Endovascular treatment, first therapeutic choice for aortic aneurysms

The traditional surgical treatment for the repair of aortic aneurysms, started in the late 50's of the last century, involves the practice of large incisions and abdominal or thoracic dissections to be able to change the aorta damaged by a vascular prosthesis sutured to the healthy aorta.. This intervention requires general anesthesia, blood transfusions, the interruption of the circulation of the area to be repaired, and although it is still effective, it is related to serious complications that can lead in some cases to the death of the patient.

That is why many surgeons were wondering how to reduce these difficulties. It was not until 1990 that surgeon Juan Carlos Parodi realized the possibility of minimizing surgical trauma through endovascular treatment . Endovascular treatment consists of preventing the rupture of aortic aneurysms by implanting a stent or endoprosthesis , which compressed into carrier catheters, are introduced on a guide through small femoral incisions or even percutaneously and are opened or deployed in the interior aneurysms in the desired location and controlled by X-ray vision. Due to the presence of proximal and distal anchors and seals, a new duct is created where the blood will circulate, thus excluding the aneurysm and preventing its expansion and, consequently, its potential rupture, initiating a process of resorption or reduction in size. of the aneurysm.

This treatment can be performed with local or epidural anesthesia , there is no need to stop the circulation or blood transfusions , recovery is rapid (admission is reduced to one or two days) and related complications are five times less frequent than with traditional treatment or open. One of the most important advantages, especially for men, is the elimination of the risk of sexual disorders or impotence with the new technique, because with conventional surgery they reach frequencies of up to 40%.

All patients with a thoracic or abdominal aortic aneurysm can be submitted to this surgical technique, with the sizes considered at risk for rupture and with proximal and distal segments of the aorta sufficiently healthy to allow the anchoring and sealing of the endoprosthesis.. More recently , we have initiated the pioneering and unique experience in our country of the application of endovascular sutures , inside the arteries, to better ensure the seals and anchorages of the endoprostheses.. Therefore, currently, it is not an alternative, but rather constitutes the first therapeutic choice for most aortic aneurysms , according to the latest international guidelines of clinical practice.

Less than 6% of cases require corrections

The risks inherent in this technique are associated with possible errors in anatomical calculations, in the selection of stents or an inaccurate procedure. Good case planning combined with excellent execution with the best imaging and X-ray technology, however, ensure the success of the procedure. Currently, less than 6% of cases require corrections in the first 5 years. This represents a substantial improvement over the first stages of this technology when up to 25% of patients required to undergo some type of reoperation in that same period of time. The durability of the technique has improved significantly, but this does not exempt the performance of annual controls now with ultrasound.