Diabetes, Heart Disease, & Stroke - NIDDK
Abdominal Aortic Aneurysm
Cook Zenith Stent Graft. The Zenith AAA Endovascular Graft is made up of three parts: a "main body" and two "legs." The main body is positioned in the aorta. The legs are positioned in the iliac arteries and connect to the main body. The graft thus extends from the aorta below the renal arteries (kidneys) into both iliac arteries.
The graft itself is made of a polyester graft material like that used in open surgical repair. Standard surgical suture is used to sew the graft material to a frame of stainless steel stents. These self-expanding stents provide support. The graft has several gold marks to help the doctor see the device during placement. All of these materials have a long history of use in medical implants.
Medtronic Endurant Stent Graft. The Endurant Endovascular Graft is made up of two parts: a "main body with one leg attached" and a contralateral leg segment. The stent graft, which is woven polyester tub (graft), is covered by a tubular metal web (stent) and is sewn together at many points.
The main body with leg attachment is positioned in the aorta. The contralateral extension is positioned in the iliac artery. There is a fixed section where the graft attaches above the kidney arteries to prevent the graft from moving (migration). The graft thus extends from the aorta below the renal arteries (kidneys) into both iliac arteries.
Gore Excluder Stent Graft. The endovascular graft is a two-piece, bifurcated graft that lines the aorta and extends from below the renal (kidneys) arteries into both iliac arteries. It is made up of an ePTFE (expanded polytetrafluoroethylene) covering with an outer metallic support structure known as a stent.
The main body with leg attachment is positioned in the aorta. The contralateral extension is positioned in the iliac artery. The graft thus extends from the aorta below the renal arteries (kidneys) into both iliac arteries.
Endologix AFX Stent Graft. The graft itself is made of an ePTFE (expanded polytetrafluoroethylene) over a Nitinol framework skeleton. It is unique in that it has a unibody-bifurcated design for delivery from the main side with a large introducer and from the opposite leg with a very small introducing sheath.
Trivascular Ovation Stent Graft. At 14F OD, the Ovation Prime Abdominal Stent Graft System is the lowest profile AAA endograft system, offering enhanced deliverability — even through narrow and tortuous anatomies. It has a trimodular design with suprarenal stent fixation. The size has been decrease to use without a sheath for insertion.
Upon deployment, integrated polymer-filled sealing rings are expanded to exactly conform and seal to the patient's unique anatomy, excluding the aneurysm.
Immediately afterwards, you may need to lay flat for 2-6 hours to allow the leg wounds to begin healing. Patients have reported feeling discomfort for the first few days following the procedure in the groin areas as the anesthetic wears off. You may experience side effects such as swelling of the upper thigh, numbness of the legs, nausea, vomiting, leg pain or throbbing, malaise, lack of appetite, or fever. You will be given appropriate medications to take home which will include antibiotics.
What Is An Endarterectomy?
If you have symptoms of peripheral artery disease (PAD) and medicines and lifestyle changes aren't enough to control it, you might need surgery. An endarterectomy is one of the common surgeries doctors can use to treat your narrowed arteries, improve blood flow, and relieve symptoms of PAD.
The surgery involves removing fatty substances called plaques from your arteries. It's most likely you'll have this procedure if you have a lot of plaque and your arteries are severely narrowed.
Surgeons most often use an endarterectomy to open large blood vessels when there is a blockage or narrowing at places where your arteries branch off. Sometimes this can happen in the carotid arteries, the pair of blood vessels on both sides of your neck that send blood to your head and brain. Doctors call the procedure to remove plaque from the carotids a carotid endarterectomy.
Most endarterectomy procedures aim to restore blood flow to the femoral artery, which is in the top of your thigh. PAD is the most common condition that affects this artery. It's a major blood vessel for carrying blood to your lower body and is important for normal blood flow to your legs. Your doctor may recommend you have a femoral endarterectomy depending on where your blockage is and how serious it is.
Your surgeon might do an endarterectomy at the same time as another procedure called bypass surgery. In bypass surgery, surgeons use part of one of your veins or a synthetic tube to create a new path for blood to flow around severely narrowed or blocked arteries. In PAD, bypass surgery can help to restore blood flow to your legs.
If you and your doctor have decided on an endarterectomy, your care providers will likely want to run some tests a few days before the surgery. These tests can make sure you can undergo surgery safely. You might need to stop taking certain medicines for a while. Ask your doctor if there's anything else you should do to get ready for the procedure.
Your doctors will give you medicine to put you to sleep or to block pain to a specific part of your body so you won't feel anything during surgery. A vascular surgeon will make a small cut where your blocked artery is. A tube or shunt near the artery they're operating on will keep your blood flowing during surgery.
Next, they'll make another incision to open up the narrowed artery and remove plaque from the artery walls with a tool called an endarterectomy spatula. They'll then stitch the artery back up and take out the shunt. Your surgeon also may use a patch to help close your artery and encourage healing. These patches can be synthetic or made from your veins.
The procedure itself usually takes 2 or 3 hours. You should expect the whole process including preparation and recovery to take several more hours.
The goal of surgery is to restore blood flow, relieve discomfort or other symptoms of PAD, and prevent serious complications. Most of the time, endarterectomy works well and is safe.
You will likely be able to return to normal activities within weeks of your endarterectomy. Ask your doctor if they have any specific guidelines or recommendations to help you recover from surgery.
You may not notice any side effects from surgery. Some people have some numbness around their incision. Your doctor will follow up with you after surgery. They'll explain how it went and what you can do to help prevent more plaque from building up in your arteries.
Any surgery comes with some risks, but endarterectomies don't usually have complications. Ask your doctor about any special risks or concerns in your case. Sometimes an artery that's been cleared surgically can get blocked again. Talk to your doctor about treatments and lifestyle changes that will make this less likely.
The best ways to keep all of your blood vessels healthy are to:
Call your doctor right away if you notice any of the following symptoms, which could signal a sudden blockage of your femoral artery:
Peripheral Artery Bypass
Content
Femoropopliteal (fem-pop) bypass surgery is used to bypass diseased blood vessels above or below the knee.
To bypass the narrowed or blocked blood vessel, blood is redirected through either a healthy blood vessel that has been transplanted or a man-made graft material. This vessel or graft is sewn above and below the diseased artery so that blood flows through the new vessel or graft.
Before you have surgery, the doctor will determine what type of material is best suited to bypass the blood vessel. Whenever possible, the surgeon will choose to use an existing piece of vein taken from the same leg. Man-made graft materials (such as polytetrafluoroethylene [PTFE] or Dacron) are more likely to become narrowed again, but they are still effective.
The section of vein or man-made blood vessel graft is sewn onto both the femoral and popliteal arteries so that blood can travel through the new graft vessel and around the narrowed or blocked area.
General anesthesia or an injection in the spine (epidural) is used for this surgery. General anesthesia will cause you to sleep through the procedure. An epidural prevents pain in the lower part of the body.
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