Surgical repair of such aneurysms and interposition of vascular protheses were until recently the only treatment option for complicated cases (diameter „d 5.5 cm; impending rupture; malperfusion syndrome; recurrent pain). Although great strides have been achieved by improving surgical techniques, postoperative complications (such as persistent paralysis of both legs, stroke, acute renal failure or pulmonary dysfunction) and 30-day mortality remain high. Especially elderly patients with accompanying illnesses (high blood pressure, chronic pulmonary disease or heart failure) are at high risk. Therefore, these comorbidities have a significant impact on postoperative outcome and further life expectancy.
Conversely, endovascular stent-graft implantation seems to be a promising, non-surgical and less traumatic therapeutic option and avoids surgical opening of the chest. Endovascular protheses are based on the concept of a metal grid covered with graft material (Dacron). The natural healing process begins after complete sealing of the proximal entry tear in dissection (see figure 2) and induces thrombus formation in the false lumen and reconstruction of the aortic wall.
In our institution stent-graft placement was performed in the cardiac catheterization laboratory with patients under general anesthesia and ventilation. In all patients, the femoral or distal iliac artery was surgically exposed and the stent-graft was inserted, advanced and deployed inside the aorta with the use of fluoroscopy and simultaneous ultrasound. Once stent apposition was achieved, the catheter delivery system was removed, and the incision was surgically closed.
Camilla Dormer | alfa
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