Aortic Stent Grafting
This is an endovascular or minimally invasive method of treating Abdominal Aortic Aneurysm (AAA). This is a dilated and weakened artery that is generally painless until it bursts.
A ruptured AAA is a grave diagnosis with a high risk of death from uncontrolled bleeding. Classically aneurysmal change affects the Aorta in the upper abdomen.
The aim is to exclude the aneurysm from the circulation so that it is no longer pressurized and hence has no risk of rupture. The AAA is left intact and will shrink with time. The graft is a cloth covered metal cage that comes pre mounted in a delivery system.
Access to the circulation is obtained by exposing the femoral arteries in the groin with twin incisions – each about 7 cm long. The operation is done in a Catheter Lab with either general or epidural anaesthesia.
The stent graft is railroaded into place in the abdomen over stiff wires fed up from the groin. There are generally three parts – a body and two legs that trombone into each other sequentially.
Post operatively you are in hospital for 2-4 days, can eat and drink within 4 hours, and walk the next day. The stitches dissolve.
The advantages to this over conventional open surgery include;
- Less pain.
- Faster operative time.
- Faster recovery.
- A lower risk of major complications, including death.
- Less blood loss.
- Lower anaesthetic risks.
- A lesser risk of sexual problems post operatively.
- Not all AAA’s are the right shape to be stent grafted. In that case open surgery is used to repair them.
You will need to be followed up by a combination of Ultrasound, plain X-Rays or CT scanning to ensure the AAA remains excluded from the circulation. The follow up is long term although less rigorous as time goes on.
There is a 5% chance per year that some other type of procedure is required to ensure the AAA remains unpressurized.