Introduction

As the field of medicine progresses, simultaneously, there are newer and modern treatment techniques being invented as well. All the merit goes to the medical researchers and the doctors across the globe, whose persistent efforts are saving a lot of lives every day. More specifically, there is an exorbitant amount of pressure on those associated with the sphere of Cardiology. There are millions of people, who suffer from different types of Heart related ailments. So, it is very crucial that the required treatment too is available at the right time to avoid an unfortunate outcome.

One of the issues that can burden a patient majorly is known as an Aneurysm. It affects the Aorta, which is the largest part of the body’s artery system. A smooth and harmoniously functioning Aorta is very crucial for our body because it provides oxygen-rich blood to all areas of the body, including the Heart, Brain Stomach, Intestines, etc. Any damage to the Aorta affects this whole system and Aneurysm is one of the problems that can create a lot of trouble for the Aortic system.

Overview:Aneurysms

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An Aortic Aneurysm is when a section of this artery too expanded or enlarged in diameter, because of degeneration or weakness in the artery’s walls. Usually, Aneurysms occur in the Aorta, which is the largest artery in the body. It runs from the Heart via the Chest and the Abdomen. An Aneurysm occurring in the Abdomen is known as Abdominal Aortic Aneurysm (AAA), whereas, the one occurring in the Chest is a Thoracic Aortic Aneurysm (TAA). Aneurysms also happen in the arteries present in the Spleen, Thighs, Knee, Kidneys, Stomach or Liver. AAA is the most commonly occurring Aneurysm, which is mostly located below the Kidneys.

Not all cases of Aneurysm need surgical intervention. If it is small in size and is not causing any symptoms, then all that is required is to be wary about any noticeable symptom and report about it. However, if the Aneurysm keep growing in size and shows symptoms, then the patient is recommended anAneurysm Repair Surgery. The Aneurysms occurring in the upper chest are life threatening in nature and must be operated at the earliest; while those in the lower chest region are not that dangerous. At the same time, if the diameter of the Aneurysm has grown to about five centimetres in size and is showing symptoms, then a surgery is needed.

Amongst the various areas of body, where an Aneurysm may occur, the Thoracic Aortic Aneurysm, which is the dilation of the Aorta in the Chest area, can be one of the most challenging. Another thing that the patient needs to know is that medically managing an Aneurysm is possible, but at the same time, there might be reasons why the patient might not be able to consume certain medicines – reasons like High Blood Pressure, High Cholesterol, escalated blood sugar levels, etc.

Symptoms of Aortic Aneurysm

Symptoms mostly don’t show until the Aneurysm has become large or has burst. But while it is growing in size, few of the symptoms that the patient might start noticing, include:

  • Back pain
  • Chest Pain
  • Difficulty in swallowing
  • Breathing issues
  • Hoarseness
  • Coughing

If the Aneurysm bursts inside the body, then the patient might feel the following symptoms:

  • Sudden and sharp pain in the upper back that radiates towards the lower part of the body
  • Difficulty in breathing
  • Pain in the jaw, neck, arms, chest

Causes

When it comes to Thoracic Aortic Aneurysm, genes play a very significant role as a cause. A person might be born with conditions that affect the Aorta badly. Conditions such as Bicuspid Aortic Valve, Loeys-Dietz Syndrome and Marfan’s Syndrome. There can be other causes too, like:

  • Infection
  • High Blood Pressure
  • High Cholesterol
  • Accumulation of plaque in the arteries, which is known as Atherosclerosis
  • Sudden traumatic injury

How is an Aneurysm treated?

There are three ways to treat an Aneurysm, which are:

  • Open Aortic Aneurysm Repair: This surgical approach is implemented on a patient, when there is bleeding inside the body from an Aneurysm or when the patient is at the risk of the Aneurysm bursting
  • Endovascular Aneurysm Repair (EVAR): This is a minimally invasive surgery, which uses long, thin tubes known as catheters. The surgeon threads these catheters via the blood vessels. Generally, an Endovascular treatment takes place inside the arteries
  • Complex Arch Replacement and the elephant trunk – This is a very intricate surgical procedure done on a patient having extensive Aortic Aneurysms, which involve the artery around and the aortic arch.

What is an Endovascular Aneurysm Repair?

