Vascular and endovascular surgery including Aneurysm surgery/EVAR

Overview

Aneurysm is an endovascular disease, the manifests as ballooning or bulging of specific regions of arteries due to weakening of the arterial wall as a consequence of trauma, atherosclerosis, hereditary conditions and abnormal blood flow.
Aneurysms are typically formed in the Brain arteries, heart chambers, Aorta and even in coronary arteries; these are diagnosed, evaluated and monitored safely with the help of Ultrasound, Magnetic resonance imaging – MRI and Angiography imaging modalities.
Brain – Cerebral aneurysm, Anterior communicating (Acom) artery aneurysm & Basilar artery aneurysm
Left Ventricle & Right Atrium- Left ventricular aneurysm (LVA), Atrial septal aneurysms (ASA)
Aorta – Abdominal aortic aneurysms (AAA), Thoracic aortic aneurysms (TAA) and Thoracoabdominal aortic aneurysm (TAAA).
Once diagnosed, either the aneurysms are repaired immediately if the aneurysm is diagnostically large and located in upper chest as in the case of ascending thoracic aortic aneurysm; or monitored carefully over time if present below the lower chest or abdomen to see any pathological increase in size. If the size measured isn’t life threatening, then these aneurysms are left untreated to avoid complex surgical procedures.
If left untreated this ballooned area of the artery can rupture due to pressure and can lead to life threatening bleeding.
For repairing the aneurysms formed in various locations of the arteries an open vascular repair surgeries or minimally invasive endovascular procedures are employed by our endovascular specialists.

Heart/cardiac Aneurysms Repair

  • Open heart surgery for left ventricular aneurysm repair – The scarred and weakened ventricular site with aneurysm is repaired through a reconstructive Circular Patch Plasty surgical procedure using a prosthetic patch.
  • Minimally invasive or open heart surgery for coronary artery aneurysm repair – the coronary aneurysm is repaired either through percutaneous intervention with stent placement or coronary artery bypass grafting by ligation, resection or marsupialization with interposition graft of the aneurysm.

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Aortic Aneurysm Repair

  • Open heart surgery for aortic root aneurysm repair – The weakened aortic root is either replaced or reinforced with tube shaped graft at the base/root of the aorta.
  • Open surgery for descending or ascending aortic aneurysm repair – The weakened arterial wall is replaced or reinforced with a stent graft by opening the abdominal or chest wall.
  • Endovascular aneurysm repair (EVAR) – An optional procedure for some patients who do not qualify for the open surgery due to age, diagnostic outcomes and medical history. In this procedure a stent graft is deployed through a catheter at the aneurysm site in the aorta to reinforce the weakened aneurysm site. Endovascular aneurysm repair without surgery is advantageous over open surgeries in offering less trauma, scarring and faster recovery times. All types of aneurysms of the aorta viz. abdominal aortic aneurysms (AAA), thoracic aortic aneurysms (TAA) and thoracoabdominal aortic aneurysm (TAAA) can be successfully treated through EVAR procedure with minimum complication and maximum success rate.
  • We have done complex endovascular repair including debranching surgery and hybrid repairs.

Pseudoaneurysm or false aneurysm may form anywhere in the large arteries or aorta as a consequent complication of cardiac catheterisation. It is managed either through ultrasound mediated compression, pharmacological intervention; or ligated surgically or through endovascular stenting procedure.

Cerebral Artery Aneurysm Repair

  • Clipping for Cerebral and Anterior communicating artery aneurysm repair – An invasive and technically challenging surgical procedure (craniotomy) that clips off the aneurysm from the parent blood vessel, for restoring native anatomy or cerebral circulation.
  • Endovascular Flow Disruption for cerebral & basilar aneurysm Repair – A minimally invasive catheter based surgical procedure that introduces fine mesh plug inside the aneurysm to disallow blood from entry into the aneurysm and create pressure, which might cause further increase in aneurysm size. This novel has been found to be very effective in treating the cerebral aneurysms in minimising bleeding and put less medication burden on the patient.
  • Endovascular Flow Diversion for cerebral aneurysm Repair – A minimally invasive catheter based surgical procedure that introduces fine mesh stents at the site of aneurysm to divert the blood flow disallow from entry into the aneurysm and create pressure, which might cause further increase in aneurysm size.
  • Endovascular Coiling for cerebral aneurysm Repair – A minimally invasive catheter based surgical procedure that introduces coil into the aneurysm to promote blood clotting thereby disallowing blood to enter and create pressure, which might cause further increase in aneurysm size.

The choice of treatment is at the best discretion of our brain aneurysm repair surgeons –neurosurgeons & interventional neurologists based on the observation and the aneurysm’s size, location and neck geometry.

Extracranial, Carotid Artery Aneurysm Repair

Minimally invasive or open heart surgery – the carotid aneurysm is repaired either endovascular stent grafting procedure through percutaneous intervention or an invasive bypass surgery using autologous venous graft or a prosthetic vessel.
Best of our endovascular surgeons, neurosurgeons, interventional cardiologists & neurologists are extensively experienced and highly trained in performing challenging and complex endovascular procedures for treating aneurysms of different origins in collaboration with radiologists and anaesthetists.

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