If an aneurysm is growing rapidly or reached a size associated with increased risk of rupture or dissection, then surgical intervention is indicated. The standard and most common type of surgery for aortic aneurysms is open abdominal or open chest repair. It involves a major incision (cut) in the abdomen or chest.
A newer approach, called an endovascular repair, involves the use of a catheter that is inserted into the groin, in a similar fashion as an aortogram, however, the catheter is used to insert a self-expanding stent graft into the aneurysm. Endovascular repair of aneurysms does not require a large incision and has a substantially shorter recovery than the conventional open surgical approach. However, not all aneurysms are suitable for endovascular repair.
UCSF has a world-renowned program in endovascular surgery, one of the largest and oldest in existence. Vascular surgeons at UCSF have extensive experience in performing technically challenging surgeries for complex aortic aneurysms, those involving arteries running to the kidneys and intestines. Morbidity and mortality rates at UCSF for endovascular surgeries are among the lowest, and the program is recognized as a Center of Excellence and referral center.
Vascular surgeons at UCSF were among those who pioneered the field of endovascular aneurysm repair for the abdominal aorta and thoracic (chest) aorta. Our physician-scientists are on the forefront of research, serving as Principal Investigators in clinical trials testing state-of-the-art endovascular devices that will advance the treatment of aortic aneurysms. These trials are open to patients who meet the eligibility criteria for the trial and may benefit by participation
In endovascular repair, the aneurysm isn't removed. Instead, a graft is inserted into the aorta to strengthen it. This type of surgery is done using catheters (tubes) inserted into the arteries; it doesn't require surgically opening the chest or abdomen.
The surgeon first inserts a catheter into an artery in the groin (upper thigh) and threads it to the aneurysm. Then, using an x ray to see the artery, the surgeon threads the graft (also called a stent graft) into the aorta to the aneurysm. The graft is then expanded inside the aorta and fastened in place to form a stable channel for blood flow. The graft reinforces the weakened section of the aorta to prevent the aneurysm from rupturing.
Endovascular Aneurysm Repair: The illustration shows the placement of an endovascular stent graft in an aortic aneurysm. In figure A, a catheter is inserted into an artery in the groin (upper thigh). The catheter is threaded to the abdominal aorta, and the stent graft is released from the catheter. In figure B, the stent graft allows blood to flow through the aneurysm.
Endovascular repair reduces recovery time to a few days and greatly reduces time in the hospital. However, surgeons can't repair all aortic aneurysms with this procedure. The location or size of the aneurysm may prevent a stent graft from being safely or reliably placed inside the aneurysm.