The usage of stent in the field of medicine, particularly, in the field of Cardiology, is not new. The concept has been there for quite some years and has gained an immense amount of popularity. With newer and more patient-friendly stents being invented, it is not only considered safe but has an excellent track record. Owing to this, stents are being used in curing Aneurysms as well. Also, referred to as Endovascular Stent Grafting, Endovascular Aneurysm Repair is an extremely progressive form of treatment, which have been found very fruitful as a way to reinforce the Aortic walls and to prevent the rupturing of the affected area.

Prior to Endovascular Aneurysm Repair Surgery

  • About two weeks before the surgery, the patient must visit the doctor to ensure that health conditions like High Blood Pressure, Diabetes, any Heart or Lung issues are under control
  • The patient is advised to stop taking certain medications that might make it hinder blood clotting
  • The patient must be aware about the medications that he or she is allowed
  • The patient must inform the doctor if he or she develops any health issues like flu, Herpes breakout or any other form of allergy, cold, fever, etc.
  • Needs to stop smoking at least two weeks prior to the surgery
  • On the evening before the surgery, the patient needs to avoid drinking or eating anything post-midnight

Evaluation Phase before Endovascular Aneurysm Repair

The evaluation process starts with a detailed study of the patient’s medical history. A detailed checking is very essential to find out the root cause and to finalize the right course of treatment and surgical approach. The doctor does a physical check-up, which includes trying to feel the Aneurysm through the skin or also listening to the arteries with the help of Stethoscope.

After this, some diagnostic tests are suggested to find out the size of the Aneurysm and also to specify its location. The tests include:

  • Duplex Ultrasound
  • Computed Tomography (CT) Scan
  • Angiography
  • Magnetic Resonance Angiography (MRA)

How is the actual Procedure performed?

evar procedure

The best way to mend an Aneurysm or the choice of the surgical approach depends on multiple factors like the shape and location of the Aneurysm as well as the overall health condition of the patient.In Endovascular Aneurysm Repair a graft is inserted inside the Aneurysm, by making small incisions in the Groin. This is done with the help of guidance provided by X-ray images. These images help the surgeon to position the stent aptly as well as keep a check if the Aneurysm is bleeding inside the patient’s body.

  • The surgery is mostly performed under general anaesthesia but occasionally it is possible to do it using local anaesthesia as well
  • Small incisions are made in the Groin and the access is via the femoral arteries
  • One of the incisions is used to perform Angiography throughout the surgery
  • Once this is done, then the following steps are done:
    • Visualization of vessel anatomy with the help of contrast agents –Angiography
    • Placement of the stent using a catheter delivery system
    • Releasing the stent from the catheter delivery system
    • Monitoring the progress of this process using Angiography
    • If and when required, a balloon is used to help the stent expand and adapt to the walls of the artery
    • Then, removing the catheter delivery system
    • Closing the femoral artery

evar procedure

By positioning a stent in the affected vessel, the Aneurysm is separated and any blood flow to it is stopped. Since the Aneurysm is not exposed to the blood pressure, which is there in the Aorta, there is not further enlargement and the risk of Aortic Dissection is prevented too. Further, if Aortic Dissection has already happened, then the tear is appropriately sealed by the stent. Overall, this whole process helps in stabilizing the damaged section of the Aorta.

This surgery has a very good track record. If the Aneurysm is successfully treated, then there are hardly any chances of it blocking or bursting. Over the years, this surgery has gained a very safe and Post a successful Endovascular Aneurysm Repair surgery, the patient has a very high likelihood of enjoying a much enhanced quality of life.

Recovery after this Surgery

If a patient had an uncomplicated Endovascular Aneurysm Repair procedure, then the patient can expect a smooth recovery process.Once the patient is fully awake, the patient is introduced to fluids and later solid food items as well. The nursing staff helps the patient to start walking at the earliest. Once this is fluent handled by the patient, he or she is ready to get discharged. Painkilling medications and other medications are prescribed for a smooth recovery period.

Generally, the patient recovers almost fully in about two weeks; however, depending on the patient’s health condition, it may take a bit longer. With recommended amount of activity and sufficient amount of rest, the patient is able to resume his or her normal activities soon; including sexual activity. On the work front, the patient can resume going to office in a month’s time.

Advantages of Endovascular Approach

Be it the Open Surgical approach or the Endovascular approach, the aim is to treat the Aneurysm and provide the patient a long lasting relief. Both are beneficial in their own ways, however, the Endovascular being the minimally invasive approach, is more favoured by the surgeons as well as the patients.

