Traditional surgical treatment for the repair of aortic aneurysms, initiated in the late 1950s, involves large abdominal or thoracic incisions and dissections in order to replace the damaged aorta with a vascular prosthesis sutured to the healthy aorta. This procedure requires general anesthesia, blood transfusions, interruption of the circulation in the area to be repaired, and although it is still effective, it is associated with serious complications that can lead in some cases to the death of the patient.
This is why many surgeons wondered how to reduce these difficulties. It was not until 1990 that surgeon Juan Carlos Parodi made the possibility of minimizing surgical trauma through endovascular treatment a reality. Endovascular treatment consists in avoiding the rupture of aortic aneurysms by implanting an endovascular prosthesis or endoprosthesis, which compressed inside carrier catheters, are introduced on a guide through small femoral incisions or even percutaneously and are opened or deployed inside the aneurysms in the desired location and controlled by X-ray vision. By the presence of anchors and proximal and distal seals, a new conduit is created through which blood will circulate, thus excluding the aneurysm and prevents its expansion and, consequently, its potential rupture initiating a process of resorption or reduction in size of the aneurysm.
This treatment can be performed under local or epidural anesthesia, there is no need to stop 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 or open treatment. One of the most important advantages, especially for men, is the elimination of the risk of sexual disorders or impotence with the new technique, which with conventional surgery reaches frequencies of up to 40%.
All patients with thoracic or abdominal aortic aneurysm, with sizes considered at risk for rupture and with proximal and distal aortic segments healthy enough to allow anchoring and sealing of the endoprosthesis, can undergo this surgical technique. 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 sealing and anchoring of the endoprosthesis. Therefore, currently, it is not an alternative, but is the first therapeutic choice for most aortic aneurysms, according to the latest international clinical practice guidelines.
Less than 6% of cases require corrections
The risks inherent to this technique are associated with possible errors in anatomical calculations, in the selection of stents or an imprecise 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 early stages of this technology when up to 25% of patients required some type of reoperation in the 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.