Endovascular repair is usually the preferred treatment for aortic aneurysm

Pre-operative preparation

The workup is similar to that of patients undergoing open repair. In order to prepare for this procedure, it is vital that a full medical work-up be obtained to confirm fitness for anaesthesia.

 This will involve a number of blood tests, and an assessment of the heart with an ECG, thallium scan, and referral to a cardiologist if there are any concerns about your heart.

A CT scan would have been performed for planning the procedure.

It would be fair to say that this procedure has broadened the scope of elective AAA repair, as many patients previously unfit for open repair, can now be offered Endovascular Aneurysm Repair.

Day of procedure

You may be admitted on the morning of the procedure if your work-up has been completed. You will be required to bring ALL of your usual medications.

It is important to fast for at least 6 hours prior to the procedure. For a morning procedure, you will need to fast from midnight, whereas for an afternoon procedure, this will mean fasting from 7am.

Your anaesthetist will consult you prior to the operation and explain the anaesthetic and its risks to you.

The procedure

A full general anaesthetic is administered, and a tube inserted into your windpipe (trachea) to help with your breathing while you are asleep. A catheter is also inserted into your bladder so we can monitor your urine output. This will remain in-situ for the first 48 hours.

The operation is performed under sterile conditions in a Catheter lab or Hybrid theatre with x-ray facilities.

The femoral (groin) arteries are punctured and sheaths inserted into these arteries. The endoluminal graft is delivered into the aorta via the sheaths. The device is modular, consisting of 3 parts, a main body and two extension limbs. When deployed, it resembles a pair of trousers. With a satisfactory seal at the top and bottom, the AAA is thereby excluded from the circulation. As the AAA is no longer subjected to any arterial pressure, it will gradually decrease in size, reducing the risk of rupture.

As the sheaths are sizable to accommodate the graft, the hole in the femoral artery is sealed with a closure device. Where the femoral artery is very diseased with calcification, it is sometimes deemed safer to perform an open exposure of the artery.

Post-operative course

All patients return to the ward for observation. Diet and gentle ambulation are readily resumed. Most patients are fit for discharge within 48 hours.

It is imperative that all patients remain under surveillance, with scans at regular intervals to ensure all is well.

What is an Endoleak?

An endoleak occurs when there is still some blood flow in the aneurysm sac outside the stent graft. This can create pressure in the sac, causing it to expand and potentially rupture.

A type 1 endoleak occurs if the seal at the top or bottom of the stent-graft has been lost.

Persistent flow in arteries emerging from the aneurysm sac (the lumbar arteries or inferior mesenteric artery) can cause a type 2 endoleak.

Disruption of the components of the graft can cause a type 3 endoleak.

If you have any questions about Endovascular Aneurysm Repair or ready to book an appointment, contact our experienced team.