TCV : Endovascular Surgery

An abdominal aortic aneurysm occurs when the abdominal aorta dilates abnormally. As it stretches beyond normal dimensions, the vessel becomes prone to rupturing, often resulting in death.

Traditionally, vascular surgeons have repaired abdominal aortic aneurysms once they reach a certain size-generally 5cm. The conventional approach to repair requires major surgery, which involves opening the patient's abdominal cavity and replacing the dilated aorta. While most patients do quite well with this operation, it can cause a great deal of discomfort and require an extended hospital stay, as well as a lengthy recovery period.

Vascular surgeons have long sought a way to repair these aneurysms less invasively, aiming to reduce discomfort, shorten recovery time, and return the patient to normal activity sooner. They have also wanted to be able to repair aneurysms in patients, who are not candidates for traditional open surgery-e.g., those with severe cardiac, pulmonary or other significant medical problems.

Recently, the FDA approved two devices that allow vascular surgeons to repair abdominal aortic aneurysms less invasively through the use of an endovascular approach. Endovascular surgery, a rapidly developing, expanding discipline, utilizes digital X-ray technology with video and monitoring equipment in the same way cardiologists repair a blocked coronary vessel with a balloon or stent without opening the patient's chest. Through endovascular surgery, vascular surgeons use a single point of entry into the vascular system to transport devices for imaging and repair. Thus they can access an abdominal aneurysm from a remote site and repair it within the blood vessel.

Generally, a 2" incision is made in the patient's groin area, and the surgeon delivers a covered stent or endograft from the femoral artery to the aneurysm. This allows repair of the aneurysm within the vascular tree, without having to enter the abdominal cavity. Patients with abdominal aortic aneurysms repaired via this technique generally go home the day following surgery and return to full activity within a week.

At Winthrop, vascular surgeons in the Department of Thoracic and Cardiovascular Surgery have been quite successful at repairing abdominal aortic aneurysms using conventional open surgery, as well as the less-invasive endovascular technique. Taking into account each patient's medical history, all patients are informed about the advantages and disadvantages of either approach. Sometimes surgery is not indicated, and close observation is recommended for a period of time. This allows patients and their families to select the approach to their care after carefully examining all available options.