Endovascular Abdominal Aortic Aneurysm Repair: Update
Ramy Essam Abd El-fattah El-kady;
Abstract
Abdominal aortic aneurysm is one of major vascular problems in which management is considered challenge for vascular surgeons as It usually affect elderly patients with other comorbidities as ischemic heart disease and chronic obstructive pulmonary disease .
Management of abdominal aortic aneurysm can be done by:
• Conservative managment:
Indicated for aneurysms less than 5.5 cm in asymptomatic patients. This includes smoking cessation, blood pressure control, medications as; Beta blockers, Doxycycline & statins. Follow up is required every 6 months for surveillance of the aneurysm.
• Surgery :
It offers complete cure of the aneurysm. However, abdominal aortic aneurysm usually affect elderly people who are usually unfit for surgery, and inspite of great advances in anaesthesiology and postoperative care morbidity and mortality is still high .
• Endovascular repair :
Endovascular repair of abdominal aortic aneurysm was originally developed for patients who were considered to be physically ineligible for open surgical repair. Even at this early stage, it is evident that a good stent-graft by itself is not enough to make this procedure successful. Persistent perfusion of the aneurysm sac from retrograde flow in branch vessels is a major long-term concern. An additional intervention may be required, such as sac ablation with a thrombogenic substance.
Patients whose aneurysms begin just below the renal arteries are difficult or impossible to accommodate with current stent-grafts and require Fenestrated grafts (FEVAR).
The development of stent-grafts with side-arms to accommodate critical aortic branches will further increase the applicability of this technology.
When compared with open surgery, there are definite early benefits to stent-graft repair of abdominal aortic aneurysm. The procedure entails less hemodynamic stress than surgery, which is an important consideration in elderly patients.
Blood loss is lower with stent-graft repair compared with open surgery (average, 400 versus 1200 ml), Patients are able to ambulate the next day, and hospital stays are reduced from 7-10 days to 2-3 days.
The main problems following EVAR can be anticipated from the nature of the procedure and materials. For example , Migration, Endoleak, Graft thrombosis, renal artery occlusion, Aortic neck dilatation.
• Future of EVAR:
Endovascular robotic technology may simplify complex endovascular tasks by reducing the manual skill required, while potentially reducing procedure times and radiation exposure. Further clinical evaluation is necessary to understand its wider applications and long-term role.
Management of abdominal aortic aneurysm can be done by:
• Conservative managment:
Indicated for aneurysms less than 5.5 cm in asymptomatic patients. This includes smoking cessation, blood pressure control, medications as; Beta blockers, Doxycycline & statins. Follow up is required every 6 months for surveillance of the aneurysm.
• Surgery :
It offers complete cure of the aneurysm. However, abdominal aortic aneurysm usually affect elderly people who are usually unfit for surgery, and inspite of great advances in anaesthesiology and postoperative care morbidity and mortality is still high .
• Endovascular repair :
Endovascular repair of abdominal aortic aneurysm was originally developed for patients who were considered to be physically ineligible for open surgical repair. Even at this early stage, it is evident that a good stent-graft by itself is not enough to make this procedure successful. Persistent perfusion of the aneurysm sac from retrograde flow in branch vessels is a major long-term concern. An additional intervention may be required, such as sac ablation with a thrombogenic substance.
Patients whose aneurysms begin just below the renal arteries are difficult or impossible to accommodate with current stent-grafts and require Fenestrated grafts (FEVAR).
The development of stent-grafts with side-arms to accommodate critical aortic branches will further increase the applicability of this technology.
When compared with open surgery, there are definite early benefits to stent-graft repair of abdominal aortic aneurysm. The procedure entails less hemodynamic stress than surgery, which is an important consideration in elderly patients.
Blood loss is lower with stent-graft repair compared with open surgery (average, 400 versus 1200 ml), Patients are able to ambulate the next day, and hospital stays are reduced from 7-10 days to 2-3 days.
The main problems following EVAR can be anticipated from the nature of the procedure and materials. For example , Migration, Endoleak, Graft thrombosis, renal artery occlusion, Aortic neck dilatation.
• Future of EVAR:
Endovascular robotic technology may simplify complex endovascular tasks by reducing the manual skill required, while potentially reducing procedure times and radiation exposure. Further clinical evaluation is necessary to understand its wider applications and long-term role.
Other data
| Title | Endovascular Abdominal Aortic Aneurysm Repair: Update | Other Titles | تحديث ﺇصلاح تمدد الشريان الأبهر البطنى عن طريق الاشعة التداخلية | Authors | Ramy Essam Abd El-fattah El-kady | Issue Date | 2014 |
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