An endovascular stent graft is a woven fabric tube wrapped around a metal stent used to treat aortic aneurysms. Known as a stent-graft device, this minimally invasive approach is most commonly used to treat abdominal aortic aneurysms and thoracic aortic aneurysms (weakened bulges in the aortic wall). If not treated, both conditions can become life-threatening because of risk of rupture.
Endovascular stent grafts are an alternative to traditional open aortic repair, where an incision is made in the abdomen or chest to remove the aneurysm and replace it with a graft made of synthetic material. The best method for each aneurysm repair depends on factors such as the location and shape of the aneurysm and the overall health of the patient.
Why Choose The Ohio State University Medical Center?
The vascular surgeons at Ohio State have extensive experience with traditional open repair of abdominal aortic aneurysms, including repair of complex cases. They also are experts at minimally invasive repairs and have experience in the use of all of the available stent graft technologies available to treat a wide variety of aneurysms.
What Is Endovascular Stent Graft?
An endovascular stent graft is a tube made of fabric, which is supported by a stent (expandable metal coil). It is most commonly used in the treatment of abdominal aortic aneurysm or thoracic aortic aneurysm.
Stent graft is performed using a catheter (thin, long tube), which is inserted into an artery in your groin and threaded along a long thin wire (guide wire) to the area of an aneurysm (weakened area of artery that bulges or expands). The stent graft is threaded using X-ray guidance into the aorta to the area of the aneurysm. Once positioned, the stent graft expands inside the aorta to form a conduit for blood to flow through.
Why Have Endovascular Stent Graft?
The aorta is the major artery that carries blood from the heart to the rest of the body. Aneurysms can occur in different areas of the aorta. An abdominal aortic aneurysm occurs in the area of the aorta that is in the abdomen, while a thoracic aortic aneurysm occurs in the area of the aorta that is in the chest. Aneurysms can grow and rupture, resulting in life-threatening internal bleeding.
Treatment depends on the size and location of the aneurysm as well as the condition of the patient. Symptoms may never occur, though aneurysms are often found incidentally on routine physical examination. Once diagnosed, your doctor may recommend open repair or endovascular stent graft. The goal of treatment is to prevent the aneurysm from ever rupturing.
To determine if you are a candidate for endovascular stent graft, your doctor will perform a history and physical examination. You may also undergo some tests to evaluate your heart health as well as the size, shape and location of your aneurysm. These tests may include:
- Angiogram – An X-ray of blood vessels to identify blockage; it is performed by inserting a tube into an artery in the leg and injecting a contrast dye into the artery.
- CT scan (computed tomography scan, also called CAT scan) – An imaging procedure that uses X-rays and computer technology to produce cross-sectional, detailed images of the body, including bones, muscles, fat and organs.
What to Expect During Endovascular Stent Graft
Preparing for Your Procedure
Tell your doctor about all of the medications you are taking, including over-the-counter medications, and also if you are allergic to any medications or IV dye or contrast. You may be asked to discontinue glucophage or metformin if you are diabetic. You may be asked not to drink or eat anything for several hours prior to your procedure. If you are pregnant or if there is any possibility that you may be pregnant, inform your doctor.
During Your Procedure
You will receive a general anesthetic through an intravenous line inserted prior to the procedure. The area of catheter insertion will be shaved and cleaned.
Your doctor will make a small skin incision in the area of your groin. A long thin wire will be inserted into your femoral artery through the groin and guided to the area of the aneurysm. Using X-ray and contrast dye for guidance, a catheter is threaded over the wire. Another large catheter called a sheath is inserted. The sheath contains the graft stent that will be placed at the site of the aneurysm. When the graft reaches the aneurysm site, the sheath is withdrawn, the graft expands and is left in place.
After Your Procedure
Once the procedure is complete, you will be moved to a recovery room where your IV line will be removed. Your catheter site will be monitored for a period of time for bleeding and swelling. Your heart rate will also be monitored.
You will spend a couple of days in the hospital, during which time you will be asked to get up and walk. You will be able to eat normally. Your stent graft will be monitored periodically with imaging tests to be sure the stent is functioning.