Using Stents in Aneurysms

An aneurysm is an abnormal increase in the diameter of an artery that is almost invariably the result of a weakness in that artery's muscular wall. Most aneurysms occur in the aorta, which directs blood from the heart into a series of smaller arteries that "feed" the body's organs and tissues. Aortic aneurysms are further categorized by their location as being either an Abdominal Aortic Aneurysm (AAA, "Triple A") or a Thoracic Aortic Aneurysm (TAA, an aneurysm in the chest or "thorax"). Of these, AAA is by far the more common.

Most aneurysms are found "incidentally," which means during routine physical exams or when the patient seeks treatment for an unrelated medical condition. Practically all cases of TAA are first detected on a routine chest x-ray while most AAAs are found as a painless, pulsating abdominal mass.

Once an aneurysm is suspected, a Computed Tomography (CT) Scan of the chest or abdomen is usually ordered to confirm the diagnosis. Depending on the location and diameter of the aneurysm, decision is made as to whether it is safe to "keep an eye" on the condition or to consider surgical intervention. Fortunately, "elective" (non-emergency) surgical repair of aneurysms can be performed at practically all major hospitals.

In the traditional, or open, procedure the aneurysm is exposed via a surgical incision and a graft made of a synthetic material such as Gortex is inserted to restore the artery to its normal size. Since many patents with aneurysms also have heart disease or other circulatory problems, these procedures carry a definite risk of major complications such as a heart attack.

Over the past decade, a procedure known as Endovascular Stent Grafting has been developed as an alternative to open aneurysm repair in certain, preselected cases. In this procedure, specially-constructed tubes known as catheters are inserted into the large arteries in the groin and then advanced to the aneurysm itself. Once the position of the catheters is conformed the catheters are used to place stents, tubes of synthetic material, to repair the aneurysm from the inside (the "Endovascular" part).

While Endovascular Stenting can certainly reduce some of the risks associated with open aneurysm repair, it also carries its own unique set of potential complications such as the inadvertent puncture if the aneurysm's wall or leakage of blood between the stent and the aneurysm. Depending on the type of complication and its severity, such events may require emergency surgical correction.

In summary, although aneurysms of the aorta can pose a significant risk if left untreated, modern surgical technology has progressed to the point that both "open" and "closed' non-emergency aneurysm repair pose fewer risks than can be expected if these conditions were left untreated.