Repairing of aortic aneurysms depends upon several factors which include shape & location of aneurysm along with physical condition of the patient. Basically, a minimally invasive procedure which is meant to treat aortic aneurysms in place of open aneurysm repairs, Endovascular Aneurysm Repair is known as EVAR in short. Endovascular stent graft procedure is performed inside the aorta with help of thin & long tubes which are called catheters. Catheters are normally utilized for stent placements which are fabric liners reinforcing weak spots. Patients who are eligible for endovascular surgery must have an aneurysm which is 5 centimeters or more in size & which has not yet ruptured.
Why Undergo Endovascular Stent Grafting?
Goal of endovascular stent grafting procedure is to reduce the risk of complications associated with aneurysms. Major risk associated with untreated aneurysm is that it can get bigger or may in some cases rupture. Other factors which are considered as decisive while determining endovascular stent grafting include the following.
- Size of aortic aneurysm, particularly the diameter.
- Presence of symptoms including pain in inner thigh, groin, back pain or pain in abdomen.
- Growth rate of the aneurysm. Rapid aneurysm growth is more than 1 cm per year.
- Development of aortic dissection which is accompanied by sudden, severe 7 sharp tearing pain in back or chest region.
- Overall medical condition of the patient.
Endovascular stent grafting does not involve removing any portion of the aorta. Nevertheless, although small but a significant risk of rupturing of the aneurysm is a bit higher than that from open surgery repair of the aneurysm. Some other risks of complications associated with endovascular stent grafting include the following.
- Blockage of flow of blood through the stent graft.
- Leakage of blood around stent graft.
- Movement of stent graft from initial placement site.
- Fracture of stent graft.
- Rupturing of aorta or aneurysm.
Doctors will schedule periodic visits following endovascular stent grafting in order to monitor these possible complications. It is essential for the patient to keep up with appointments in order to make sure that the stent is properly functioning. Endovascular stent grafting is generally a very safe procedure. Moreover, special precautions are also taken in order to decrease risk of complications. However, patients must make it a point to question doctors & be sure that they understand risks of procedure, outcomes & why it is recommended for them during initial appointment prior to undergoing endovascular stent grafting.
One of the first tests which is performed for diagnosing coronary artery disease is electrocardiogram which shows the patient’s heart rhythm. Exercise electrocardiogram or stress test is also done sometimes, though it may be too strenuous for some heart patients. Cardiac catheterization is a definitive test which is also often considered. This procedure requires injection of special contrast dye into coronary arteries while the catheter is threaded into the arteries of the heart & x-rays display any narrowing or blockage on a monitor. The patient will, however, need to avoid eating or drinking anything for up to 12 hours prior to undergoing endovascular stent grafting or combined angioplasty with stent placement. An intravenous line is also inserted during the operation in order to administer anticoagulant medications so as to prevent formation of clots alongside radioactive dyes for x-rays. Groin area of the patient will be shaved & cleaned with antiseptic in preparation for the incision. Endovascular stent grafting patients are also given a mild sedative an hour prior to the operation so that they may sufficiently relax during the procedure. Pre-procedure tests are normally conducted a few days prior to endovascular stent grafting & patients may need to stop taking certain medications as instructed by doctors. The healthcare team will provide specific instructions as to what the patients are required to do in preparation for endovascular stent grafting.
Conditions Treated with Endovascular Stent Grafting
Cardiac conditions which are most often treated with endovascular stent grafting include aortic aneurysm, stenosis of carotid artery in neck & coronary artery disease.
- Aortic Aneurysm – This is a life-threatening bulge of aorta which can occur anywhere along this artery including in chest or in abdomen. This happens when aorta gets blocked by significant amount of plaque. Pressure is eventually created & may cause bulging like a balloon directly below or above the blockage site due to a weakening of blood vessel wall. Subsequently, aorta may rupture & cause massive bleeding including death. Quite often, aortic aneurysms are diagnosed when the patient complain of pain. However, in some cases, there may not be any obvious symptoms. Therefore, in quite a few cases emergency surgery may be required when an aortic aneurysm ruptures to cause massive internal bleeding & eventual loss of consciousness. Endovascular stent grafting is a minimally invasive surgical intervention which is designed to repair aortic aneurysms.
- Stenosis of Carotid Artery in Neck – Carotid arteries which pass through the neck carry blood & oxygen to the brain. Narrowing or blocking of this major artery can interrupt blood flow to brain in order to cause disabling strokes. Carotid endarterectomy surgical procedure is normally performed for removing fatty deposits so as to allow free flow of blood & oxygen to brain. Though this is an effective surgical procedure it presents high risk to patients, especially those who are greatly compromised. Endovascular stent grafting is a less invasive operation with few risks. This is often the surgeon’s priority for prevention of strokes among high-risk patients.
- Coronary Artery Disease – This is a circulatory disorder which results from blockages due to plaque within arteries of the heart. Heart is basically a muscle requiring constant flow of blood & oxygen through blood vessels in order to perform critical functioning of supplying blood to the whole body. Arteries narrow & flow of oxygen & blood get blocked when fatty deposits accumulate within the two main arteries supplying blood to heart. These blockages can eventually cause angina (chest pain) or a heart attack when blood vessels get closed up.
Endovascular stents are basically tiny wire mesh tubes which look like coiled spring before placement. These grafts are fabric tubes supported by metal wire inbuilt like scaffolding & designed to reinforce weak sports within aorta. Stent implantation is performed through tiny incisions where catheters are used to deliver them to the treatment site within the blood vessel. Eventually, stents mechanize a way to hold open a blood vessel & improve flow of blood over long-term. Quite often, stents are implanted through the same incision following balloon angioplasty. Stents largely reduce likelihood of medical emergency caused due to blockage of important blood vessels requiring immediate cardiac surgery for correction. Endovascular stents are implanted for both, treatment of new blockages & restenosis which is repeat buildup of plaque following prior treatment. Moreover, some stents are also designed to deliver anti-plaque drugs at the site of blockage. These are known as drug-eluting stents & aim to prevent restenosis in order to avoid further surgery.
