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Vascular & Endovascular Centre

Disease focus: Abdominal aortic aneurysm (AAA)

An abdominal aortic aneurysm is an enlarged area in the lower part of the major vessel that supplies blood to the body (aorta). The aorta runs from your heart through the center of your chest and abdomen.

The aorta is the largest blood vessel in the body, so a ruptured abdominal aortic aneurysm can cause life-threatening bleeding. Abdominal aortic aneurysms often grow slowly without symptoms, making them difficult to detect. Some aneurysms never rupture. Many start small and stay small; others expand over time, some quickly. If you have an enlarging abdominal aortic aneurysm, you might notice:

  • Deep, constant pain in your abdomen or on the side of your abdomen
  • Back pain
  • A pulse near your bellybutton

True to our name, the vascular and endovascular center headed by our vascular surgeons are able to provide you options in this regard. Conventionally, AAAs that are repaired through an open surgery can be treated with endovascular surgery.

Aneurysms can develop anywhere along the aorta, but most aortic aneurysms occur in the part of your aorta that’s in your abdomen. A number of factors can play a role in developing an aortic aneurysm, including: Hardening of the arteries (atherosclerosis).

  • Blood vessel diseases.
  • Infection in the aorta.
  • Trauma.

Tears in one or more of the layers of the wall of the aorta (aortic dissection) or a ruptured aneurysm are the main complications. A rupture can cause life-threatening internal bleeding. In general, the larger the aneurysm and the faster it grows, the greater the risk of rupture. Signs and symptoms that your aortic aneurysm has ruptured can include:

  • Sudden, intense and persistent abdominal or back pain, which can be described as a tearing sensation
  • Low blood pressure
  • Fast pulse

Not all abdominal aortic aneurysms need surgery. If your aneurysm is small, your doctor may decide to wait and watch carefully to see if there are any changes. If you have high blood pressure, your doctor may prescribe medication to reduce it. If you smoke, your doctor may suggest that you find help in quitting. Your doctor may also ask you to make changes in your diet or exercise habits. If the doctor feels there is a risk that the aortic aneurysm will burst, he or she may recommend one of two aneurysm repair methods: either open surgical repair or endovascular stent grafting.

Open Vascular Repair

With open surgical repair, the surgeon makes a large cut, or incision, into your abdomen where the aneurysm exists. The area damaged by the aneurysm is then separated surgically from the main part of the aorta and replaced with a synthetic tube (known as an aortic graft), that is sewn into place. Open surgical repair of an abdominal aortic aneurysm is performed under general anesthesia and takes about 3 to 4 hours. You can expect to spend 3 days in an intensive care unit and remain in the hospital for 7 to 10 days.

Endovascular Aneurysm Repair (EVAR)

Endovascular aortic aneurysm repair (EVAR) is a minimally invasive procedure where the vascular surgeon inserts a stent through the area that has the aneurysm to restore blood flow. It is designed to be placed without surgically opening the aorta. EVAR has been shown to reduce blood loss, operative time, length of hospital stay, mortality, and morbidity compared with open surgical repair of infrarenal abdominal aortic aneurysms (AAAs). Because endovascular aneurysm repair is less invasive than open surgery, you can expect your hospital stay to be shorter – typically as short as 2 to 4 days. In CVSKL, vascular surgeries are performed in our state of the art hybrid operating theatre. These are complex patients who normally require two significant staged interventions, the sequence of which exposes them to risk from the untreated morbidity.

Disease focus: Deep Vein Thrombosis

Formation of blood clots in lower legs

Deep Vein Thrombosis (DVT) is a blood clot that forms in the deep veins of the lower leg or calf, which can block the flow or blood. It can causes pain or swelling but can also be present without any symptoms. DVT is treatable but can cause serious complications if left unchecked.

The risk factors of developing DVT are as below:

  • sitting for long periods of time (eg traveling)
  • recent surgery
  • smoking
  • obesity

The symptoms of DVT are:

  • swelling & tightness in the leg
  • persistent, throbbing, cramp-like feelings in the leg
  • pain or tenderness when standing or walking

Prevention of DVT
If left untreated, DVT can give rise to complications. In serious cases, part of the clot may break away and travel through the blood stream to the lungs. This can cause a pulmonary embolism and is potentially life threatening.

In CVSKL, there are a few options to treat DVT:
Blood thinners: Anticoagulants are the common treatment for blood clots.
Compression stockings: Used to aid blood flow by providing graduated pressure that is more firm at the bottom and becomes lesser at the top. This graduation improves blood flow back to the heart because gravity and pressure makes it difficult for the blood to flow in an upward direction.

Endovascular Options:

  • Thrombolysis
  • Stent replacement
  • Vena cava filters

#KnowYourOptions

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