Endovascular surgery is a modern, less invasive technique for treating blood vessel issues such as aneurysms, which are swellings or “ballooning” of the vessels. Using this method, your endovascular surgeon will make two small incisions near the hips to introduce the endovascular graft – a fabric tube device framed with stainless steel self-expanding stents. It is inserted into the aorta via a catheter, and upon reaching its destination, it expands and seals off the affected area in order to prevent any further flow of blood into it. Upon completion of this process, the graft is left firmly implanted in the aorta.
Before, this condition was treated with open surgery, which involved making a cut on the side of the chest or breastbone and taking a long time to heal. After open surgery, most people stay in the hospital for seven to ten days and get better in three months.
Endovascular surgery, a less invasive alternative to open surgery, has several advantages, including a shorter recovery period, less discomfort, local or regional anaesthesia rather than general anaesthesia, smaller incisions, and minimal stress on the heart. It is also a better option with fewer risks for people who already have other health problems. Patients who need surgery but have other health problems that make them more likely to have problems could benefit from this procedure.
Advanced Endovascular Treatments
Standard endovascular repair is not always possible for patients in some instances. Sometimes the aneurysm is too close to critical aortic branches, or the arteries are too narrow or complicated to allow the catheter used in endovascular surgery to pass through. Your endovascular surgeon may advise three choices in these situations: no treatment, open surgery, or complex endovascular repair.
Endovascular techniques for complex conditions have been developed. These advanced techniques can be used to treat thoracoabdominal aortic aneurysms (TAAA), which involve important arteries to the abdominal organs, and arch aortic aneurysms, which involve important arteries to the brain.
Preparation
Prior to undergoing the surgery, it is important that your endovascular surgeon perform a medical evaluation. This will involve taking your medical history and doing a full physical examination. Additionally, it may be necessary for them to conduct a stress test and ECG in order to evaluate the health of your heart’s electrical activity.
You will undergo tests to determine whether your aneurysm can be treated with endovascular surgery, including a CT scan and angiography, which will enable your doctor to see your aorta and blood vessels. These tests also enable the doctor to choose the right graft size.
During this time, your surgeon will brief you about endovascular surgery and address any questions you may have.
Procedure
Before the procedure, you will be given either a sedative and regional anaesthesia to make you more comfortable and numb the area of the operation, or general anaesthesia. To avoid infection, the insertion site will be cleansed and shaved. To reach your blood vessels, your doctor will make a tiny incision around the hip, near the crease between the hip and thigh. A guide cable is inserted through the incision and guided to the aneurysm via a blood vessel.
Special X-rays will be taken to pinpoint the precise location of the aneurysm. Your endovascular surgeon will then place a catheter—a long, flexible, and thin tube over the guide wire. The catheter is used to deliver the graft to the artery above the aneurysm via your blood vessels. Once the graft is in place, it is freed from the catheter and expands. This stops blood from going to the aneurysm, which causes it to shrink over time.
Before the procedure is over, X-rays will be taken to make sure that blood is going through the graft instead of the aortic aneurysm. Sutures will then be used to seal the incisions near your hip.
Recovery
Your endovascular surgeon and team will carefully monitor and care for you after surgery. The majority of people stay in the hospital for two to three days. You will be able to walk and intake food on the first day after surgery. However, most patients report a loss of energy and appetite for about two weeks after the procedure.
When you are ready to return home, you may take sponge baths, but you should avoid soaking the area around your incision until it has healed completely. Most patients can resume their usual activities four to six weeks after surgery.
Following Up
You will have a follow-up appointment with your doctor or Vascular Surgeon one to two weeks after surgery to assess your recovery status. Imaging tests will be taken between one and six months after surgery to ensure that your graft is functioning correctly. After the first year, you’ll have imaging tests every year to check on your aneurysm and graft.
