Endovascular Aneurysm Repairs

What is an abdominal aneurysm?

The aorta is the largest artery which carries oxygen-rich blood from the heart to all parts of the body.  The section of the aorta which runs down into the abdominal region is called the abdominal aorta and this large artery which measures approximately 2cm across, supplies blood to the lower part of your body.

In an abdominal aortic aneurysm (AAA), there is an abnormal bulge in the aorta (like a balloon) due to weakening of the aortic wall combined with pressure of the blood exerted on the weakened wall. This bulge may increase in size over time and cause the aorta to rupture (burst) causing life threatening internal bleeding.

What are risk factors for developing an abdominal aortic aneurysm?

High blood pressure and smoking are 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 re-line the inside of the aortic wall. This reinforces the weakened abdominal aorta.

What are the indications for an abdominal aneurysm repair?

Abdominal aneurysm repair is indicated under the following situations:

• Abdominal aneurysm repair is performed for the treatment of symptomatic aneurysms (pain in abdomen/lower back or pressure effects from the aneurysm on surrounding structures such as the ureter which is a tube draining urine from the kidney to the urinary bladder).
• Asymptomatic abdominal aortic aneurysm measuring 5.5cm or more.
• When the growth of the aneurysm is more than 1cm in a year.

Is it a dangerous condition?

How is endovascular abdominal aneurysm repair performed?

The procedure is performed under general anaesthesia or regional anaesthesia. A small incision is made over the femoral artery in the groin and a catheter (thin tube) is introduced into the artery over a wire. Contrast (dye) imaging using sophisticated Xray equipment allows to visualise the catheters and wires inside the artery with great accuracy.  The stent graft is advanced over the wire and the position of the graft is confirmed following which the graft is deployed. The stent graft relines the inside of the aorta and prevents the aneurysm from rupture, allowing blood to flow freely without weakening the wall.

What can you expect after abdominal aneurysm repair?

The anticipated in-hospital stay after aortic stent repair is 2-3 days. The recovery time for an endovascular stent graft repair is less than open surgical aneurysm repair. On the first day after surgery you will be able to walk around and allowed to eat as tolerated.  However, driving and lifting heavy weights is to be avoided for 4 to 6 weeks or until the physician approves. You will return for a follow-up visit after the first few weeks and will require imaging of the stent graft at regular intervals lifelong to ensure that the stent graft is in a satisfactory position.

Are there any complications of the abdominal aneurysm repair?

Like all surgical procedures, endovascular repair may be associated with certain complications. These may include:

Endovascular abdominal aneurysm repair

• Damage to surrounding blood vessels, organs, or other structures by instruments
• Bleeding
• Limb ischemia (loss of flow of blood leg/feet) from blood clots
• Wound infection or large blood-filled bruise (hematoma) near the groin
• Endoleak (continued leakage of blood from the graft, into the aneurysm sac, which may potentially rupture)
• Kidney damage
• Spinal cord injury

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.