Open repair of aortic aneurysms

Mr Gibbs - Vascular Consultant at Imperial College - talks about choices regarding options of treatment of aortic aneurysm repair.

Mr Gibbs - Vascular Consultant at Imperial College - explains minimally invasive treatment of AAA.

Mr Gibbs explains that an endoleak is the finding of blood flowing into the aneurysm around a stent graft (medical device) after it has been inserted in endovascular (keyhole) repair. This is one of the important complications to be aware of and can be found on scans during follow up. There are different types of endoleaks, some of which can lead to high pressure blood flow into the aneurysm, and these need procedures to prevent rupture (bursting).

Mr Gibbs talks to Mr Jaffer about if we can predict whether EVAR (keyhole repair) is likely to be successful or not in which patients. It appears to be the key factor is poor or complex anatomy (configuration) of the aorta, which can lead to higher rates of leakage or slippage of the graft. This is important to consider with your clinician.

Mr Gibbs explains some of the complications after aneurysm repair by both EVAR (keyhole repair) or open surgical repair. This can be a very important factor for many patients to consider before deciding which operation to choose. The most common post-operative complications for EVAR are usually small. The risk of significant complications for open repair is much higher than EVAR, which can include major bleeding, lack of blood flow to the legs or guts. But in the longer term, EVAR tends to have more complications as they are less durable.

Mr Gibbs talks to Mr Jaffer about the importance of length of stay in hospital after aneurysm repair in deciding whether to opt for endovascular (keyhole) repair or open surgery. With endovascular repair, a lot of patients can expect to be in hospital for about one to two days. But for open repair, because this is a much larger operation, this would need at least one day in intensive care or high dependency units, and another few days in hospital. But it is important to weigh this up against the longer term outcomes of durability, which tend to favour open repair.