Aortic – AAA or abdominal aortic aneurysms are the commonest manifestation of this condition where the wall of the main artery in the abdomen thins and the artery balloons out leading to a dilated sac. This does not cause any symptoms and most patients are unaware that they have an aneurysm. Left untreated however, most aneurysms continue to enlarge and are more at risk of rupturing (often a fatal complication) the larger the size they reach. Aneurysms are commoner in men and can run in families or be associated with hypertension and atherosclerosis without a family history. There is now a national screening programme for 65 year old men, but women and younger patients (where the incidence is much lower) are not covered by this. Some aneurysms are more complex and involve the thoracic aorta or the abdominal aorta at the level of the renal and mesenteric arteries (involving the blood supply to the kidneys and guts). These aneurysms require a more specialized treatment plan and often need custom stents or sophisticated surgical procedures only available at larger specialist vascular centres. The Lindo Wing, St Mary’s Hospital has one of the largest experiences of such cases in the UK.
The Lindo Wing, St Mary’s Hospital was the site of the world’s first installation of endovascular robotics system and our team has pioneered its development. We performed the worlds first robotic endovascular repair and now have the largest series of robotic cases in the world.
- Open surgery for all aneurysms
- Endovascular aortic repair
- Complex custom made stent grafting techniques
- Robotic endovascular aneurysm repair
Peripheral – less commonly aneurysms can affect the popliteal (leg artery behind the knee) or femoral arteries, sometimes palpable as a pulsatile lump. Although aneurysms here behave differently from aortic aneurysms, they often still need treatment to prevent them thrombosing (occluding) or embolising (fragments breaking off) leading to ischaemia of the foot or leg. These aneurysms can be diagnosed with a simple non-invasive duplex scan and can be treated with surgery or, where appropriate, stenting.
- Open surgical bypass
- Endovascular stent graft repair
- Endovascular coiling and occlusion
Rare Vascular Conditions
Rare Vascular Conditions – include aortic dissections, carotid body tumours and vascular malformations. Diagnosis of these conditions requires experience and expertise. They are best managed at high volume specialist centres with a well established tertiary referral practice.