Endovascular Stents

Although I have written mostly about cardiac cases because they are the most exciting and memorable, we cover a lot of vascular cases as well. The smaller ones like varicose vein surgery, amputations, and fistula creation for dialysis are straightforward. But some of the more interesting surgeries include stenting of aortic aneurysms. Aortic aneurysms, weakness in the wall leading to dilation of the vessel, form in elderly hypertensive smokers and can be life threatening if they rupture. In the past, open surgical procedures were accompanied by high morbidity and mortality, but the development of endovascular approaches where the surgeons go up a leg vessel and deploy a graft to stabilize the aneurysm has helped us treat patients who previously had no recourse.

The anesthetic for these is not complicated; surgeries last an hour or two and patients do well afterward. But it's fun for me to be able to see on fluoroscopy the progress of the surgeons and the anatomy of the vessels. Furthermore, for some aneurysms, like those in the thoracic region, we put in a lumbar CSF drain. We don't do this often, but it's not hard because it is simply placing an epidural catheter in the spinal space (rather than the usual epidural space). I believe in the future, more and more high risk surgery will be done with minimally invasive approaches as intravascular valve replacements and aortic stenting become more widespread.

Image of a stent in the abdominal aorta is in the public domain, from Wikipedia.