Endovascular repair with a stent for an abdominal aortic aneurysm
The use of an endovascular stent graft to repair an aortic aneurysm has become more common, although the
long-term follow-up is not entirely clear. Stent grafts may help strengthen a
weak aortic wall and may be an option for some people who cannot have traditional (open) surgery,
such as older people or people with severe heart, lung, or kidney disease.
Usually people are evaluated for this procedure with
computed tomography (CT) scans that allow the surgeon
to measure the aneurysm, the exact size of the neck of the
aneurysm, and what size stent graft would be appropriate.
We've all heard the stories: someone seemingly healthy, with normal
cholesterol levels and no obvious risk factors, drops dead of a heart attack.
How can this happen?
Morteza Naghavi, MD, says it's because traditional risk factors may not tell
you what you really need to know: whether your arteries are diseased.
"Why are cholesterol, smoking, family history so lousy? Because they're
just risk factors," says Naghavi, chairman of the Society for Heart Attack
Prevention and Eradication (SHAPE)...
An endovascular stent graft procedure is better in some ways over open surgery. But it is still a relatively new procedure. So doctors do not know how well it works over the long term. An endovascular repair is not an open surgery, so it does not have the risks or complications of a major surgery. For example, you have less blood loss, are not in the hospital as long, and can recover faster. But later you may have complications caused by the stent. Experts are still studying the long-term effects of the endovascular stent procedure.
With an endovascular repair, the risk of dying during or soon after the procedure is lower than the risk from open surgery. For an endovascular repair, about 1 out of 100 people die during surgery or within 30 days after surgery.1 For an open surgery, about 4 to 6 out of 100 people die during surgery or within 30 days after surgery.1 But over time, this benefit for endovascular repair might disappear. After a couple of years after the repair, people who had open surgery may live as long as people who had endovascular surgery.
In an endovascular repair, you get intravenous (IV)
sedation and local anesthesia. The surgeon makes a small incision in the groin
area. Then a catheter is placed in the femoral (groin) artery and "floated"
to the aneurysm. The surgeon is guided by a
fluoroscopy (an X-ray and contrast dye).
A stent graft is run through the catheter to the aneurysm. It either
expands on its own or is expanded with an angioplasty balloon.
After the surgery, frequent follow-up is required. A computed
tomography (CT scan) is done before you leave the hospital, then at 3, 6, and
12 months, and once a year thereafter.
The U.S. Food and Drug Administration (FDA) gave a premarket approval
application to stent grafts in 1999. In 2001, the FDA issued a Public Health
Notification for two of these devices: The Ancure System (Guidant) and the
AneuRx System (Medtronic AVE). Placement problems, which were associated with
damaged artery walls, were reported for the Ancure System. Problems such as
leaking, slipping out of place, suture breaks, fabric tears, and poor graft
placement were reported for the AneuRx system. Because only a small number of
people with these devices have had these problems, the devices remain in use.
But the Ancure System has not been made since 2003. If you have one of these systems implanted, consult your doctor.
Isselbacher EM (2008). Abdominal aortic aneurysms
section of Diseases of the aorta. In P Libby et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed., pp. 1458-1469. Philadelphia: Saunders
Primary Medical Reviewer
E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer
David A. Szalay, MD - Vascular Surgery
January 26, 2010
WebMD Medical Reference from Healthwise
January 26, 2010
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