Novel Advancements in the Treatment of Aortic Aneurysm
Endovascular aneurysm repair with smaller incisions, less pain and faster recovery time.
An aortic aneurysm is a bulging or dilation in the wall of the aorta which is a major blood vessel that carries blood from heart to body, that is due to weakness or degeneration that develops in a portion of the aortic wall. Aortic aneurysms include:
- Abdominal aortic aneurysm: occurs along the part of the aorta that passes through the abdomen.
- Thoracic aortic aneurysm: occurs along the part of the aorta that passes through the chest cavity.
An aneurysm might enlarge and the wall of the aorta cannot stretch any further. At this point, an aneurysm is at risk of rupturing and causing potentially fatal conditions. If ruptured aortic aneurysm could not be accurately diagnosed and effectively treated in time, it can cause life-threatening internal bleeding which leads to the increased chances of sudden death. Therefore, timely and effective treatment for aortic aneurysm does not only play a major role in the reduction of mortality rates but it also significantly enhances long-term improvements of patient’s quality of life.
Minimally Invasive Surgery for Aortic Aneurysm
The most appropriate approach to repair an aortic aneurysm depends upon several factors including the location, size and shape of the aneurysm as well as the physical condition of individual patient. Surgical repair of an aortic aneurysm might be performed through 2 main techniques; an open incision (open aneurysm repair) and minimally invasive surgery called “endovascular aneurysm repair”.
To treat either abdominal or thoracic aortic aneurysms, instead of an open aneurysm repair in which chest and abdomen are surgically opened through a large incision, endovascular aneurysm repair is a minimally invasive method to treat an aortic aneurysm with superior advantages covering less pain, fewer post-operative complications, faster recovery time and shorter hospital stay as well as cosmetic benefits.
During the endovascular aneurysm repair, the cardiothoracic surgeon first inserts a catheter into an artery through small incisions made in the groin and threads it to the aortic aneurysm. Then, using an x-ray to see the aorta, the surgeon threads a stent graft (a fabric tube supported by metal wire stents) into the aneurysm. The graft is subsequently expanded inside the wall of aorta and fastened in place to form a stable channel for blood flow. The graft reinforces the weakened section of the aortic wall to prevent the aneurysm from rupturing.
Endovascular repair of aneurysms does not require a large incision whereas the conventional open surgical approach does. Surgical outcomes substantially result in a shorter recovery time with less pain and lower complications. However, not all aneurysms are suitable for endovascular repair. The location or size of the aneurysm in some patients may prevent a stent graft from being safely or reliably placed inside the aneurysm. In this case, open surgery might be advised.
Enhancing Surgical Performance by Hybrid Operating Room
Our hybrid operating room at Bangkok Heart Hospital is an advanced surgical theatre that is well equipped with cardiovascular operating room and cardiac catheterization laboratory (cath lab). Diagnostic imaging equipment is used to visualize the abnormalities of arteries of the heart while cardiac operation is performed. The combined unit of a hybrid OR effectively enables cardiothoracic surgeons to perform interventional and surgical procedures at the same time.
The Hybrid OR consists of cardiac surgical facilities with cutting edge medical imaging systems including “Flexmove-Heart Navigator”, a high quality X-ray imaging system which is able to clearly provide high resolution images of heart and vessels in all dimensions during performing endovascular procedures. Intraoperatively, it allows cardiothoracic surgeons to significantly improve surgical accuracy such as verifying the placement of complex aortic stent grafts (endografts) with less time consumption.
Furthermore, the operating table can be fully adjusted with 360 degree rotation in order to achieve the optimal surgical positions, resulting in greater efficiency and flexibility to access the surgical sites. Additionally, advanced fluid management system, with maximum rate of fluid infusion up to 6 L./min, is used to replace body fluid from blood loss during surgery. The efficient fluid resuscitation enables patient’s blood pressure to be kept steadily while performing operation. As a result, more safety and lower operative complications could be achieved.
Benefits of minimally invasive surgery for aortic aneurysm
- Smaller incision and less pain.
- Reduced blood loss and chance of receiving blood infusion after surgery.
- Faster recovery time and shorter hospital stay which usually takes 5-7 days, depending on medical conditions of each patient.
- Decreased risk of complications such as lung infection and pneumonia, especially in elderly patients with underlying diseases who tend to have increased susceptibility to infections.
Even though, short- and medium-term benefits of endovascular aneurysm repair could be greatly seen, an annual follow-up by performing CT scan (computerized tomography) with contrast injection remains essential to closely monitor the dislocation of stent graft that might occasionally happen after graft placement.
The most appropriate method to repair an aortic aneurysm will be selected by expert cardiothoracic surgeons and patients by taking into consideration of several factors including the degree of severity, size and location of the aneurysms as well as the individual conditions and health status of patients. Before treatment begins, patients and families will be fully informed about surgical benefits and possible risks. If a patient is good candidate for “endovascular aneurysm repair”, surgical results will get rid of all safety concerns with better cosmetic advantages and a quick return to daily life.
Dr. Attapoom Susupaus, a cardiothoracic surgeon and assistant director of Bangkok Heart Hospital