Stenting

A minimally invasive procedure, stenting is performed on blood vessels to restore or improve blood flow. A stent is a small, flexible mesh tube often made of metal (wire mesh). Other stents, known as covered stents or stent grafts are made of fabric material. Stent grafts are commonly used on larger blood vessels. When the stent device is deployed in the patient’s Aneurysm to seal it off and to prevent it from Rupturing, this process is called Endovascular Aneurysm Repair (EVAR).

Why choose our vascular surgeon for Stenting for Endovascular Aneurysm Repair?
An Aortic Aneurysm is an enlargement of the largest artery of the body (the Aorta) more than 1.5 times of its normal diameter. This condition is potentially fatal, especially when the Aneurysm enlarges to more than 5cm. The risk of ‘bursting’ or rupture of the aneurysm is much higher than the risk of surgically repairing it. If the Aneurysm ruptures, the death rate is almost 90%. Famous people who have died of this condition include Albert Einstein and Lucille Ball.

Open surgeries to repair this condition has high risk of stroke, heart attacks and other serious complications because of the magnitude of the operation. Patients also have to contend with a big incision, which is what Surgeon’s call a midline Laparotomy Scar. Increasingly over the past decade surgeons have replaced the open repair surgery with Endovascular Aneurysm Repair (EVAR).

Our vascular surgeon is currently a regional proctor for simple and complex EVAR procedures. He has been involved in teaching and training doctors in the region in this Life-saving procedure and has helped doctors in Vietnam kick start this procedure in their own hospitals. This minimally invasive method does not require General Anaesthesia and shortens the patient’s ICU stay. EVAR involves small cuts in the patient’s groins and through these cuts the stent device is deployed in the patient’s Aneurysm to seal it off and to prevent it from Rupturing. Patients only have 2 small scars in the groin.

If the patient is suitable, the whole procedure can even be done percutaneously and under Local Anaesthesia; which means there are no cuts on the groin and patient can have a quick recovery. In Summary, Stenting for Endovascular Aneurysm Repair has transformed the management of this serious condition and made treatment much more safer and comfortable for the patient, removing the need for long ICU stays and inpatient stays.

Stenting: What is it and how is it done?

Our surgeon may perform the stenting procedure if you have weak, narrowed or blocked blood vessels. When a stent is placed, it opens up the blood vessel to improve blood flow. Stents also close up tears on blood vessels and provide support to the walls of weak blood vessels to prevent them from bursting.

Developments in stenting have produced custom stents for cases such as very small arteries and veins. Stents as small as 2.5 millimeters in diameter are available for treating smaller vessels. Some stents can be custom made to fit better while drug-eluting stents are coated with chemotherapeutic drugs that are released into the veins or arteries to prevent growth of scar tissue, cholesterol lowering drugs and anticoagulants to prevent formation of clots in the blood vessels that may cause deep vein thrombosis (DVT) or chronic venous insufficiency in limbs.

Narrowed or blocked blood vessels are normally caused by build up of a waxy substance, which hardens into plaque inside the blood vessels. Blockages can also be caused by blood clots. When your blood vessels become narrowed, they can cause conditions such as high blood pressure, coronary heart disease and atherosclerosis among others.

Blood flow in narrowed blood vessels is compromised. This means some organs and tissues do not receive sufficient blood supply. This results in arterial diseases. Narrow arteries that supply blood to limbs often cause peripheral artery occlusive disease, a condition characterized by pain and cramping. Sometimes the narrowing can worsen, cutting off blood supply completely. Blockages in veins in the legs raise the venous pressure and cause venous diseases such as chronic venous insufficiency, varicose veins and spider veins.

Why go through Stenting and what are the benefits?
If our doctor determines that narrow or blocked blood vessels are a threat to your health, stenting may be recommended to restore blood flow and relieve symptoms.

Stenting procedures can be performed through the femoral artery in the groin, the brachial artery in the arm or through the radial artery on the wrist. During the procedure, the patient is put on mild sedative. An intravenous line is established and the area where the incision is made is sterilized and anesthetized with local anesthesia.Guided by X-ray, a catheter is inserted and positioned near the location where the artery originates.

Another catheter with a balloon tip and mounted with a stent is then guided to the narrowed area. Once in place, the doctor inflates the balloon to expand the stent and fit it within the walls of the blood vessel to open them up.

The stent is left in place as the catheter is removed. Eventually (after about six weeks), the stent is completely covered by arterial tissue.

Post Stenting care
Following the stenting procedure, you will be instructed to avoid things like strenuous activities or lifting heavy objects for at least 24 hours. Medication, particularly anticoagulants and anti platelet medications are normally prescribed to prevent the formation of clots. It is also best to avoid MRIs at least up to six months after the procedure.