Endovascular Surgery

In recent years, a treatment has been developed to repair an aneurysm without major surgery. Many surgeons have been using less invasive endovascular surgery on abdominal aortic aneurysms. The procedure results in less blood loss, less trauma to the aorta, and fewer (or no) days in intensive care. Because results with endovascular repair of abdominal aortic aneurysms have been encouraging, similar techniques are being developed for the treatment of thoracic aortic aneurysms as well.

Endovascular surgery may benefit those who need surgery but are at high risk of complications because of pre-existing medical problems. However, not every person is a good candidate for this procedure. The appropriate choice of procedure, open versus endovascular, depends on many factors and is best determined by the medical team in consultation with the patient.

In endovascular surgery, a synthetic graft (stent-graft consisting of a polyester tube inside a metal cylinder) is attached to the end of a thin tube (catheter) that is inserted into the bloodstream, usually through an artery in the leg. Watching the progress of the catheter on an X-ray monitor, the surgeon threads the stent-graft to the weak part of the aorta where the aneurysm is located.

Once in place, the graft is expanded. The stent-graft reinforces the weakened section of the aorta to prevent rupture of the aneurysm. The metal frame is expanded like a spring to hold tightly against the wall of the aorta, cutting off the blood supply to the aneurysm. The blood now flows through the stent-graft, avoiding the aneurysm. The aneurysm typically shrinks over time.

Although endovascular surgery reduces recovery time to a few days, it still carries risk. And because the procedure is fairly new, long-term results are unknown. Complications can occur with this procedure, namely blood leaking from the graft, known as endoleak. For this reason, patients who have repair of their aortic aneurysms with stent-grafts are initially required to return for monitoring every six months.