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Getting the Therapy
Endovascular stent grafting is a less-invasive alternative to open surgical repair.
The procedure is not for everyone. Before recommending endovascular stent grafting for you, your doctor will take a number of factors into consideration, including your age, the size of your aneurysm and aorta, your medical history, and your health history.
If you are a candidate for endovascular stent graft therapy, your endovascular surgery team will be involved at every stage. The team may consist of vascular surgeons, radiologists, anaesthetists, nurse practitioners, and other specialists as needed.
Unless you are faced with a medical emergency, you will have time to learn about your surgery, what to expect, and how to prepare. Take an active role in learning about the procedure, so that when your doctor explains the surgery to you, you will already be somewhat familiar with the procedure.
If you have been told by your doctor that you have an aneurysm in your thoracic aorta that needs repair, this is because your doctor may feel that the aneurysm is getting bigger and there is a risk of it rupturing.
Currently, the standard treatment for a thoracic aortic aneurysm is open surgery. In this procedure, the section of the vessel where the aneurysm has formed is replaced with a synthetic graft.
An alternative to open surgery for thoracic aortic aneurysm repair is a minimally invasive procedure called endovascular stent grafting or endovascular aneurysm repair (EVAR).
Endovascular stent grafting is called a minimally invasive procedure, because, unlike open surgery, the stents used in endovascular stent grafting are designed to be placed inside the area of the thoracic aneurysm without removing part of the aorta. Furthermore, open surgery involves a long cut in your abdomen, whereas endovascular surgery requires only two small incisions in the area of your groin.
You may be a candidate for endovascular stent grafting if you are:
You may not be a good candidate if you have a very large thoracic aortic aneurysm, irregularly shaped thoracic aneurysms or blood vessels, or other conditions that your doctor may discuss with you.
It is very important that you talk to your doctor about treatment alternatives for your thoracic aneurysm. Your doctor can provide details about the endovascular stent grafting procedure and whether or not it is right for you.
Even though endovascular stent grafting is called a minimally invasive procedure, several highly skilled healthcare professionals will be involved in your surgery. Their job is to make you as comfortable as possible, make sure that your surgery is performed successfully, and help you recover quickly.
Here is a brief description of some of the experts who may be involved in your endovascular stent grafting procedure.
The vascular surgeon typically performs the endovascular stent grafting procedure and leads the surgical team. Surgeons have medical degrees and several years of specialised surgical training.
In most cases, they have passed certification exams to demonstrate their competence. They are experts in endovascular stent grafting and can answer your questions about the procedure.
Anaesthetists are doctors with medical degrees who have specialised training in anaesthesia. Their focus is on pain management and making sure that you are safe. They will be involved in all stages of your surgery before and after the endovascular stent graft is placed in your aorta.
The radiologist is a doctor who works closely with the endovascular surgeon to provide images that enable the surgeon to guide the stent graft into place.
Nurses are a critical part of the surgical team. It is their responsibility to manage your care and comfort at each stage of the procedure – from preparation to recovery. They also assist the surgeon during the operation.
Since it may be difficult to eat after surgery, proper nutrition is essential before surgery and during recovery. Nutritionists are highly trained experts who instruct nurses responsible for your care on how best to meet your nutritional needs and speed your recovery.
The physiotherapist may work with you and your doctor to help you recover physically from the surgery. They advise you on what types of physical activity you should or should not do and how best to regain your strength and mobility after surgery.
Many hospitals provide social workers who are available to discuss any needs you may have after surgery to help you make the transition back to your daily routine.
Endovascular stent grafting is a surgical procedure done inside of your aorta using a thin tube called a catheter. Unlike open surgery, which involves a long cut in your abdomen, endovascular surgery requires only two small incisions in the area of your groin.
The surgery usually takes 2 to 3 hours to complete, which, in many cases, is much shorter than open surgical aneurysm repair.
The following information describes what you can expect at each stage of the endovascular stent graft procedure.
Prior to the procedure, a number of diagnostic tests will be performed. These diagnostic tests allow the doctor to visualise the thoracic aortic aneurysm and the surrounding area, and help the surgeon decide what type of stent graft is most appropriate for you. During this time, your doctor will discuss the surgery with you, and answer any questions you may have.
Before the procedure begins, the area of your groin where the catheter and stent are introduced will be cleaned and shaved. Then you will receive either local anaesthesia, to numb the area of the surgery, or general anaesthesia to put you to sleep during the surgery.
After the anaesthesia has taken effect, your surgeon will make a small incision in both of your thighs. Using x-rays to see the exact location of the aneurysm, the surgeon will guide the delivery catheter through the large vessel in your thigh (iliac vessel) to the aneurysm site in your chest.
When the delivery catheter is properly positioned inside the thoracic aneurysm, the stent graft is slowly released from the delivery catheter into the blood vessel. When the stent graft comes into contact with blood, it expands to a preset size.
After the stent graft expands, the delivery catheter is withdrawn and removed, leaving the stent graft within the thoracic aorta. Depending on the shape and size of your aneurysm, additional stent grafts may be placed to ensure that the aneurysm is completely excluded from normal blood flow.
X-rays and ultrasound imaging help the doctor make sure that the stent graft is properly placed and occluding blood flow to your thoracic aneurysm.
After surgery, you will be monitored carefully by experts on your surgical team. Your doctor may require you to lie flat for 4 to 6 hours to allow the leg wounds to begin healing. There may be some discomfort.
You may experience side effects such as swelling of the upper thigh, numbness of the legs, nausea, vomiting, leg pain or throbbing, malaise, lack of appetite, fever, and/or absence of bowel movement for 1 to 3 days. You can typically expect to stay in the hospital for 2 to 3 days.
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