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The Ideal Candidate for an Endograft of an Abdominal Aortic Aneurysm

An abdominal aortic aneurysm is a potentially dangerous weakening of the abdominal aorta, which supplies blood to the lower half of the body. It is characterized by a bulging or expansion of the aorta that can rupture with life-threatening consequences. An endovascular stent graft (endograft) is a minimally invasive surgical procedure designed to repair aortic aneurysms. Ideal candidates for this procedure must fit several criteria.

  1. The Basics

    • In an endograft for an abdominal aortic aneurysm, surgeons insert a long tube called a catheter into a patient’s blood vessels. They then use updated X-ray images on an external monitor to guide a specialized fabric and metal tube (endovascular stent) through the catheter to the aneurysm site. The weakened section of the aorta is then replaced with the stent, which is sutured into place.

    Size of the Aneurysm

    • The first factor in deciding an individual’s candidacy for an endograft is determining if his or her aortic aneurysm requires surgical repair at all. The main question here is the risk of aneurysm surgery vs. the risk of aneurysm rupture. According to the Mayo Clinic, if an aneurysm is 4 cm in diameter or smaller, a patient’s doctors may first recommend watching and waiting to see how the aneurysm develops. If an aneurysm is between 4 and 5.5 cm in diameter, doctors will be more inclined to recommend surgery. If an aneurysm is larger than 5.5 cm—or grows more than half a centimeter in six months—the risk/benefit ratio of surgery shifts substantially, and doctors will likely recommend surgical treatment.

    Endograft Vs. Open Surgery

    • The next step is determining whether a patient is better suited for an endograft or traditional open surgery. According to the Society for Vascular Surgery, patients are more likely to receive an endograft if they suffer from other serious medical conditions. Additionally, the aneurysm must be of a size and shape that fits the specific needs of endograft surgery, including the placement of a graft through the interior of the patient’s blood vessels. If an aneurysm is poorly shaped, or located near sensitive structures such as the renal arteries feeding the kidneys, surgeons may decide that the procedure is too dangerous and recommend a traditional surgery.

    Follow-Up Procedures

    • Typically, recipients of an endograft experience significantly shortened recovery times after surgery. The risks of serious or fatal surgical complications are also substantially reduced. However, endografts also require more care after surgery. To retain candidacy for an endograft, patients must be able to undergo frequent checkups that involve taking computed tomography (CT) scans of the surgical site. In addition, they must be willing to undergo regular maintenance procedures that confirm the proper function of their grafts.

    Additional Considerations

    • Several additional factors may also affect an individual’s candidacy for an endograft. These include bleeding problems, the use of blood-thinning medications, a history of kidney problems or diabetes, and allergies to substances including iodine, shellfish, contrast dye, and latex or rubber. Patients should consult their doctors or surgeons to learn more about the criteria for endograft surgery.

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