast, the aneurysm is excised during surgical repair.

Complications Connected with Stent-Graft Abdominal Aortic Aneurysm Repair

The morbidity of abdominal aortic aneurysm stent-graft procedures reported in the literature is significantly lower than that of conventional surgery, with fewer major complications, less need for recovery in intensive care units and lower overall blood loss. The average hospital stay is from two to three days. The long-term outcomes of stent-grafts for AAA are not yet known and delayed rupture of abdominal aortic aneurysm following stent-graft repair has been reported in initial clinical trials. It is also important to note that not all patients are suitable candidates for stent-grafts, primarily due to anatomic features that cannot be accommodated by current stent-graft abdominal aortic aneurysm repair designs.