Endovascular surgery can be used to treat patients with an aneurysm or weakening of a blood vessel wall. As opposed to open surgery that repairs vessels from the outside through an incision and opening in the bone, endovascular surgery can be performed within a blood vessel.
The primary use of endovascular surgery is to prevent and treat the rupture of a brain aneurysm that can cause bleeding in the brain. Approximately 30,000 people in the United States per year suffer a brain aneurysm rupture according to the Brain Aneurysm Foundation.
Groups at greater risk of developing a brain aneurysm include women, African Americans, smokers and people with uncontrolled high blood pressure. Those who have already had a ruptured aneurysm are at a slightly higher risk for developing a separate aneurysm. Individuals who have two immediate relatives with a history of bleeding into the brain from an aneurysm are at greater risk of developing a cerebral aneurysm and should be screened around age 35 or 40.
Brain aneurysms are often not discovered until they rupture, although they can present with symptoms related to local pressure in the brain. Symptoms of a ruptured brain aneurysm include severe headaches, nausea and vomiting, neck pain or stiffness, loss of consciousness, seizures and light sensitivity.
Detection and Diagnosis
Quick detection and diagnosis of a brain aneurysm is crucial due to the risk of a catastrophic rebleeding episode. The highest risk of rebleeding after a brain aneurysm ruptures is during the first 24 to 48 hours.
Brain aneurysms are detected with imaging procedures, such as CT scans, MRIs and catheter angiograms. Ruptured brain aneurysms are commonly diagnosed via a CT scan, which detects blood inside the brain. A catheter angiogram is used to evaluate the blood vessels of the neck and brain.
During endovascular surgery, a flexible catheter is inserted into the femoral artery (at the top of the right leg) and advanced directly into the aneurysm. Detachable coils and stents can be inserted to block the flow of blood into the aneurysm and cause it to become clotted. Fluoroscopic imaging is used to visualize the patient's blood vessels and show progressive blockage of the aneurysm as the coils are placed within it.