Aortic prosthesis

What is an aortic prosthesis?

An aortic prosthesis is a vascular prosthesis that is inserted into the main artery (aorta).
It is an implant that is permanently inserted into the body for therapeutic reasons. It replaces vessel sections that e.g. has been damaged by aortic dissection, aneurysm, or trauma. This will repair the defect and aggravate the damage, e.g. a life-threatening rupture of an aortic aneurysm, prevented.

Indications for an aortic prosthesis

The most common indication for an aortic prosthesis is an aortic aneurysm.
With an aneurysm, the wall of the vessel is dilated. If the diameter of the aneurysm becomes too large, an aortic prosthesis must be used. Because the larger the aneurysm, the greater the pressure on the vascular wall and thus the risk of a life-threatening aortic rupture increases. The affected area of ​​the aorta is then replaced by the prosthesis, which can be inserted using various methods.

Aortic dissection is a special form of aneurysm that is also treated with an aortic prosthesis. A crack in the inner vessel wall causes the layers of the vessel wall to split up. Again, there is a risk of aortic rupture.

Another indication is trauma, such as an accident. External forces can cause injuries or even complete rupture of the aorta. An operation should then take place as soon as possible in which the prosthesis is inserted in order to keep blood loss as low as possible.

You can find important information at: Calcifications in the abdominal artery

How is an aortic prosthesis implanted?

There are basically two options for inserting an aortic prosthesis: a vascular surgery or an operation using a catheter.

Aneurysms in the chest, especially on the ascending aorta and the aortic arch, but also in the abdomen, are treated by surgery. The affected part of the aorta is replaced by a tissue tube. During the procedure, a heart-lung machine is used to oxygenate the blood and pump it back into circulation while the aorta is interrupted. In addition, the blood is cooled down to slow down the circulation and to protect the brain.

Catheter interventions are much gentler than surgery. They are mainly used for aneurysms in the Abdomen suitable. A vessel is punctured in the groin and the stent is advanced by catheter to the affected area. There it unfolds and thus surrounds the aorta from the inside and the aneurysm is removed from the bloodstream.

You might also be interested in: Illustration of the aorta

What material is an aortic prosthesis made of?

Aortic prostheses are artificial tissue tubes. They usually consist of plastics such as Polyethylene terephthalate (PET). PET is usually used for large vessels such as the aorta.
PET prostheses are tubular and have a folded surface, making them more flexible and better able to mimic the properties of real blood vessels. Some time after implantation, the inner layer of the prosthesis is naturally occupied by platelets. This creates a layer that is similar to the inner layer of natural vessels.

What are the risks?

In addition to general surgical risks, such as inflammation, wound healing disorders and allergic reactions, there is always the risk of cardiac arrhythmias with an operation near the heart. When the aorta is interfered with, there is always a chance of injuring it, which can lead to bleeding.

An emergency operation on an aortic aneurysm also has a significantly higher risk of complications than a planned operation. Complications can also arise afterwards, such as a rupture of the surgical scar, which can lead to internal bleeding.
In general, however, the risk of an intervention is significantly lower than that of an untreated aortic aneurysm. Because if an aortic rupture occurs, there is an acute danger to life and there is little time for treatment. In order to keep the risks as low as possible, you should go to regular preventive examinations if there are appropriate indications.

Also read: Aortic rupture - it's that dangerous!

What is the life expectancy with an aortic prosthesis?

Life expectancy after using an aortic prosthesis depends on the underlying disease.
The most common disease that is treated with such a prosthesis is the aortic aneurysm. The prosthesis represents a "repair" of the affected area, which normally lasts for life. The factors leading to the aneurysm, e.g. Atherosclerosis, but persists.
So life expectancy depends on how effectively you can fight these underlying diseases in order to avoid further diseases.

More on this topic: Treatment of atherosclerosis

How is the aftercare?

The follow-up treatment depends on the disease that led to the insertion of an aortic prosthesis.

In the case of the aortic aneurysm, the recovery phase after the procedure takes 2-3 weeks for a prosthesis inserted via catheter, and up to 8 weeks for a surgical procedure. The earlier you start to get out of bed and move around, the better the regeneration usually goes. However, you shouldn't strain yourself too much, lifting loads over 5 kg is taboo and should be avoided for 3 months after the procedure. This can lead to a break in the surgical scar.
Furthermore, cardiovascular risk factors such as smoking, diabetes or high blood lipid levels should be reduced. Follow-up treatment also includes follow-up appointments during which the aorta is assessed by ultrasound.

You can find an overview of the diseases of the heart here: Diseases of the heart

Do I need blood thinning / anticoagulation afterwards?

After the procedure, there is usually no need to take extra blood-thinning medication.
The aftercare is mainly about physical rest with a slow increase in stress and regular check-ups in order to detect possible complications at an early stage.