ENDOVASCULAR TREATMENT OF ANEURYSMS (BALLOONS) AND DISSECTIONS (TEARS) AT LEG-ARM AND SOLID ORGAN ARTERIES
What is it?
Aneurysm or ballooning is a condition where a vessel is enlarged more than it should; is ballooning. Dissection is when a vessel ruptures, causing obstruction or bleeding. Aneurysms can be divided into two main groups as true (involving all vessel layers) and pseudoaneurysms (pseudoaneurysm, not involving all layers). Aneurysms larger than 2 cm are usually recommended to be treated. Solid organ aneurysms refer to the abnormal dilation or bulging of an artery in a solid organ of the body, such as the liver, spleen, or kidney. These aneurysms can occur due to weakening or damage to the artery wall, which may be caused by various factors such as trauma, infection, or atherosclerosis (a buildup of plaque in the arteries). The most common types of solid organ aneurysms are hepatic (liver) and splenic (spleen) aneurysms. While these aneurysms are typically asymptomatic, they can lead to serious complications such as rupture, which can cause internal bleeding and even be life-threatening. Treatment of solid organ aneurysms may involve surgical intervention, such as endovascular repair or open surgery, depending on the size and location of the aneurysm and the overall health of the patient. Regular monitoring and management of any underlying conditions, such as high blood pressure or atherosclerosis, can also help prevent the development or progression of solid organ aneurysms.
Why is it done?
The wall of the ballooning vessel structure weakens and as it expands, the risk of bursting increases. Exploding ballooning can cause serious problems. For this reason, ballooning that has the risk of bursting should be treated. Vascular ruptures (dissections) may cause tissue death by creating obstruction in the area they feed, or cause problems related to nutritional disorder, which we call ischemic changes. Tears can also protrude (rupture) causing bleeding.
How is it done?
There are different treatment options according to the shape, location and width of the ballooning and tearing. Generally preferred endovascular treatment methods include a coil (metallic coagulant coils) or covered stent (covered metallic tube) or vascular plug for aneurysms;
After placing an inguinal sheath, with the help of thin wires and pipes, the area of aneurysm or rupture would be reached. Stents, graft, coils or embolizing agents would be applied. The aim is to exclude ballooning or rupture, to prevent it from bursting, causing vascular occlusion, and to maintain normal tissue nutrition.
Risks and Complications of the Procedure
Depending on your age and current health condition, the following risks and undesirable conditions may occur during the procedure.
1- Contrast substance reactions:
a) Anaphylactoid reaction: It is a serious allergy-like reaction, which can lead to death.
b) Spasm and edema in the respiratory tract: It causes respiratory distress.
c) Mild allergic reactions: Sneezing, tearing, redness in the body, urticaria (hives).
d) Feeling of warmth at the injection site, pain.
e) Nausea, vomiting.
f) Kidney failure. Most failure is temporary. Permanent renal failure and treatment may be required in a very small proportion of patients.
g) Heart rhythm disorders, low blood pressure
h) Epilepsy (episodic seizure).
These undesirable conditions occur between 2 and 5 out of 1000 patients. Death is extremely rare. Despite all the interventions, a patient may die in every 250,000 – 400,000 procedures.
2- Complications related to the entry site:
a) Due to infection at the incision site; redness, pain, discharge or abscess may occur.
b) Dissection (separation in the vessel wall)
c) Vascular occlusion or narrowing. Malnutrition may occur that requires treatment through surgery or angiography.
d) Aneurysm (pouching in the weakened area of the vessel wall), pseudoaneurysm (posing that occurs around the vessel due to the inability to close the entrance in the artery), bleeding, nerve damage.
e) Arteriovenous fistula (the formation of a connection between the artery and the vein) may result in malnutrition and swelling that requires surgical or angiography treatment in the inserted limb.
f) Temporary or permanent damage to the area fed by the vessels as a result of the catheter causing the interruption of the flow in the vessel due to a previous narrowing in the vessel through which the catheter passes, or the dissection, spasm or coagulation or rupture of the clot by catheter or wire manipulation. In this case, treatment through emergency surgery or angiography may be required.
g) Bleeding. Bleeding may occur in the groin area as well as into the abdomen.
3- Catheter related complications:
a) The guide wire or catheter remains in the vessel by breaking off
b) Separation (dissection) of the vessel wall by insertion of the wire or catheter into the vessel wall
4- General complications:
b) Vasovagal reaction (fainting)
5- Complications related to the materials used
c- Closing a non-targeted area and related nutritional disorders
6- rupture and bleeding in aneurysms
7- death <1%