The MUSC Advanced Aortic Surgery Program

Abdominal Aortic Aneurysm Repair

Abdominal Aneurysm Open Repair

Open repair of an abdominal aortic aneurysm involves an incision of the abdomen to directly visualize the aortic aneurysm. The procedure is performed in an operating room under general anesthesia.

The surgeon will make an incision in the abdomen either lengthwise from below the breastbone to just below the navel or across the abdomen. Once the abdomen is opened, the aneurysm will be repaired by the use of a long cylinder-like tube called a graft. Grafts are made of various materials, such as Dacron (textile polyester synthetic graft) or polytetrafluoroethylene (PTFE, a non-textile synthetic graft). The graft is sutured to the aorta connecting one end of the aorta above the aneurysm to the other end below the aorta.

Open repair remains the standard procedure for an abdominal aortic aneurysm repair.

Endovascular Aneurysm Repair (EVAR)

Endovascular aneurysm repair (EVAR) is a minimally-invasive procedure performed to repair abdominal and thoracic aortic aneurysms. EVAR may be performed in an operating room, radiology department or a catheterization laboratory. The first EVAR procedure in South Carolina was done here at MUSC.

The physician will make a small incision in each groin to visualize the femoral arteries in each leg. With the use of special endovascular instruments, catheters and guidewires, along with x-ray images for guidance, a stent-graft will be inserted through the femoral artery and advanced up into the aorta to the site of the aneurysm.

A stent-graft is a long cylinder-like tube made of a thin metal framework (stent), while the graft portion is made of various materials such as Dacron or polytetrafluoroethylene (PTFE) and may cover the stent. The stent helps to hold the graft in place. The stent-graft is inserted into the aorta in a collapsed position and placed at the aneurysm site. Once in place, the stent-graft will be expanded (in a spring-like fashion), attaching to the wall of the aorta to support the wall of the aorta. The aneurysm is prevented from growing and rupture and may eventually shrink down onto the stent-graft.

Fenestrated EVAR

Current stent grafts are not designed to be used for aneurysm that abut or involve the arteries to the kidneys (renal arteries), bowel (mesenteric artery) or stomach/liver (celiac artery). Open surgery for this part of the aorta also has increased risk and recovery time.

A new stent graft device has recently been introduced in the U.S. for treatment of such aneurysms. MUSC, with its expertise, is the only center in the state of S.C. to have access to this device and technology. We are able to provide this option for many patients, who would otherwise be denied surgery or treatment.

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