The aorta (abdominal artery) is the largest artery of the body. In adults, it averages 2.5 to 3.5 centimetres in width and 30 to 40 centimetres in length. It has the shape of a cane, with an arch-shaped outset and a straight course downwards into the abdominal area. A weakened vessel wall is a serious condition, as a tear of the aorta is life-threatening. Nowadays a lot of aortic diseases can be treated by intervention.
Endovascular treatment of an aortic aneurysm using EVAR
What is an aortic aneurysm?
A widening of the main abdominal artery is called an abdominal aortic aneurysm. It is most common in men and grows mostly undetected. An increase in width of the artery leads to a much higher risk of a crack in the vessel. As a tear of the aorta is mostly fatal, the primary goal of treatment is to prevent the bursting of the aneurysm (a so-called aortic rupture) by means of a preventive operation.
How to spot an aortic aneurysm?
Most aortic aneurysms are discovered by chance in the course of other examinations, because there are no extensive preventive screenings yet. To determinate the point, at which an operation is necessary, a standard ultrasound examination would suffice. However, for a detailed plan of treatment, a computer tomography using a contrast agent (CT-angiography) is required.
How to treat an aortic aneurysm?
For more than 60 years, the open aortic replacement by synthetic pipe- or Y-prothesis has been used as a standard method. It can be applied regardless of the form or extent of the aneurysm and requires a general anaesthesia. The minimally invasive alternative is an endovascular aortic replacement (EVAR), which is offered at the Centre for Microtherapy. A Y-shaped wire mesh surrounded by a synthetic membrane (a so-called stent graft), is advanced through the groin arteries and released at the affected areas of the abdominal vessels. This operation can even be performed with a local anaesthetic only due to its minimally invasive nature.
Endovascular occlusion of endoleaks following EVAR
By now, most abdominal aortic aneurysms are treated endovascularly using EVAR. However, this otherwise elegant and minimally invasive method has a downside, as it can lead to a so-called endoleak, meaning a persistent blood circulation of the aneurysm bag, which potentially increases the width of the aneurysm and thus the danger of a rupture. There are 5 known types of endoleaks, which can be determined using CT-angiography. Hence, an imaging follow-up inspection is imperative after an endovascular aortic replacement. Depending on the type of endoleak, different therapeutic methods can be applied, almost all of whom are minimally invasive.