Aortic Aneurysm

Endovascular (Stent-Graft) Surgery for Aortic Aneurysm

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Whenever feasible, physicians at Mayo Clinic prefer to use less-invasive endovascular surgery to repair thoracic and abdominal aortic aneurysms. The procedure results in less blood loss, less trauma to the aorta, and fewer (or no) days in intensive care. Average recovery time is about one to two weeks, compared to six weeks with open surgery.

Endovascular surgery may benefit those who need surgery but are at high risk of complications because of pre-existing medical conditions. According to a national study conducted at medical centers throughout the United States, endovascular repair of abdominal aortic aneurysms has fewer complications than traditional surgery.

However, this procedure is not right for every patient. Mayo Clinic has extensive experience with endovascular surgery and finds that it is an effective treatment in properly selected patients. The appropriate procedure, open versus endovascular, depends on many factors and is best determined by the medical team in consultation with the patient.

At Mayo Clinic, endovascular surgery for aortic aneurysms is performed by cardiac and vascular surgeons and interventional radiologists who specialize in blood vessel surgery. In the procedure, a synthetic graft (stent-graft consisting of a polyester tube inside a metal cylinder) is attached to the end of a thin tube (catheter) that is inserted through an artery in the leg. Watching the progress of the catheter on an X-ray monitor, the surgeon threads the stent-graft to the weak part of the aorta to reinforce the weakened section and prevent rupture of the aneurysm. Once in place, the metal frame is expanded like a spring to hold tightly against the wall of the aorta, cutting off the blood supply to the aneurysm. The blood now flows through the stent-graft, avoiding the aneurysm. With this technique, there is no need to make a large incision in the abdomen or to cut away the damaged section of the aorta. The aneurysm typically shrinks over time.

The success rate of using stent-grafts to treat abdominal aortic aneurysms has risen to above 95 percent. Although endovascular surgery reduces recovery time to a few days, it still carries risk. And because the procedure is fairly new, long-term results are unknown. Complications can occur with this procedure, namely blood leaking from the graft, known as endoleak.

Stent-grafts are usually the best option for older patients, for whom surgery poses significant risk. Patients whose aneurysms are repaired with stent-grafts must return to Mayo Clinic for monitoring every six months initially.