Endovascular stent grafting procedure patients will either receive general anesthesia or a sedative & local anesthesia at the start of the operation. Surgeons will then make small incisions in groin through which they will perform surgery. Catheters are inserted through these openings so as to guide & deliver stent grafts through blood vessels to the aortic aneurysm site. Endovascular stent grafting procedure uses x-ray guidance to help surgeons identify the aneurysm site. This is where the graft is meant to be opened up inside the aorta & held in place with help of stents & metal hooks. The area above & below the aortic aneurysm is tightly sealed while the graft allows blood to pass through without putting any pressure on the aneurysm.
Typically performed in a cardiac catheterization laboratory equipped with fluoroscope, x-ray monitor & special x-ray machine, endovascular stent surgery patient will be placed on x-ray table & covered with sterile sheet. Groin area inside of upper leg will be washed & treated with antibacterial liquid as preparation. Patients are given local anesthesia in order to numb the incision site. The stent is subsequently threaded through the incision site in groin to the affected blood vessel on a catheter along with a deflated balloon at the tip & inside the stent. All the while, the surgeon will view the entire procedure with a fluoroscope & guide the catheter to the blocked area. The balloon is subsequently inflated at the blocked site & which causes the stent to expand & press against the wall of the blood vessel. Following this the balloon is deflated & taken out of the blood vessel. The stent will now permanently remain within the blood vessel & keep open the way so as to allow blood to freely pass & function normally like healthy arteries. Eventually, cells & tissue will grow & cover the inner surface of stent to become a permanent portion of a functioning artery.
Duration of Endovascular Stent Grafting Procedure
This entire procedure generally takes about 2 – 3 hours to complete. Endovascular stent grafting patient will stay for 1 – 2 days time at the hospital. However, full recovery from this minimally invasive surgery may take about 30 days of time to complete.
Endovascular Stent Grafting Surgery Aftercare
Patients will spend several hours in the recovery room following endovascular stent grafting & where they will be monitored for vital body functions. Patients will also have to lie flat for the first 24 hours during which time their activities will be limited. Consuming fluids is very important as it will help in flushing out dye which was used with x-rays during the procedure. Patients with stents are usually put on anticoagulant or aspirin therapy immediately after the operation. This is to prevent blood clots from occurring within stents. Surgeons will also provide specific instructions for patients to follow after endovascular stent graft procedure until the time incision has healed properly.
These include feeling a bit tired for a few weeks after operation. Some patients may develop an inflammatory response due to stoppage of blood flow through the repaired aneurysm site. Inflammation may go on so as to cause low-grade fever & feel like flu, but these aortic stent complications usually go away over time. Patients will not feel or notice the stent as such. The endovascular stent graft will make no difference in the ability of patients to perform normal daily activities. Most endovascular stent graft patients will be able to bet back to every regular activity without any restrictions.
Surgeons normally discuss outcomes of endovascular stent graft procedure with patients during initial appointment. While endovascular surgery is normally able to produce good outcomes, patients will however need to undergo scheduled follow-up visits to the doctor. Nevertheless, most patients are able to lead a normal life following stent graft procedure. In any case, it would be sensible for patients with aneurysm to follow a healthy lifestyle which includes regular exercise along with a healthy diet since aneurysms increase risk of developing atherosclerosis & heart disease as well. It is also advised that endovascular surgery patients should undergo full evaluation in order to assess risk of other associated diseases.
Benefits of Undergoing Endovascular Stent Graft Procedure
This is a minimally invasive surgical procedure & does not require to be performed through the open-chest or open-abdominal approach. This reduces time for recovery among most aneurysm surgery patients by several days. Endovascular stent graft procedure patients most often return home early & resume normal activities within 4 – 6 weeks of time.
Aortic aneurysms, heart attacks & strokes all have the same type of preventive measures. Plaque formation within blood vessels can be effectively reduced by making dietary & lifestyle changes including the following.
- Consuming a healthy diet which is rich in vegetables, fruits & whole grains along with limited amounts of dairy products & meat will immensely be helpful. Avoiding trans-fatty-acids found in butter substitutes, some vegetable oils & chemical or heat-extracted oils like margarine would also be sensible.
- Avoiding salty foods like prepared & packaged foods, pickles & sauerkraut, processed meats, chips & reducing use of table salt will help keep blood pressure down.
- Since excessive weight strains the entire circulatory system, losing weight in case it is required will help in reducing blood pressure.
- Moderate exercise which works up sweat & increases heart rate is recommended several times a week. Indulging in brisk walking for 20 minutes at least thrice a week is understood to be sufficient for less physically active people.
- It is also important to control cholesterol through diet & with help of certain medications.
- Heart should be examined once every year with help of an electrocardiogram test. Patients should also enquire with cardiologists if they can take aspirin for prevention of blood clots.
- Quitting smoking should be a priority as it encourages buildup of plaque. While nicotine raises blood pressure, carbon monoxide which is present in smoke reduces the amount of circulating oxygen in blood. Doctors have established a strong link between smoking & stroke or heart attack.
- Alcohol should be used in moderation, which means just one or two drinks a day. This has also shown to be helpful in improving circulation, increasing levels of ‘good’ cholesterol & in reducing risk of formation of clots in blood.
Excellent & Affordable Endovascular Stent Graft Procedure
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