Surgery

An Introduction to Endograft Protocol



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An endograft is a stent, consisting of a wall made of wire mesh and a wraparound fabric material, which is designed to withstand the chemical and physiological insults encountered in human circulation. Thus, it is made for the specific purpose of being placed inside a ‘blood vessel’ and the procedure undertaken for its placement is termed the ‘endograft protocol’.

What is the usefulness of an endograft?

The consistency of the endograft wall enables it to act as a secondary support device to a weakened blood vessel wall and therefore it has the ability to bridge aneurysms formed in the ‘aorta’ (‘the great vessel in the human body’).

What is an ‘aneurysm’?

An aneurysm is a dilated portion of a blood vessel and the reason for its dilation is its wakened structure. If kept unattended, an aneurysm can rupture (dissection of the aortic aneurysm) and it can lead to instantaneous death. Aneurysms are more dangerous than other heart and vessel wall lesions because of their asymptomatic nature until late, which make them difficult to diagnose early.

What are the steps of an ‘endograft protocol’?

Pre-procedure:

The pre-procedure preparation involves taking a detail history and performing a complete physical examination, which would be supplemented by several tests. These include several blood tests, EKG or ECG, 2D Echocardiogram and a Chest X-ray.

Apart from these, a CT scan and an arteriogram to visualize the extent of the aneurism are also performed prior to the procedure. The entire procedure and the follow-up requirements will be explained to the patient in detail by a physician or a nurse and will request the patient to give his or her consent before proceeding.

Procedure:

Prior to the procedure, an intravenous cannulae is inserted and used to give anesthetic agents during the procedure as well as for giving medications in a state of emergency. The abdomen and the groins will be cleaned using an antiseptic solution and a small incision is made in the groin area to make way for the ‘stent’ or the ‘endograft’. The stent is inserted through the femoral artery and a ‘radio opaque’ dye (a dye which make the artery visualized through x-ray) would be injected to visualize the aneurysm and coordinate the proper placement of the stent. Following the procedure, imaging studies will be done to ascertain proper flow of blood and the correct placement of the stent.

Post procedure:

Following the procedure, the patient is observed for several days until the doctors can exclude any dangerous complications. Usually, the patient can be allowed to go home on the 2nd or 3rd day following giving advice regarding physical exercises, diet, medications, and other lifestyle habits.

What are the possible complications following placement of an endograft?

Among the complications, bleeding from the puncture site and infections at the same site are relatively common while impairment or failure of the kidneys could take place due to the x-ray dye. Blood vessel rupture could be a rare complication although it can necessitate immediate surgery to save the life.

What are the advantages of endograft protocol in comparison to ‘open surgery’?

By performing an endograft protocol, the patient could expect to go home early and it would not involve large skin incisions or heavy bleeding. Furthermore, the recovery time following the procedure is significantly less.

Reference:

Central Ellionois Radiological Associates - Placement For Aneurysms

The Emerging Role of Fenestrated & Branched Aortic Endografts in the Treatment of Complex Aortic Aneurysms By Dr. Ricotta : Emory healthcare


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