Endovascular treatment of abdominal aortic aneurysms

Aortic aneurysm is a life-threatening condition, which manifests itself in atrophy of elastic fibers and thinning of the walls of the arteries. During systole, blood flows into the aorta under high pressure. With insolvency aortic wall, the artery sooner or later will not sustain the tension and could rupture.

Open Surgery

Open surgery for aortic aneurysm is a standard surgical intervention aiming at vessel prosthesis. Operational access is carried out in a spot of projection of the pathological lesion. The incision length is 10-20 cm. After the access is performed, the aorta above and below the aneurysm is cut, a vascular prosthesis is implanted, and a drainage is installed. An important part of the operation is ensuring of sutures tightness for the prevention of postoperative bleeding due to their insolvency.

In our clinic we use vascular prosthesis with a silver impregnation for the treatment of aortic aneurysms, which makes them particularly resistant to infectious agents. The average operation on prosthetic aortic aneurysm lasts 4 hours. The patient is, then, placed to the intensive care ward for observation, and the next day is transferred to the surgical ward. The standard length of stay in hospital after this treatment is 7 days.

Endovascular Therapy

Endovascular therapy is a minimally invasive surgical procedure, which is performed through the lumen of the vessel, without dissection of the soft tissues. When aortic aneurysm endovascular stenting is applied – EAT and EVAR operations. Stent is a tube with a special frame, which passes a blood through, removing the pressure from the weakened area of the aorta. Thus, aorta does not rupture, and hence there is no risk for the patient.

Advantages of endovascular therapy against open surgery:

• There is no soft tissue injuries;
• There is no need to clamped aorta and, hence, no risk of associated complications.
• During the intervention, the internal organs do not suffer from low blood supply, since not a single part of the cardiovascular system is turned off from the circulation.
• The heart is not overloaded during endovascular therapy.
• Minimally invasive treatment causes lesser stress to the body against surgical treatment of aortic aneurysms.
• There is no need for general anesthesia; surgery is performed under local anesthesia.
• The period of hospital stay is reduced by half.

For stent installing procedure patient receives local anesthesia in the area of the femoral artery projection (the outer lateral area of the thigh). A surgeon performs a small incision of the vessel wall and it enters the endovascular tube with the stent attached to it to enhance aortic aneurysm. Under the control of X-ray the prosthesis goes up to systemic circulation: from the femoral artery into the external iliac, then the common iliac and out into the abdominal aorta. Next the stent is up to the spot of aorta aneurysm localization.

Upon reaching a pathological lesion the surgeon performs the disclosure of the stent in such a way that its top and bottom flat against the unaffected parts of the vessel, which ensures tight sealing of the aneurysm of the aorta. Without achieving absolute sealing eventually develops blood dripping to the site of the aneurysm. If it is a minor leak, the operation is considered successful, but if the blood enters to aortic aneurysm in large volume, it is necessary to conduct additional endovascular intervention.

At the aneurysm of bifurcation segment of the aorta (the place of the separation of the abdominal aorta to the iliac arteries) operation lasts longer and is performed through an incision in the femoral artery. Two of the stent are held in the arteries and connected in the site of the aneurysm.

After surgery, the patient is sent to the intensive care unit and stays in the hospital for 2-3 days. The total duration of rehabilitation after endovascular treatment of aortic aneurysm is not more than 10 days

Endovascular Prostheses

Endovascular prostheses or stents are composed of a metal mesh and a special coating. Intravascular prosthetic aortic aneurysm performed in unchanged position. There are following types of endovascular prosthesis depending on the location of the aneurysm:

• Cone-shaped prosthesis for the thoracic and abdominal aorta;
• Cylindrical stent for thoracic and abdominal vessels;
• Bifurcation endovascular prosthesis used for the separation zone (bifurcation) of the aorta. The bifurcation stent consists of two parts that are connected during operation.

Laparoscopic Treatment of Aortic Aneurysm

Laparoscopic surgery is a minimally invasive surgery. Access to the pathological lesion is performed through a few (usually 3) punctures on the anterior abdominal wall. Surgical procedures are performed with laparoscopic instruments, and the surgeon controls the course of the operation on the special monitor to which image is transmitted from the camera introduced into the abdominal cavity.

The advantages of laparoscopic treatment of aortic aneurysm before open surgery:

• Minimal damage to the soft tissues.
• It reduces the risk of possible complications of the treatment of the aneurysm.
• A shorter period of post-operational rehabilitation.