Warsaw/Innovative minimally invasive treatment of aneurysm in the aortic arch

Head of the Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Prof. Sławomir Nazarewski told PAP that the procedure consisted in implanting a stent graft (an artificial vessel) into the aortic arch in an approx. 70 years old patient, who developed an aneurysm - an excessive bulging of that vessel. Stent graft protects the vessel against possible rupture, which would pose a direct threat to the patient`s life.

The procedure was performed by Dr. Tomasz Jakimowicz and his team. It was supervised by Prof. Stephan Haulon, head of the leading aortic disease treatment centre in Paris, president of the European Society for Vascular Surgery.

This is yet another innovative, minimally invasive treatment of the aortic arch aneurysm performed at the Medical University of Warsaw. The Medical University specialists performed the first two such procedures in Poland at the end of 2016 in two patients aged 80 and 85.

Stent grafts are implanted in patients, in whom traditional open chest surgery with extracorporeal circulation would be very risky. These grafts are inserted into the vessel in a rolled form with a catheter, and then expanded to the internal walls of the aorta. As a result, the aneurysm does not pose a risk of bleeding and rupture.

"The difficulty of these procedures lies in the fact that three vessels originate from the convex aortic arch: the brachiocephalic artery, the left common carotid artery and the left subclavian artery" - explains Prof. Nazarewski. Therefore, like in the previous patients, in this case it was also necessary to order this type of intravascular prosthesis tailored for the patient`s aorta, because in each person the aortic arch with vascular branches is slightly different.

The greatest difficulty was the precise placement of the stent graft with the sleeves exactly at the mouths of the appropriate arteries. This graft must be positioned so that its sleeves are exactly in the place of the vessels` exits. Insufficient fit could result in acute cardiac ischaemia and myocardial infarction, or cerebral ischaemia and massive stroke.

According to Prof. Nazarewski, until now the limit of vascular surgeons` activity was the level of the left subclavian artery - that was the point until which cardiac surgeons could operate using the open heart method. The clinic team hopes that the minimally invasive method will become widely used and more available to Polish patients.

Other types of aortic arteries have been treated with the minimally invasive method in the Department of General, Vascular and Transplant Surgery of the Medical University of Warsaw since 1998. Approximately 200 implantations of stent grafts are performed annually. In total, the method has been used in more than 2.5 thousand patients.

In June 2010, the department started a program of treatment of periarenal and thoraco-abdominal aneurysms using stent grafts with holes (fenestrated) and branches. 429 such procedures have been performed, which makes the department the leading centre in Poland and one of the leading centres in Europe and in the world.

In 2016, the Medical University of Warsaw department was the tenth centre in the world to use stent grafts with branches for aortic arch arteries in the treatment of the aneurysms. This is the latest technology used in vascular surgery and access to it is limited to centres with extensive experience in endovascular treatment. (PAP)

Author: Zbigniew Wojtasiński

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