Riambau Alonso Vicente
What is an aneurysm?
An aneurysm is an abnormal narrowing of an artery, normally caused by arteriosclerosis (degenerative hardening of the arteries), hypertension or chronic infections. The majority of aortic aneurysms are asymptomatic. An aneurysm may appear in any artery of the human body, but it more frequently occurs in the aorta, especially at the level of the kidneys and the larger arteries of the legs (abdominal aortic aneurysm).
Abdominal Aortic Aneurysm in Scanner 3D (MMS®)
The different international studies, such as EUROSTAR, among others, demonstrate to us, that the techniques of endovascular repair for thoracic aortic aneurysms offer lesser mortality rates and complications at short and medium-terms. The most feared complication in aortic thoracic surgery is paraplegia because of the danger of having the circulation that carries blood to the spinal column interrupted. Endovascular surgery reduces this risk by three times, although it does not completely eliminate it. We are speaking of a rate of paraplegia of 2%. Although the initial results are spectacular; nevertheless, yearly follow-up for these patients is recommended for the purpose of detecting late complications, which, although rare, are less than 10%, and which require a new repair, generally an endovascular one. Also, patients operated on with open surgery require a post-operative annual check-up, even though the possibility of a re-intervention is less than those operated on with an endovascular means.
In our group, with an experience of more than 250 thoracic endografts, the mortality rate has been 3%, including acute and emergency cases. During the average follow-up of six years, a new repair has been required in 4% of the patients treated endovascularly. Our rate of paraplegia is 1%.
- Research: future directions
Some areas of improvement with respect to the novel endovascular technique exist today. The most relevant aspect, consequently, is the durability of the technique, which depends on the wear and tear of materials and all the systems of implantation. Likewise, the rate of re-intervention is intimately related to the limited durability of the endograft. The present endografts already offer improvements in this sense, which are reflected in materials evermore resistant. Other points to be researched are the behavior of the Type II endoleaks, the so-called endotension: which are the important ones, which ones have to be treated, how to diagnose them and how to prevent them. The cost of the procedure and of the follow-up with instrumental techniques is another element upon which to be improved. The applicability to a greater number of patients will depend, in a large part, on the anatomical limitations for some endografts, thanks to the development of engineering.
All techniques in medicine and surgery are subject to variations and improvements. Endovascular surgery does not escape from these. Because of this, our group finds itself constantly researching and in contact with other international scientific groups, and participating actively in the development of new endovascular products. Proof of this is our group’s organization of the International Symposium of Endovascular Therapeutics, SITE, which takes places every two years in Barcelona. The most eminent experts worldwide assemble at SITE for the discussion and analysis of knowledge on this passionate and revolutionary technique.
Example of technological evolution and technical capacity is the application of endoprosthesis with branches for the visceral arteries. (On the right is a case made by our group).
The application of abdominal and thoracic aortic stent grafts is a consolidated treatment. This technical modality today, is formed, in part, out of the therapeutic availability of the therapeutic novelty of these techniques. There exist determined elements of improvement and limitations, which will, without a doubt, will be resolved in the near future. The best methods, in our opinion, are those, which integrate experience and skills of a multi-disciplinary team, together with the knowledge of engineers who may be developing these grafts.
Our team of professionals remains at the disposal of ensuring excellent care, both in conventional as well as endovascular surgery, to patients who suffer from these types of vascular pathologies, which can have a grave prognosis and a potentially mortal outcome, and, which, fortunately, in many cases, may be resolved in an expeditious, safe and effective manner.
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Monday | 09.00 - 21.00 h | - |
Tuesday | 09.00 - 21.00 h | - |
Wednesday | 09.00 - 21.00 h | - |
Thursday | 09.00 - 21.00 h | - |
Friday | 09.00 - 21.00 h | - |