  • Lesser invasive and hence doesn’t require to open the chest
  • The graft attachment is more secure in this approach because in the Open surgery, follow up scans are required to find out if the stent has slipped
  • Blood loss in lesser as compared to the traditional approach
  • No need for blood transfusion
  • Smaller incisions, which gives cosmetic benefits
  • The stent is placed without the removal of any tissue from the Aorta
  • Recovery time is less
  • Patients are back on their feet faster

Complications associated with this Surgery

  • Bleeding around the graft due to which another surgery might be needed
  • Bleeding before or after the surgery
  • Blockage of the stent
  • Damage to a nerve, causing weakness, pain, or numbness in the leg
  • Lowered blood supply to legs, Kidneys, or other organs
  • Kidney failure
  • Heart Attack
  • Deep Vein Thrombosis is also one of the risks. In case a patient develops this issue, then the treatment is immediately started, and this can prolong the hospital stay
  • Sexual Dysfunction – issues related to getting or keeping an erection
  • Surgery is not successful, which leads to the need for anOpen surgery
  • The stent may have slipped

Life after the Surgery

There are some things with which the patient can help himself or herself to enjoy a trouble free life after this procedure:

before and after Aneurysm repair

  • Stop smoking: Quitting smoking plays a very crucial role as it helps the arteries to stay protected, which in the long run prevents the patient from suffering from strokes or Heart Attacks
  • In general exercise is considered very important. After this surgery, light form of exercise such as walking, or cycling is recommended for better quality of life and for improving overall fitness
    • Exercise also helps the body to produce good cholesterol and helps the arteries to fight against bad cholesterol
  • High Blood Pressure: This is a huge risk factor behind the rupture of an Aneurysm. It is very important that the patient gets his/her blood pressure checked at regular intervals.
  • Diabetes: Keeping blood sugar levels under control
  • High Blood Cholesterol levels: It is the fatty substance in our blood. To keep this under control, a good and balanced diet is a must. If required, the patient can take the help of a Dietician
  • Driving: The patient must avoid driving till he or she is given a go ahead by the doctor
  • Missing any of the follow-up appointments is strictly a no-no, till the patient has completely recuperated
  • Taking the medications as instructed

Why opt for India for Endovascular Aneurysm Repair Surgery?

The popularity of Indian healthcare system is undoubtedly very high across the globe. India has advanced in leaps and bounds in every area of medicine. There are very few nations around the globe that stand a chance to fight against India in this matter. This is why Indian as well as patients from many other different countries prefer to finalize India as their final treatment venue, which has given a major boost to Medical Tourism to India.

One of the key attributes are the hospital spread across the prime cities of India. There are hospitals that have been dedicatedly serving enumerable patients for several decades now. These centres of excellence are very careful about upgrading their infrastructure so that the latest surgeries and treatment techniques can be accommodated. The treatment opportunities available here are seamless and the patients face hardly any issues while undergoing any treatment. The staff at these hospitals are very fluent in English so the patients mostly do not face any language issues; even if they do, there are language translators’ facility that can be arranged. Further, the international patients are given high priority and are assured of the highest standards of healthcare services.

Few of these hospitals, for which India has acquired a very respected position, are:

  • Fortis Hospitals
  • Apollo Hospitals
  • Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute
  • GleneaglesGlobal Hospitals
  • Sri Ramachandra Medical Centre
  • Tamil Nadu Government Multi-specialty Hospital
  • Yashoda Hospitals

To a major extent, the credit behind the fame achieved by these hospitals, goes to the doctors and surgeons working here. This is particularly in the matter of Cardiac specialists, who have acquired an extremely remarkable stature owing to their commitment and efforts towards their patients. Having an extensive amount of experience in the field of Cardiology, these surgeons are exceptionally skilled to handle highly complex surgeries. These surgeons have not only been associated with hospitals in India but also with esteemed hospitals abroad. Their dedication is evident from their amazing surgical success rates as well as that they are always keeping their knowledge about the latest in the field of Cardiology, updated to give nothing but the best to their patients.

A few of the pioneers belonging to this field, are:

  • Dr. Pankaj Patel
  • Dr. S. Jayakumar
  • Dr. Adil Sadiq
  • Dr. Ravi Chandra JB.
  • Dr Y. Vijayachandra Reddy

Like these, there are several other proficient Cardiac experts, who can handle such intricate procedures with utmost confidence. Not only this, the patients can also expect a lot of cost benefits while in India. No matter, how modern the surgery is, in India it is very affordable as compared to other leading countries around the world.

With so many treatment benefits in store for the patients, India is undeniably the best option for availing any treatment.

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