Aneurysms and dissections of the aorta in the chest can be treated by inserting stents to strengthen the artery. This is used to prevent rupture when aneurysms are getting larger. In dissections it can be useful to repair the tear in the wall which can allow the artery to remodel back towards normal structure. Surgery to sew in a graft to repair the thoracic aorta involves opening of the chest, and is therefore a major procedure. If stenting is technically possible it offers a less invasive option. Closer to the heart there are some important branches to see head and upper limbs from the aorta. In this area stenting can be more challenging. A combination of surgery and stenting is sometimes needed to deal with aneurysms and dissections in the "arch" of the aorta.
These procedures are usually performed under a general anaesthetic, good control of blood pressure, and deliberate reduction of blood pressure can be needed during the procedures to help with stent release. The stents are introduced from the femoral artery in the groin and the axillary artery in the shoulder/upper arm. The exposure to introduce these stents can be limited, and this facilitates a quicker recovery without major discomfort. Discharge home after 2-3 days is possible if the stent procedure is not too complicated.
Major complications occur in approximately 5% of cases. Specific problems related to stenting in the chest of the risk of stroke and the risk of lower limb weakness and paralysis. There are branches from the aorta in the chest to the brain and to the spine. If the stent changes the blood flow to these areas as a result of either embolism of small clots or covering small branches, then the nerve function in these areas can be affected. Precautions are taken to avoid these complications and they are not common. Careful blood pressure control after the procedure and sometimes a drain in the spine are used to keep the circulation to the spine and the brain at an optimal level.
These complications can also occur with open surgery, and there is some evidence that they may be more likely with open surgery. Stenting therefore remains a good less invasive option for aneurysms and dissections in the chest. However they should only be used when the risk of rupture or reduced circulation to important organs is significant justifying the risks involved in the procedure.
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