Overview
This lecture covers abdominal aortic aneurysm, its risks, and compares the traditional open repair method with the newer endovascular stent graft procedure.
Abdominal Aortic Aneurysm (AAA)
- AAA is a dangerous enlargement of the abdominal aorta due to degeneration of its wall.
- If untreated, an AAA can rupture and lead to life-threatening bleeding.
Treatment Approaches
- Traditional AAA repair involves open surgical intervention.
- Endovascular repair uses less invasive techniques with a stent graft.
Endovascular Stent Graft Procedure Steps
- A guide wire is inserted into the abdominal aorta via the femoral artery.
- The stent graft, with a polyester body and metal frame, is advanced over the wire under fluoroscopy.
- The graft is partially deployed just below the renal arteries.
- A second guide wire is placed via the contralateral iliac artery into the stent graft’s limb.
- The upper (suprarenal) stent is deployed next, anchoring the device.
- The contralateral limb is inserted and deployed, overlapping the main body to prevent leakage.
- The ipsilateral limb is deployed in a similar fashion.
- A balloon expands all junctions for a tight seal.
- Guide wires and sheaths are removed, and femoral arteries are repaired.
- Blood now flows through the stent graft, reducing pressure on the aneurysm.
Purpose and Outcome
- Endovascular repair aims to reduce aneurysm pressure and risk of rupture or further enlargement.
Key Terms & Definitions
- Abdominal Aortic Aneurysm (AAA) — a weakened, ballooned section of the abdominal aorta.
- Stent Graft — a tube composed of fabric and metal used to reinforce a vessel.
- Endovascular — relating to procedures performed inside blood vessels using special instruments.
- Fluoroscopy — real-time X-ray imaging used to guide procedures.
Action Items / Next Steps
- Review the steps and indications for endovascular AAA repair.
- Learn the advantages and disadvantages of open vs. endovascular repair methods.