Aortic Surgery & Stenting

Diseases of the aorta (the largest artery in the body supplying blood from the heart to the rest of the body) are now recognised to be commoner in people of Asian descent than previously thought. They are more frequent in men and the consequences of untreated aortic disease can be catastrophic particularly when this large artery ruptures.

The aorta can be affected both in the chest and in the abdomen by two conditions – aortic aneurysms in which the aorta swells or balloons out due to a weakness in its wall or an aortic dissection in which the inside lining of the aorta splits leading to a rupture or a loss of blood supply to an important organ.

Our vascular surgery service offers both endovascular (keyhole) repair with stents as well as traditional open surgical repair (for patients unsuitable for endovascular surgery) for both forms of aortic disease.

An EVAR is an endovascular (keyhole) procedure carried out to repair a diseased aorta that lies within the abdomen. It is performed under general anaesthesia via a small 1-2 cm cut in each groin. Stents are then carefully placed via the leg (femoral) artery to re-line the inside of the diseased segment of the aorta with a stent covered with fabric (a tube within a tube). This takes the pressure off the diseased aortic wall and prevents a rupture from occurring.

Sometimes additional stents to protect the arteries to the kidneys (renal arteries) or the gut (mesenteric artery) are required and these are called chimney stents. This more complex procedure may especially be needed in Asian patients when more standard stents cannot be used.

This is similar to an EVAR procedure except that the diseased aorta is within the chest cavity. Stents are placed the diseased segment in the chest, but great care is required to protect the carotid arteries that supply blood to the brain during this procedure.

Occasionally, chimney stents or an additional open surgery component called a carotid-carotid bypass id required to protect the carotid arteries during a TEVAR.

This major surgical procedure is fortunately not often required now if the procedure is a planned elective operation, when an endovascular repair is usually feasible. However it may be the only option to prevent death in the event of an aortic rupture, when an emergency procedure to replace the diseased aorta with a special fabric tube called a graft is performed. This is a high risk life-saving procedure and recovery will include a period of time in an intensive care unit.

Early detection of aortic dissections and aneurysms that are at risk of rupture by screening can prevent the need for this major open surgical operation, when keyhole surgery may be an option instead.