Stent graft surgery for an abdominal aortic aneurysm

The use of an endovascular stent graft in surgery for aortic aneurysms 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 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 take measurements of the aneurysm, the exact size of the neck of the aneurysm, and what size stent graft would be appropriate.

A stent graft procedure for an abdominal aortic aneurysm has several advantages, including:¹

• No need for a large abdominal incision.
• No clamping of the aorta.
• No tearing or cutting of the abdominal cavity (retroperitoneal dissection).
• Improved cardiovascular function during the operation period.
• Less stress to the body.
• Improved kidney and digestive function.
• Less time in the hospital.
• Lower 30-day mortality rate. You are less likely to die within 30 days of having this type of surgery than if you have traditional surgery. You may also have fewer complications. But more studies are needed about the long-term benefits of endovascular surgery compared to traditional surgery.^{2, 3, 4}

In this type of surgery, the person receives intravenous (IV) sedation and local anesthesia. The surgeon makes a small incision in the groin area, and a catheter is then 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 physician. You may also want to consider being a part of a clinical trial. Clinical trials use volunteers to test new treatments.

Citations

1. Thompson MM, Bell PR (2000). Arterial aneurysms. BMJ, 320(7243): 1193–1196.

2. Greenhalgh R (2004). Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm, 30-day operative mortality results: randomised controlled trial. Lancet, 364(9437): 843–848.

3. Prinssen M, et al. (2004). A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. New England Journal of Medicine, 351(16): 1607–1679.

4. Blankensteijn JD, et al. (2005). Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. New England Journal of Medicine, 352(23): 2398–2445.