Aortic aneurysm repair is a major surgical procedure aimed at correcting aneurysms in the aorta (the largest artery in
the body). An aneurysm is an abnormal, irreversible bulge in the wall of an artery, which can lead to life-threatening
complications if it ruptures. The two primary approaches to aortic aneurysm repair are
Open Surgery:This traditional method involves a large incision (from chest wall reaching up to abdomen) to
directly access the aorta. The enlarged section of the artery is removed and replaced with a synthetic graft.
Open surgery is often reserved for large or complex aneurysms and can be performed on different parts of the
aorta, including the thoracic (chest) and abdominal sections. The recovery period is usually longer, and the
risks include typical surgical complications like infection, bleeding, and damage to surrounding organs.
Endovascular Repair:This less invasive technique involves inserting a stent graft through a small incision,
usually in the groin. The stent graft is guided through the blood vessels to the site of the aneurysm. Once in
place, it reinforces the weakened section of the aorta, preventing rupture. The main advantage of
endovascular repair is a shorter hospital stay and faster recovery compared to open surgery. However, it may
not be suitable for all types of aneurysms, and there's a risk of the graft moving or leaking over time.
Fenestrated and Branched Endovascular Aortic Repair (FEVAR/BEVAR):These are advanced forms of
endovascular repair designed for aneurysms near branches of the aorta, like renal or visceral arteries. FEVAR
involves a custom-made graft with holes (fenestrations) or scallops to accommodate these branches, while
BEVAR uses grafts with actual branches (side arms) that extend into the side arteries. These techniques allow
treatment of complex aneurysms that were previously not amenable to standard endovascular repair. They
require careful planning and high technical expertise.
Each approach has its indications, advantages, and risks. The choice between open surgery and endovascular
options, including FEVAR/BEVAR, depends on the aneurysm's location, size, shape, and the patient's overall health
and anatomy. The decision is made by a vascular surgeon and cardiothoracic surgeon, often after detailed imaging
studies like CT scans or MRIs.
Regular monitoring and follow-up are crucial after repair, regardless of the method used, to ensure the long-term
success of the procedure and the patient's overall health.
1. THORACIC ENDOVASCULAR STENTING (TEVAR)
Thoracic Endovascular Aortic Repair (TEVAR) is a revolutionary minimally invasive surgical procedure used
to treat aortic diseases, particularly thoracic aortic aneurysms (TAA) and dissections. The aorta, being the
main artery that carries blood away from the heart to the rest of the body, when affected by an aneurysm or
dissection, poses significant risks to health, including the threat of rupture, which can be life-threatening.
TEVAR involves the insertion of a stent-graft, a tubular fabric supported by a metal mesh, into the aorta. This
procedure is performed using a catheter, usually inserted through the femoral artery in the groin. The
catheter guides the stent-graft to the affected area of the aorta. Once in position, the stent-graft is expanded,
creating a new path for blood flow, effectively isolating the aneurysm or dissection, thereby reducing the risk
of rupture.
One of the main advantages of TEVAR is its minimally invasive nature. This results in shorter hospital stays,
reduced recovery times, and less pain and discomfort for patients. TEVAR is often a preferred option for
patients who are deemed high-risk for open surgical procedures due to age, existing health conditions, or
previous surgeries. TEVAR is not without risks and complications including endoleaks (where blood
continues to flow into the aneurysm), migration of the stent-graft, or damage to the blood vessels used for
access can happen. Long-term surveillance post-procedure is essential to monitor the integrity of the stent-
graft and the overall health of the aorta.
Advancements in TEVAR technology and techniques are continuously evolving. Custom-made stent-grafts
and improved imaging techniques have made the procedure applicable to more patients, including those
with complex aortic anatomy.
2. STENTING TO REPAIR ANEURYSMS IN ABDOMINAL AORTA.
Stenting to repair aneurysms in abdominal aorta offers a less invasive and highly effective treatment option
for patients with abdominal aortic aneurysms. Abdominal aortic aneurysms, characterised by an abnormal
bulging or ballooning in the wall of the aorta, pose a serious risk as they can lead to life-threatening ruptures.
Traditionally, open surgical repair was the primary treatment option, but with the advent of stenting, minimally
invasive alternative has emerged.
The procedure, known as endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms, involves
the insertion of a stent-graft into the aorta. This stent-graft (which is a tube composed of fabric supported by
a metal mesh) is deployed to reinforce the weakened section of the aorta, thereby preventing the aneurysm
from rupturing.
One of the key benefits of stenting is its minimally invasive nature. The procedure is typically performed
under local or general anesthesia, with small incisions made in the groin to access the blood vessels. A
catheter is used to guide the stent-graft into place within the aorta, all while monitoring through advanced
imaging techniques. This approach significantly reduces recovery time and the risk of complications
compared to open surgery.
Stenting of abdominal aortic aneurysms has proven particularly beneficial for patients who are deemed high-
risk for open surgery due to age, other medical conditions, or the location of the aneurysm. The customised
nature of the stent-grafts allows them to be tailored to fit the specific anatomy and requirements of each
patient, ensuring a more effective and personalized treatment. Patients undergoing stenting require lifelong
surveillance to monitor the status of the repair and the condition of the aorta to ensure long-term success.