What does stenting involve?
Arch and descending aneurysms can sometimes be treated with endovascular stent graft placement. This is a procedure where a wire is inserted into the femoral artery in the groin, and used to insert a covered stent into the aorta, across the aneurysm. The stent is held in place in a relatively normal sized section of aorta above and below the aneurysm:
This procedure is performed in a hybrid theatre where the stent can be placed under continuous X-ray fluoroscopy guidance.
Sometimes surgical procedures are necessary before stenting, to redirect the blood flow in the branch arteries of the aorta, so that the stent will not obstruct blood flow to important organs.
There are procedural risks that are specific to stent-graft placement, and these centre around complications related to the graft itself as well as the techniques required to insert it.
Your surgeon will counsel you about the risks of:
- Access vessel injury (bleeding or aneurysm formation in the femoral artery in the groin)
- Access site infection
- Contrast-induced nephropathy (temporary kidney injury due to the dye used for the X-rays)
- Endoleak (blood leaking around the stent graft)
- Stent-graft migration (movement of the graft away from the intended location)
- Ischaemic complications (organ dysfunction due to the obstruction of blood flow to the major organs, including the spinal cord
These risks have to be balanced against the risk of paraplegia, stroke, death etc due to dissection or rupture of the aneurysm, and your surgeon will advise you about the balance of risk.