Endovascular Stent Graft

Introduction

Arteries are the blood vessels that carry oxygen-rich blood from the heart to all parts of the body. An aneurysm is a balloon like bulging or swelling along the wall of an artery due to weakening of the wall. An aneurysm can grow large, eventually bursting or rupturing causing internal bleeding and death. An aortic aneurysm develops in the aorta (largest blood vessel in your body) and can be treated with an endovascular (inside a blood vessel) stent graft. Endovascular stent grafting is a new treatment method for abdominal aortic aneurysms and thoracic aortic aneurysms. It is a less invasive procedure when compared to an open surgical repair. Endovascular stent grafting involves use of a stent graft to re-line the inner wall of the artery and thus reinforce the wall and prevent rupture.

Indication

Your surgeon may recommend endovascular stent grafting if you are diagnosed with an abdominal aortic aneurysm or thoracic aortic aneurysm. Suitability for endovascular stenting depends on various factors including patient’s age and fitness, anatomy of the aneurysm and other technical factors.

Pre-surgical care

Your surgeon may request a CT scan to evaluate the extent and location of the aneurysm and the feasibility of endovascular surgery. It also allows for accurate measurements of the aneurysm morphology so as to match a suitably sized stent graft that will ensure a secure and durable repair. You will be given specific advice regarding certain medications which require to be ceased before the surgery. An anaesthetic assessment may also be required to ensure a safe anaesthetic during the surgery and a smooth post-surgical recovery.

Surgical procedure

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.

Post-surgical care

The anticipated in-hospital stay after aortic stent repair is 2-3 days. 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.

Risks and complications

The complications of endovascular stent grafting include:

• Infection
• Endoleak (leaking of blood around the graft)
• Graft fracture
• Migration of the graft away from the desired location
• Blockage of the blood flow through the graft