Which examination will help diagnosis of aortic aneurysm?
CT scan, MRI, color duplex ultrasound, CT angiography
Treatment principles of aortic aneurysm
If aneurysm’s diameter below 4cm with no symptom, patient can choose conservative treatment. Strictly control blood pressure, pay close attention to the change of the diameter, and do CT scan or ultrasound every year or every half year. Surgery intervention will need when aneurysm’s diameter is over 5cm, and growth rate is faster than 0.5cm/yr.
Two surgical intervention treatment for aortic aneurysm?
1.Traditional surgery, operational wound is relatively large.
2.Endovascular aneurysm repair (EVAR), new technique with less invasive wound.
What is surgical operation?
Surgery is the removal of the vascular lesion, replaced with artificial vascular graft.
1.Under general anesthesia, cardiopulmonary bypass may needed
2.Large invasive wound
3.Long operation time, about 4-6 hours;
4.Big volume of blood loss, postoperative recovery is slow;
5.More complications, such as myocardial infarction, cerebral infarction, acute renal failure, acute respiratory failure, lower limb ischemia, artificial vascular occlusion, bleeding and infection, etc.
6.Most elderly patients cannot tolerate.
What is endovascular aneurysm repair (EVAR)?
Endovascular repair is a new treatment method. The idea of the treatment is to reconstruct the blood flow through the path of minimal wound.
1.The so-called micro trauma refers to the incision in the groin area of the patient, the length is only 6-8mm.
2. Reconstruction of blood flow means enter through an incision in the groin area, position through X-ray and place the stent graft at vascular lesions, so that blood flow will go through the stent without making any pressure to the wall of aneurysm. In this way to build a new blood flow channel and to achieve cure.
3.Not all aneurysms are suitable using endovascular repair, if it’s located at ascending aorta or aortic arch still need surgery repair.
Advantage of endovascular repair
1.Less invasive, incision only 6-8mm;
2.Less operation time, around 1-2 hours;
3.Post-operative recovers fast, patients only need to stay in hospital for couple days, and total recovery time is 2-6 weeks;
4.Less post-operative complication.
What is stent graft? How it works?
Stent graft is type of vascular stent with a fabric coating that creates a contained tube but is expandable like a bare metal stent. It can reinforce the diseased part of the vessel wall and prevent the rupture of the aneurysm. It is through the delivery catheter (a tubular device that can deliver the stent to the target vessel) long into the aortic aneurysm
Process of endovascular repair
1. Insert hard wire through inguinal area of the left or right femoral artery incision to carry out preoperative arterial angiography;
2. Evaluate aortic aneurysm, select appropriate stent;
3. After complete preparation work, deliver main body of the stent through hard wire to the appropriate position of the aneurysm;
4. When position determined, release stent graft from delivery system, the stent will self-expand to stick on the wall of blood vessel;
5. Deliver contralateral branch stent, deliver process same like the main body stent;
6. Pull delivery system out of human body;
7. Post-operative angiography, evaluate effect of surgery, and do balloon dilation when needed;
8. Suture incision, process complete.