NEW Delhi, Date: The incidence of aortic diseases in India is rising with the increasing age of the population. It is thus important to raise awareness about the importance of early diagnosis and treatment.
An aortic aneurysm is a dilatation or ballooning of the main arteries in the chest and abdomen. Whenever the diameter of the arteries increases to more than 1.5 times the normal diameter of the artery, it is called an aneurysm[1]. As the size of the aneurysm increases, so does the risk of rupture, complications, and death.
Dr (Surg. Cmde.) V.S. Bedi, Chairman, Institute of Vascular & Endovascular Sciences, Sir Ganga Ram Hospital, New Delhi said, “Genetic predisposition including male sex, high blood pressure, tobacco intake, smoking, and high cholesterol are the common causes of aortic aneurysm. Aortic Aneurysms are usually asymptomatic and grow slowly with time. Usually, the first symptom is severe pain in abdomen or back, indicating a rupture or an impending rupture. Other symptoms could be because of its large size or compression of adjoining organs, like difficulty in swallowing, lump in the abdomen, thumping pulsations in chest or abdomen. Various guidelines have recommended periodic checkup for elderly and at high-risk patients”.
Dr Ajay Yadav, Vice Chairman, Institute of Vascular & Endovascular Sciences, Sir Ganga Ram Hospital, New Delhi said, “Chest X-Ray and Ultrasound abdomen are able to pick up aneurysms in some of the cases. CT Angiography of the chest and abdomen is more confirmatory and is also helpful in sizing and planning the treatment. Depending on the anatomy, co-morbidities, and general condition, the patient may be offered open surgical or an endovascular procedure”.
Open surgical procedure involves opening the chest or abdomen to expose the diseased aorta, and replacing it with a polymer-based graft. Though the surgical procedure is considered more durable in the long run, it has serious immediate post-operative morbidity, especially in elderly patients. The endovascular or the minimally invasive procedure involves putting in special stent grafts to seclude the aneurysm and allows the blood to flow from normal aorta to healthy part of the vasculature.
The Endovascular Repair of Abdominal or Thoracic Aorta (EVAR or TEVAR) is a safer and shorter procedure for treating aortic aneurysms. This procedure can be done either by small cuts in the groins or by needle hole percutaneous closure, and reduces the overall morbidity and hospital stay of the patient. In case of more complex aneurysms with involvement of kidney or intestinal arteries in the aneurysm, the same can also be treated using Fenestrated or Chimney Aortic Aneurysm Repair (FEVAR or ChEVAR). Similar techniques are also used for treating complex aneurysm involving the proximal aorta, involving the arteries to the brain and upper limbs.
The safety of the endovascular repair helps in reducing the immediate post-operative complications, hospital stay and allows the patient to return to work earlier. The minimally invasive procedure is done in dedicated Hybrid Vascular cathlab and involves the use of sophisticated imaging protocols like Intra-Vascular Ultrasound (IVUS) and EVAR guidance software. In a dedicated Vascular and Endovascular Suite, the surgical time for a standard EVAR or TEVAR procedure usually takes less than an hour and can be done under local anesthesia. The advent of newer stent-grafts and structural improvements over the years has made this procedure safer and long lasting.