What is stent graft and what is it used for?
A stent graft is a tube made of fabric graft which acts as a small, metal scaffold inside the aorta. It supports the weak area of aorta; it can be used for a variety of underlying conditions involving the blood vessels, and can be used to reinforce a weak spot in an artery called an aneurysm.
Endovascular abdominal aortic aneurysm repair is surgery to repair a widened gap in the aorta. This is called an aneurysm. Aorta is the largest artery that carries blood to the belly, pelvis, and legs.
Aneurysm affects the aorta, the body’s largest artery. Aorta carries blood away from the heart and it runs from the heart through the chest and abdomen. The normal diameter of the aorta in the abdomen is usually 2 centimetres, which is a little less than 1inch. An aneurysm is formed if the aorta grows to more 1and half to 2 times its normal diameter.
Causes of Aneurysm:
Blood pressure is the most common cause. Other factors also can cause weak arteries to bulge into balloon shape which can eventually enlarge and chances of rupture also arise.
The stent graft is designed to seal firmly the artery above and below the aneurysm. The graft is stronger than the weakened artery and it allows the blood stream to pass through it without pushing on the bulged portion. Physicians consider or recommend endovascular stent grafting to treat abdominal aortic aneurysm; they also use it to treat ailments such as thoracic aortic aneurysm and aneurysm in other locations.
The benefits of the procedure:
Endovascular aortic repair is done to tackle aneurysm that is very large in size or is growing quickly accompanied by leaking or bleeding.
One may have an abdominal aortic aneurysm that does not exhibit any symptoms or problems. Symptoms may be detected during any health check- ups or investigations suggested based on the prognosis presented by the patient.
Procedure for performing grafting:
Endovascular stent graft repair is designed to help prevent an aneurysm from bursting or rupture. These procedures require only small incision or puncture in an artery or vein. Through the punctures, a vascular surgeon inserts long tubes, called catheters, which carry the devices through the blood vessels to the location of the aneurysm. They can then be placed to strengthen the artery.
Sometimes traditional surgery may be required, if the shape or the location of the aneurysm is not favourable for an endovascular treatment. Our vascular surgeon will help you decide what procedure is best for your particular situation.
Before the procedure:
At KIMS we align the patient’s medical history to his present condition and prepare him thoroughly for the procedure. Vitals such as blood pressure Diabetes levels are well checked monitored and brought under perfect control, any medicines such as laxatives or pain killers such as naproxin are usually not administered from the day before the procedure. Few pre procedural investigations mentioned below maybe suggested or recommended.
What are the tests can perform before the procedure:
Spiral computed tomography (CT) scan: This test involves a rapid series of x rays taken in a spiral pattern around the body. A computer transforms the x ray data into three-dimensional images which thoroughly highlight blood vessels condition.
Angiography: A catheter is inserted into one of the arteries after which a dye called contrast is injected through the catheter and takes x rays
Who can undergo for endo vascular stent grafting?
- If the aortic aneurysm is large enough (5 cms, about 2 inches, wide or more).
- Endovascular stent grafting might be a good option if the risk for conventional surgical aneurysm repair is increased because of other illnesses or complications which one might have.
- Shape or placement of the aneurysm is not conducive for stent grafting.
Stent grafting, as has been stated, is not limited to the aorta. Stent grafting may additionally be an option for aneurysms that occur in arteries present in other places of the body depending on the size and location.
Risks and complications of the procedure:
This procedure is one the safest and time tested procedures which pose minimal risks or complications associated. In patients with renal insufficiencies or complications and kidney issues the dye used may not be conducive. Any other complications in the lungs or adjoining areas may be a hindrance as well.
What happens during endovascular stent grafting?
Firstly general anaesthesia or a mild sedative is administered. The i nsertion portion or area is completely cleaned of bodily hair and sterilised to avoid complication of infection, after which our vascular surgeon makes a small incision or cuts into the skin to reach the femoral artery in the groin region simultaneously guiding the catheter or wires to that carry the stent the aneurysm. The vascular surgeon takes the help of the X-rays and imaging while performing the surgery to ensure the graft is placed in the accurately. The inserted stent graft should fit below and above the aneurysm to eliminate it from the normal blood stream.
Hospitalization and recovery of the patients:
The patient will have to lie flat after the surgery initially for the first five to six hours. The patient might experience nausea, numbness in the legs, swelling of the thigh, for a day or two, after which the normalisation process begins. The discharge time will be from 2 to 4 days. At KIMS we ensure you recover completely by monitoring the round the A urinary cathether may be opted until the patient is relived of the discomfort.
The complications during procedure:
- The complications of endovascular stent grafting include:
- Blood clots may form in the legs that may travel to the lungs
- Breathing problems
- Infection, including in the lungs, urinary tract, and belly
- Heart attack or stroke
- Reactions to medicines
Potential risks :
- Bleeding around the graft area that needs monitoring
- Bleeding before or after procedure to be curtailed
- Blockage of the stent in certain situations
- Damage to a nerve, causing weakness, pain, or numbness in the leg
- Kidney failure in very rare cases
- Poor blood supply to your legs, your kidneys, or other organs
- Problems getting or keeping an erection
- Need for open surgery if stent graft is not successful
- The stent slips from its place, which is a very rare
Movement of the graft away from the targeted location (“migration”)
Sometimes fever and an increase in white blood cell count can happen shortly after endovascular stent grafting. These symptoms may usually last 2 to 10 days and are treated with medications such as aspirin and ibuprofen. Other complications that are rare but serious include a burst artery, injury to the kidney, paralysis, blocked blood flow to the abdomen or lower body and torso, and delayed rupture of AAA.
Endovascular stent grafts may sometimes leak blood through the areas where the graft components enjoin, or they can allow blood to leak back into the aneurysm sac through small arteries feeding the aneurysm sac. These leaks are called "endoleaks,” while the name is somewhat confusing, it does not imply that the aneurysm has ruptured or is leaking. Some of the leaks stop by themselves and are not dangerous; others need to be treated immediately. These leaks can even occur years after the procedure and can be dangerous if the aneurysm continues to enlarge. Thus, after endovascular aneurysm repair, physicians require their patients to undergo long term surveillance with periodic CT scans or any other requisite investigations with medications as prescribed.
If one suspects or experiences any complications because of the endovascular stent graft as described above, should contact the physician immediately.
Life after surgery:
Normal activities can be resumed after 4 to 6 weeks. The suggestions given by the surgeon need to be adhered to very strictly.
KIMS is a pioneer in endovascular stent procedure in Asia. Our cutting edge technologies and a very special and caring team of and Doctors and para medicos ensure speedy recovery.