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Vascular Disease

Vascular Disease

Vascular Disease

There is a severe shortfall of genuine vascular care in our country. At Kokilaben Hospital, we offer authentic comprehensive vascular care through a world-class facility.

What is an Aneurysm?

Aneurysm is ballooning out or bulging of the wall of the blood vessel. This occurs because of weakening of the wall of the blood vessel. It may involve the whole circumference or only a localised segmental wall of the blood vessel.

Why does the wall of the blood vessel become weak?

Wall of the blood vessel consists of three layers:

Inner : Intimal lining

Middle : Thick muscular layer

Outer : Fibrotic attachment – Adventitia. It is the middle layer which becomes weak

The flowing blood inside the blood vessels exerts pressure on the weak wall and leads to aneurysm formation.

What is Aortic Aneurysm?

Aorta is the main blood vessel distributing blood to all parts of the body. It carries blood at a high pressure: i.e. 120/80 mm of mercury, in a normal individual.

When the aorta starts dilating or bulging, it is called Aortic Aneurysm. When the aorta in the chest enlarges, we call it Thoracic Aortic Aneurysm (TAA) and in the abdomen, it is called Abdominal Aortic Aneurysm (AAA).

Who are at high risk of developing Aortic Aneurysm?

There are known risk factors which lead to development of Aortic Aneurysm.

These are:

  • Elderly Patient's above 65 Years
  • Hypertension
  • Atherosclerosis
  • Some congenital conditions – like Marfan's Syndrome
  • Family history
  • Trauma
  • Infection/inflammation of Aortic wall. Some of these condition occur in young patients
  • Smoker, Diabetes, Renal Disease etc

How does a person know he has developed an aneurysm of the aorta?

In majority of cases, aneurysm is detected incidentally, during test like x-ray of the chest, abdomen, or spine. Ultrasonography or CT/MRI can detect aneurysm.

However, few patients' can have symptoms like Thoracic Aortic Aneurysm:

  • Pain in the chest or back
  • Difficulty in breathing or swallowing
  • Persistent cough
  • Hoarseness of voice
  • Blood while coughing or vomiting is a dangerous signs

Abdominal Aortic Aneurysm

  • Pain in the back
  • Mass in the Abdomen
  • Abnormal Pulsation

Loss of consciousness drops in blood pressure, sweating, and distension of abdomen signifies rupture of aneurysm.

Why is Aortic Aneurysm dangerous?

Rupture of the aneurysm leads to sudden leak of blood, which leads to drop in blood pressure and loss of blood. This is associated with high risk of death and poor health. This event occurs rapidly and often, patients cannot survive and may not reach the hospital.

Are there any screening tests that can detect Aortic aneurysm?

People who are at high risk of developing Aortic Aneurysm should undergo regular check-up like x-ray chest and/or ultrasonography. In fact, every male over 65 years of age should undergo sonography. One should demand for screen for Aortic Aneurysm when you go for sonography/x-ray chest or general body health check up program.

What are the criteria to determine risk of rupture or patients needing treatment?

Diameter size of the aortic aneurysm is the main criteria to decide treatment of the size of the aorta becomes double the size of normal aorta, then this aneurysm needs treatment or else it is at higher risk to rupture.

In the thorax: If the aneurysm is > 5.5 cm in size.

In the abdomen: If the aneurysm is > 5 cm in size.

In some patients and conditions even a smaller size of the aneurysm needs urgent treatment.

Presence of calcium, some symptoms, eccentric bulge, and infective aneurysm with aneurysm in females may need early treatment.

How do you treat Aortic Aneurysm?

When Aortic Aneurysm is detected it is important to meet a doctor. Control of blood pressure, avoiding or countering the possible risk factors and avoiding exertion and jerks in the chest, abdomen with back are some of the standard care. If the aneurysm is smaller than the critical size then a close check up every 6 months is necessary. USG/CT scan can be undertaken to monitor the size.

If these care and precautions are ignored then there is high risk of rupture of the aneurysm. This is associated high morbidity, mortality, and cost.

What if the aneurysm is larger than the critical size?

Critical size:

Thoracic Aorta = 5.5 to 6 cm

Abdomen Aorta = 5 cm

Aneurysm larger than this size needs urgent interventions such as:

Surgical repair

Endovascular stent graft

Hybrid-surgery + Endovascular

These are complex procedures, needs general anaesthesia, stay in the ICU and hospital. Complications and death risk are 5 to 7 per cent in most of the cases.

Treatment

Angioplasty / Stenting

Atherosclerosis Deposition of Cholesterol

Lumen of the blood vessel reduces with deposition of cholesterol (fatty substance) on the inner lining of the blood vessel. This reduces the flow of blood in the vessel and supply of oxygen to the tissue.

What is Angioplasty and how does it work?

Angioplasty is a procedure wherein a catheter with a balloon is introduced at the site of blockage. With inflation of the balloon, the plaque is compressed and fragmented. This improves the luminal diameter of the blood vessel and hence the blood flow.

What is a stent and how does it work?

Stent is a mesh like metallic spring like tube. Stent scaffolds the blood vessel wall and prevents the blood vessel from re-blocking.

What is endo-vascular stent graft?

Stent-grafts are specialised medical devices which a metallic spring like device, this is a medical fabric stitched. This forms a closed tube-a new tube within the aorta. Outside the graft, blood does not flow and forms a clot. Inside the stent graft, blood flows normally. Hence, the stent graft actually excludes the aneurysm. Hence, the risk of rupture of the aneurysm reduces. Over a period the dilatation of the aorta remodels and reduces in diameter.

Do you recommend endovascular stent graft treatment for all patients? How many such procedure have you performed?

Based on the CT angiography findings, we as Interventional Radiologist plan and decide the treatment.

The advantages of endo-vascular treatment are:

  • No need to open the chest or abdomen to deliver and deploy the stent graft.
  • Small surgical cuts in the groin are all that is needed.
  • Patient with other co-morbid condition can also be treated by this method.
  • ICU and hospitalization is much less than open surgery (average 4 to 5 days).
  • Patient can be mobilized in 1 to 2 days.
  • Better tolerated by the patient
  • Being minimally invasive, as compared to open surgery, it is definitely the first choice.
  • However, certain anatomical status and medical conditions demands open surgery or hybrid procedure (i.e. surgery + endo-vascular).

How expensive is Endo-Vascular procedure?

Cost varies depending on the anatomical findings on CT scan. The average cost of the stent graft is Rs. 4.5 lakhs to 6.0 lakhs. Added to this is the cost of hospitalization, OT/ICU and catheter lab. Other consumables had doctors fee would vary.

Where do and go to check and get treated for Aortic Aneurysm?

To detect Aortic Aneurysm ultrasonography, CT scan or MRI studies are performed at Radiology Clinics. However, qualified and trained Interventional Radiologist is capable of guiding patients in the management of Aortic Aneurysm. Other specialist like vascular surgeons, CVTS surgeon and some cardiologists too treat Aortic Aneurysm.

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