An aneurysm is a widened and weakened area of a blood vessel. Over time that area can get bigger and rupture (break). Aneurysms can be repaired two different ways.
Endovascular Stent Graft
Endovascular stent graft repair is designed to help prevent an aneurysm from bursting. The term "endovascular" means "inside blood vessels."
To perform endovascular procedures, vascular surgeons use special technologies and instruments. These procedures require only a small incision or puncture in an artery or vein. Through these punctures, a vascular surgeon inserts long thin tubes, called catheters, which carry the devices through your blood vessels to the location of the aneurysm. They can then be placed to re-align and strengthen your artery.
Generally, endovascular treatments allow you to leave the hospital sooner and recover more quickly, with less pain and a lower risk of complications, and sometimes a lower risk of death, than traditional surgery because the incisions are smaller.
Sometimes traditional surgery is required, however, if the shape or the location of the aneurysm is not favorable for an endovascular treatment.
Open Aneurysm Repair
Open repair of an abdominal aortic aneurysm involves an incision of the abdomen to directly visualize the aortic aneurysm. The procedure is performed in an operating room under general anesthesia.
The aneurysm is repaired by the use of a long cylinder-like tube called a graft. The graft is sutured to the aorta connecting one end of the aorta at the site of the aneurysm to the other end of the aorta. The graft acts as a bridge for the blood flow. The blood flow then goes through the plastic graft and no longer allows the direct pulsation pressure of the blood to further expand the weak aorta wall.
You may be familiar with bypass surgery on heart arteries, but vascular surgeons also use similar bypasses to treat peripheral artery disease (PAD).
Surgical bypass treats your narrowed arteries by directly creating a detour, or bypass, around a section of the artery that is blocked.
During a bypass procedure, your vascular surgeon creates a new pathway for blood flow using a graft. A graft can be a portion of one of your veins or a man-made synthetic tube your surgeon connects above and below a blockage to allow blood to pass through it and around the blockage.
Surgeons use bypasses most commonly to treat leg artery disease, which is hardening of the arteries in the leg. Surgeons also use bypass to treat arm artery disease, as well as blockages involving blood vessels in other locations in the body.
Your carotid arteries supply blood to your neck, head, and brain. Over time, a fatty substance called plaque can build up to reduce blood flow through your carotid arteries, or to cause irregularities in the normally smooth inner walls of the arteries.
Carotid artery disease is a serious issue because clots can form on the plaque.
Plaque or clots can also break loose and travel to the brain. If a clot or plaque blocks the blood flow to your brain sufficiently, it can cause an ischemic stroke, which can cause permanent brain damage, or death, if a large enough area of the brain is affected.
If a clot or plaque blocks only a tiny artery in the brain, it may cause a transient ischemic attack (TIA), also known as a mini-stroke. A TIA is often a warning sign a stroke may occur in the near future, and it should be a signal to seek treatment soon, before a stroke occurs.
Carotid endarterectomy is an operation during which your vascular surgeon removes the inner lining of your carotid artery if it has become thickened or damaged. This procedure eliminates plaque from your artery and can restore blood flow.
If your artery is blocked (in your leg, kidney, carotid, or other vessel), you may then be treated with an angioplasty and/or stent.
During an angioplasty, the doctor makes a small puncture hole into one or more of your blood vessels. A small wire with a balloon on the end is sent up into a blocked artery in your affected artery. The doctor inflates the balloon to push the plaque (fatty deposits) against the artery wall. This makes more room for blood to flow.
If necessary, a stent is then placed in the artery to maintain blood flow. A stent is a metal, mesh tube placed in the artery to help it stay open after an angioplasty.