Aortic Stenting

A thoracic aneurysm can be repaired with an endovascular stent graft.

As a leader in patient care, the Heart Institute at Stony Brook University Hospital continually investigates methods to provide you with more efficient, more comfortable, and safer care. Our Center for the Treatment of Aortic Disease combines the expertise of our highly specialized teams of vascular and cardiothoracic surgeons to provide you with comprehensive treatments comprising both traditional open surgery and endovascular techniques. Our program is especially effective in aortic stenting, where you receive superior specialty care for an aortic aneurysm - a potentially serious condition if left untreated.

An aortic aneurysm is a bulge in the aorta, the largest artery in your body. Over time, the pressure of blood flowing through the aorta can cause a weakened area to enlarge and bulge like a balloon. In your chest, near your heart, it is called a thoracic aneurysm; in your stomach area, it is referred to as an abdominal aneurysm. Aneurysms are a potentially serious health condition because they can burst or rupture. Larger aneurysms are more likely to rupture than smaller ones and can cause internal bleeding that is fatal unless treated very quickly by an experienced emergency medical team.

An aortic stent, also called an aortic stent graft, is a metal skeleton inside a fabric graft. A graft works by exerting pressure against the portions of the artery above and below the aneurysm to cut off circulation to the aneurysm. The stent fits inside the aorta, creating a safe tunnel through which blood can pass, thereby allowing the aneurysm to shrink.

In addition to traditional methods of aneurysm repair, which involve extensive surgery, a large incision, and a long recovery time, Stony Brook University Medical Center can perform this procedure endovascularly. Endovascular means that the procedure is done within the vessel; it is performed inside the aorta through a small incision in the groin area using special devices inserted through a catheter (a thin, flexible tube). Because of the minimally invasive method, your hospital stay is shorter, you recover more quickly, you have less pain, and you have less scarring.

How to Prepare

It is important to follow your physician's specific instructions in the days and weeks prior to surgery, as they will help ensure a smooth and successful experience. To prepare for the procedure:

• Inform your physician about all medications, herbs, and supplements you take;
• Discuss any allergies with your physician, especially those to medications;
• Inform your physician and anesthesiologist if you have had a bad reaction to anesthesia in the past;
• Cut down on or stop using alcohol and tobacco products if you drink or smoke;
• Complete all paperwork as requested;
• Prepare for up to 3 days of hospital stay;
• Pack appropriate toiletries;
• Leave all valuables at home, such as jewelry and watches;
• You may be asked to consume only a clear liquid diet the day before surgery; your physician will provide you with appropriate food instructions; and
• Do not eat or drink anything after midnight on the night before your surgery. If you need to take a pill, please take it with only a small sip of water.

What to Expect

To insert the graft, the surgeon inserts catheters with the compressed stent graft through small incisions in the patients upper groin or abdomen.

To implant the stent, our surgeons make a 2- to 4-inch incision in your upper groin or abdomen and guide a catheter with the compressed stent through an artery using an x-ray monitor as a visual guide. When the graft reaches the aneurysm site, the surgeon withdraws the catheter, leaving the graft to expand to fit tight against the walls of the artery. This creates a new aortic lining and seals off blood flow into the aneurysm "bubble." Without blood to feed the aneurysm, the repaired aorta typically shrinks over time.

Recovery

You may have to spend 2 to 3 days in the hospital because your surgeon will want to make sure that the stent operates correctly. You will most likely be able to eat on the first day, and you may be up walking. Your physician will give you instructions for your return home. Recovery time is usually shorter for an endovascular procedure than traditional surgery. Your physician may instruct you to:

• Avoid driving until you are cleared by your physician;
• Avoid bathing until the incisions are healed; you may be able to shower or take sponge baths; and
• Avoid lifting anything over 10 pounds for 4 to 6 weeks after the procedure.

Your physician will schedule a follow-up visit within 1 month of the procedure.