Repairing Aortic Aneurysms That Sit Dangerously Close to Your Kidneys

McLeod Regional Medical Center was one of the first two hospitals in the state to implement a new minimally invasive repair for an abdominal aortic aneurysm that sits dangerously close to the kidneys. McLeod Vascular Surgeon Eva Rzucidlo, MD, describes how she performed the Fenestrated Endovascular Aortic Repair (FEVAR):

Here are the major points of Dr. Rzucidlo’s presentation on FEVAR:

An abdominal aortic aneurysm is a bulging of the main blood vessel in your abdomen. We worry about these abdominal aortic aneurysms, because if they grow to more than five and a half centimeters, they are at risk of rupture, in which case, most people do not survive. Typically, abdominal aortic aneurysms are not discovered on physical exam and are revealed incidentally on CT scans.

In the past, there was only one option for repair of an aneurysm more than five and a half centimeters. This was a large open procedure that required patients being in the hospital for at least five to seven days and at times, discharged to rehab. With a newer endovascular aneurysm repair, most patients spend one night in the hospital, do not require rehab placement and are able to return to work in four to six weeks.

Ten percent of people cannot have a traditional endovascular aneurysm repair.

If the CT scan shows that your aneurysm comes up to your kidney arteries, we cannot place a traditional endovascular aneurysm stent because it would cover your kidney arteries. This would cause kidney failure.

To meet this unique need, a company has designed an option for a nontraditional endovascular repair, creating a custom-made stent. Based on the CT scan, holes are carefully placed within the stent to allow for blood flow to the kidney arteries and possibly to the arteries to the intestines.

This procedure is called a Fenestrated Endovascular Aneurysm Repair (FEVAR). Through two small puncture holes in the groin we access the artery. Then we use X-ray imaging to assure the fenestrations or the holes are in the correct position when we place the custom-made stents.

Most people are able to go home the next day and there is no rehab required. Patients are usually able to go back to work within four to six weeks.

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