Difficult Aortic Aneurysms

Aortic aneurysms can involve the aorta in the chest and the abdomen. These are called thoracoabdominal aneurysms and pose special challenges in treatment.

The problem lies in the fact that important organs are supplied by branches coming from this part of the aorta. The blood supply to the liver, the bowel and the kidneys arises close to or from these aneurysms. Treatment of these aneurysms has to take this into account and preserve blood supply to these vital organs.

There are two approaches to treatment.

Surgical approach involves replacing the aneurysmal part and creating separate blood supply to the vital organs from either the arteries in the pelvis or from a normal part of the aorta. This surgery is difficult and carries a high risk.

Endovascular approaches are used in cases surgery is not feasible or too risky .

Endovascular treatment can be done by special stent grafts called BRANCHED and FENESTRATED stant grafts. These have branches or holes through which blood supply to the vital organs can be preserved while treating the aneurysm as is done in standard EVAR or TEVAR.

These special devices are usually custom made by manufacturers and are specific to each patient based on the data and measurements taken from the patient's CT scan.

Sometimes in an emergency when there is no time , we modify standard stent grafts to create special fenestrated devices that can be used in this situation. The case shown below is an example of this situation.

These procedures are a part of the technologies and skills that have made possible the survival of patients that would have been extremely difficult to save in the past.