Overview
An aortic aneurysm may in principle be treated in one of two ways: so-called catheter-guided endovascular therapy and classical open surgery. The choice of treatment depends on the shape and site of the affected area, as well as your state of health. You will be counseled in our special clinic for aortic diseases with regard to all factors and, further investigations arranged, if necessary.
Your case will be discussed with various experts in our vascular conference in order to find the best possible solution and therapy for you. We offer you both endovascular therapy as well as open surgery as very safe options given the proven expertise of our staff in the management of aortic diseases. Our team also comprises cardiologists and angiologists specializing in aortic diseases in order to provide you with optimal care before, during and after the procedure.
Endovascular therapy (stenting)
Endovascular therapy involves placement of a stent in patients with an aneurysm. This is known as EVAR (endovascular aortic repair) when performed for aortic aneurysms. The catheter-guided stent is introduced through the femoral artery and placed in the aneurysm. Stents consist of a wire frame in the form of a tube with a covering made of special material. Stent prostheses with appropriate recesses are placed if vessels supplying internal organs arise from the aneurysm. This is performed under x-ray guidance in order to ensure precise placement.
In contrast to open surgery, endovascular therapy may frequently be performed with local anesthesia and without general anesthesia. Only small incisions are usually required in both groins for insertion of the stent prosthesis, and the patient is usually discharged from hospital after four days. Regular follow-up is required after EVAR in order to ensure long-term therapeutic success. The correct position of the stent prosthesis, secure placement and the size of the aneurysm are reviewed.
A minor disadvantage of the endovascular procedure is that corrective catheter-guided interventions are required in approximately every tenth patient. Changes in the main arterial wall over time may lead to displacement of the stent prosthesis or its components. This may result in re-perfusion of the aneurysm with a fresh risk of rupture.
Open surgical therapy
Open surgery is the classical method and has been tried and tested for many years. The aneurysm is thereby removed through an abdominal or flank incision and replaced by an artificial vessel. This is carefully sewn in by hand. The aorta must be clamped for a certain period of time during the operation in order to prevent excessive blood loss. Healing after open surgery takes longer than after EVAR due to the larger surgical wound and is usually more physically stressful. Hospitalization is generally required for ten days.
The great advantage of open surgery is the longevity of treatment. Corrective interventions are very rarely required. There is no risk of re-perfusion of the aneurysm since most of it is removed during surgery. Regular follow-up is likewise essential even after operative treatment,. with due attention being paid to suture lines.
Post intervention care
The recovery phase after EVAR lasts approximately two to three weeks, and approximately six to eight weeks after open surgery. We recommend hospitalization of approximately two to three weeks in a rehabilitation facility after open surgery to regain physical stamina. This is usually unnecessary after EVAR.Walking and walking training are the best means of regaining your stamina.
You should also ensure that you follow a healthy lifestyle for optimal recovery and for the rest of your life. This includes regular physical activity, weight reduction, optimal blood pressure control, consistent use of prescribed medication and, above all, cessation of smoking.