This is an abbreviated version of the complete article.*
Endovascular stent grafting is a minimally invasive procedure used to repair an aneurysm, which is a weakened and enlarged section of an artery.
Endovascular stent grafting is usually performed for an aneurysm in the abdominal section of the aorta, the body's largest artery.
By using a catheter to place a metal-and-fabric support skeleton called a stent graft inside the artery, this procedure can eliminate the need for open surgery.
Endovascular stent grafting typically produces minimal discomfort and allows the patient to recover in a few days.
Endovascular surgery refers to a group of minimally invasive procedures that allow surgeons to treat problems in the heart or the blood vessels from within the vessels themselves by using special technologies and instruments. The procedures only require a small incision or puncture in the artery or vein; generally, this means a shorter hospital stay, a speedier recovery, and less risk of complications for the patient.
An endovascular stent graft is a slender fabric tube that a physician uses to reinforce or strengthen a week spot in a blood vessel. The 'stent' part of the graft is the hooks or barbs at each end of the fabric tube that anchor onto the arterial wall. Some stents are secured in the arterial wall after a balloon in the catheter is inflated and presses the hooks into the wall.
WHEN IS ENDOVASCULAR STENT GRAFTING INDICATED?
Not all patients are candidates for this procedure. Anatomical characteristics are significant to the selection of a patient for this procedure. The size of the proximal and distal neck of the artery must be 1.5 cm. Patients who are candidates should be in good health but have an aneurysm located in the section of the aorta just below the renal arteries, or patients who are so ill that they cannot undergo standard surgery.
Endovascular stent grafts are often used in patients with the following:
Abdominal aortic aneurysm
Endovascular stent grafting of aortic aneurysm is still considered investigational by some federal health authorities. The Food and Drug Administration, however, has approved two devices for clinical use. A physician experienced in endovascular stenting in a well-equipped medical center should perform the procedure.
WHAT TO EXPECT
The patient will usually be given a regional anesthesia. Two small incisions are made in the groin. The Physician threads a wire into the femoral artery to the area of the disease through these incisions. Two wires coming from either groin incision are necessary to advance the different segments or to position the device. Using fluoroscopy (a type of x-ray monitor) as a visual guide to show the artery and the stent graft placement, the physician inserts a catheter containing a compressed graft and places it over the guidewire. At the aneurysm site, the tube holding the graft is retracted and the graft released. The physician withdraws the catheter, leaving the graft to expand to fit flush against that section of the arterial wall. The stent achieves its final shape through elasticity or by thermal memory. Positioned against the arterial wall, the stent graft allows blood to bypass the aneurysm.
POST TREATMENT GUIDELINES
Following the procedure, the patient may spend two to three days in the hospital. Within the first day of recovery, the patient is permitted to eat and perhaps walk. Ten days following the procedure, the patient returns for a follow-up visit at which the physician checks incisions, removes staples, and assesses the patient's overall condition.
The patient should also:
Avoid driving until allowed by the physician
Avoid showering (baths are permitted)
Avoid lifting anything more than five pounds for four to six weeks after surgery
Patients will be asked to undergo an imaging scan of the abdomen one and six months following surgery.
The potential complications of endovascular stent graft include:
Leaking of blood around the graft
Movement of the graft away from the desired location (migration)
The physician may monitor the graft regularly for the rest of the patient's life to ensure that the device has not migrated.
Patients should consult their physician immediately if they suspect or experience any complications because of the stent graft.
Medical Review Date: March 9, 2005
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