CLINICAL HISTORY:
Physicians:
ANESTHESIA: Spinal
The risks, benefits and alternatives of procedure were discussed in detail with the patient and consent obtained by the vascular surgery team.
PROCEDURE:
The abdomen and bilateral groins were prepped and draped in standard surgical fashion.
Bilateral groin incisions were made in the oblique fashion and cut down exposing the bilateral common femoral arteries just below the inguinal ligament, by the vascular surgery team.
Two 19 gauge introducer needles were inserted through tiny incisions inferior to the oblique incisions.
The right access was chosen was the ipsilateral side and a wire and a glide catheter was inserted, which was subsequently exchanged with a stiff wire and a 17 French sheath was placed, which was advanced to the level just above the aortic bifurcation.
Into the left access, which is the contralateral side, a wire was inserted and an 8 French sheath was placed.
A pigtail catheter was inserted into the aorta from the left side and an angiogram was performed obtaining size measurements.
For the main an Endologix unibody bifurcated stent graft of 28 mm x 16 x 120 mm was inserted from the right side. At this time a snare was advanced from the left access and deployed just above the aortic bifurcation. The side wire (hollow) from the right main graft was advanced into the snare and subsequently snared toward the left into the left left iliac artery and pulled down using the snare.
The main body was subsequently deployed, followed by deployment of the left iliac limb over the 014 wire, which was inserted into the snared hollow wire.
The right sheath was pulled back and the right iliac limb was deployed.
After this a pigtail catheter was inserted to assess the position of the renal arteries. The top of the aortic cuff stent was placed just inferior to the right renal which was the lowest renal artery. The aortic cuff stent, 34 mm x 80 mm, was successfully deployed.
After this, a compliant balloon was used to appose the graft against the aorta and against the common iliac arteries.
Follow up angiogram demonstrated no endoleak but the left iliac limb apposition was not complete so angioplasty was performed using a 12 mm x 4 cm balloon.
Post angioplasty angiogram performed through the sheath was satisfactory.
Subsequently, all wires, catheters and bilateral sheaths were removed.
The bilateral groin cut down was closed by the vascular surgery team.
Patient tolerated the procedure well without apparent immediate complications.
Patient was given 6000 units of IV heparin with boluses during the course of the procedure.
IMPRESSION:
Successful infrarenal abdominal aortic aneurysm repair using Endologix unibody bifurcated stent graft of 28 mm x 16 x 120 mm inserted from the right side and aortic cuff stent of 34 mm x 80 mm as described.
Frequently Asked Questions
What is an Endologix AAA stent graft repair?
An Endologix AAA stent graft repair is a minimally invasive procedure used to treat an abdominal aortic aneurysm (AAA). This technique involves placing a fabric-covered stent inside the aorta to reinforce the weakened area and prevent rupture. The Endologix unibody bifurcated stent is designed to fit the unique anatomy of the aorta and iliac arteries, providing a robust solution for AAA management.
How does the Endologix stent graft get placed in the body?
The Endologix stent graft is introduced through small incisions in the groin, where access to the femoral arteries is gained. Guided by imaging, a catheter is used to position the stent graft within the aorta. The main body is deployed first, followed by the iliac limbs, ensuring a secure fit that covers the aneurysm and reduces the risk of rupture.
What are the benefits of using a stent graft for AAA repair?
The primary benefits of using a stent graft for AAA repair include reduced recovery time and less trauma compared to open surgery. This endovascular approach allows for a less invasive procedure, minimizing risks of complications and shortening hospital stays. Additionally, it provides a durable solution by reinforcing the weakened section of the aorta.
What is the role of a balloon in stent graft placement?
In stent graft placement, a compliant balloon is used to ensure the graft fits snugly against the aortic walls and the iliac arteries. After the stent graft is deployed, the balloon is inflated to press the graft into place, ensuring a tight seal that prevents blood from leaking around the graft, known as an endoleak.
Are there any risks associated with Endologix stent graft repair?
As with any medical procedure, there are risks associated with Endologix stent graft repair. These may include bleeding, infection, damage to surrounding vessels, and complications related to anesthesia. However, the procedure is generally considered safe, and complications are rare. It is important for patients to discuss potential risks and benefits with their healthcare provider.
How should patients prepare for an Endologix stent graft procedure?
Preparation for an Endologix stent graft procedure involves several steps. Patients may need to undergo pre-procedure testing, such as imaging studies, to assess the size and location of the aneurysm. They should also discuss any medications with their doctor, as some may need to be stopped before the procedure. Fasting may be required, and patients should arrange for transportation home after the procedure.
What is the recovery like after an Endologix AAA repair?
Recovery from an Endologix AAA repair typically involves a short hospital stay, often less than a week. Patients may experience some swelling or bruising at the incision sites. Most people can return to normal activities within a few weeks, although heavy lifting and strenuous activities should be avoided until cleared by a physician. Follow-up appointments are crucial to monitor the success of the repair.
What is an endoleak and how is it managed in AAA repair?
An endoleak occurs when blood continues to flow into the aneurysm sac after stent graft placement, posing a risk of rupture. It can be managed by additional procedures such as angioplasty or placing additional stents to seal the leak. Regular follow-up with imaging tests is essential to detect and address any endoleaks early.