Introduction
Endovascular aortic repair is a procedure to treat an aneurysm in the upper part of the aorta. The aorta is the largest blood vessel (artery) in the body. An aneurysm is a prominent ballooning in the blood vessel that supplies blood from the heart to other body parts while the veins bring blood back to the heart and lungs. An aneurysm can occur when part of the blood vessel wall weakens. Although endovascular repair is associated with high success, it also has complications related to the graft that causes many late complications, such as a problem with access, stability, and integrity of the endograft (the graft placed inside the blood vessel).
What Is an Aneurysm?
An aneurysm is a bulge in the blood vessels. It is a weak or expanded part of the blood vessel that bulges like a balloon. The arteries are large blood vessels that carry oxygenated blood from the heart to other body parts; when a part of the blood vessel weakens, the force of the blood pumping through results in an aneurysm. The causes of an aneurysm are unknown. Some people are born with them. An untreated aneurysm can burst open, leading to internal bleeding. The bleeding can cause blood clots that disrupt the normal flow of blood. Blood clots can be very dangerous or fatal. The aneurysm can develop in any body part but is most commonly found in the abdomen and brain. Other common areas include the legs, spleen, and, behind the knee, intestines.
What Causes an Aneurysm?
The exact cause of the aneurysm is still unclear. It can happen in any blood vessel that is more common in the belly area or chest portions of the aorta. A large aneurysm can affect circulation in the body. Any condition that causes artery walls to weaken can cause an aneurysm. The most common causes are atherosclerosis (fibrofatty plaque formation inside the blood vessel) and blood pressure. Deep wounds and infections can also lead to an aneurysm. Or the person may be born with a weakness in one of their blood vessel walls. It s very important to get the aneurysm treated as the earliest. People with a family history of atherosclerosis.
What Are the Types of Aneurysms?
The following are the types of aneurysms.
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Abdominal Aortic Aneurysms - Abdominal aneurysms form in the blood vessel carrying blood to the abdomen.
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Brain Aneurysms - It is also called a cerebral aneurysm that affects the blood vessel in the brain.
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Thoracic Aortic Aneurysms - These aneurysms are less common, and they form in the upper part of the aorta in the chest.
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Carotid Aneurysms - Carotid artery aneurysm forms in the carotid arteries. These blood vessels bring blood to the brain, neck, and face.
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Mesenteric Artery Aneurysm - It forms in the blood vessel that supplies blood to the intestine.
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Splenic Artery Aneurysms - This aneurysm develops in an artery that supplies blood to the spleen.
What Are the Complications of Aneurysms?
The rupture of the aneurysm causes internal bleeding. Depending on the site of the rupture, the bleeding can be dangerous. An aneurysm in the neck can cause blood clots that travel to the brain. When this clot blocks the blood flow, it causes a stroke. A blood aneurysm ruptures cause subarachnoid hemorrhage (bleeding inside the brain). Endovascular aneurysm repair is a minimally invasive procedure for aortic aneurysms. The goal of the endovascular aneurysm is to repair the abdominal aorta. The force of blood against a weak spot in the blood vessel wall causes the aortic walls to balloon outward, which disrupts blood flow to the organs. The symptoms include abdominal pain, back pain, groin or inner thigh pain, rapid heartbeat, dizziness, and deep venous thromboses, such as swelling, pain, or cool skin in the lower limbs.
What Happens During Endovascular Aneurysm Repair?
EVAR (endovascular aneurysm repair) is the most significant advancement in blood vessel repair surgeries that use minimally invasive techniques in which folded graft components are delivered into the blood vessel lumen through access vessel and sheath. Later, the graft is inserted and then expands and seals the vessel wall. Endovascular grafting is a minimally invasive technique to cure an aortic aneurysm. There are two types of endovascular repair: thoracic endovascular aortic repair (TEVAR) and fenestrated endovascular aneurysm repair (FEVAR), depending on the type of repair. Endovascular abdominal aortic aneurysm repair is the surgery to repair a widened area in the aorta. The following steps are done during the procedure:
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Anesthesia is given to the patient to avoid discomfort.
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The femoral artery from the groin is accessed to access the abdominal aneurysm. Needles are inserted through the skin, soft tissue, and femoral arteries.
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The doctors insert a thin tube called a catheter that contains an expandable stent graft (a tube made of fabric supported by a metal mesh called a stent) through the blood vessel. The stent graft opens and expands when the catheter reaches the aneurysm site. Normal blood flow is retained in this region.
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The graft’s wireframe forms a tight seal that keeps the graft in position and prevents blood from entering the aneurysm.
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The stent is surrounded with a fabric liner to reinforce the weak spots.
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Once the procedure is over, the catheter is removed.
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The procedure generally takes two to three hours. Full recovery will take abouta month.
What Are the Risks and Challenges of Endovascular Aortic Repair?
The complications that happen after the endovascular procedure include leaking of the blood around the graft, delayed rupture of the aneurysm or infection damage to the surrounding structures or organs, loss of blood flow to the leg or feet from the blood clot, large blood-filled with a bruise, continuous leakage of blood out of the graft with potential rupture. Endoleaks are the most common complication that occurs after this procedure. There is persistent blood flow from the aneurysm sac, indicating the procedure's failure. There are many causes for endoleaks, including:
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An improper seal of the graft attachment site.
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Continuous blood flow in the aneurysm through a patent blood vessel such as the inferior mesenteric artery, lumbar arteries, accessory renal arteries, and the left subclavian artery.
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Structural failure of the graft.
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Graft porosity.
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Continued residual aneurysm sac expansion despite the lack of evidence of an endoleak by imaging, known as endotension.
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Most patients are considered moderate to high risk for thromboembolic events such as deep vein thrombosis (DVT).
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Graft infection.
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Loss of blood supply to lower extremities can be due to thrombosis, embolism, or obstruction of blood supply due to blood clots.
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Blood vessel neck diameter, length, angulation, taper, and infrarenal length are important measurements to determine the feasibility of the repair.
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Higher complications are associated with larger diameters of aneurysms.
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The technical complications include injury to the iliac and femoral vessels and vascular damage during access, device deployment, or closure.
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The contrast dye that is used for imaging causes allergy and nephropathy.
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Blood vessel rupture and dissection can occur.
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Post-implantation syndrome presents fever, leukocytosis (increase in white blood cells), and inflammatory response with elevated levels of C- reactive protein, Interleukin-6, and tumor necrosis factor-alpha (factors that cause inflammation).
Conclusion
Endovascular aneurysm repair is a less invasive option compared to open surgery. Recovery time is shorter than traditional open surgery. If the aneurysm ruptures, it can be a medical emergency. If the patient gets immediate treatment, the prognosis is better. Many people recover well with cardiac rehabilitation programs. By following a healthy diet, exercising regularly, and avoiding smoking and alcohol, one can avoid complications after the surgery.
