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State-of-the-Art Endovascular Procedures

As a recognized leader in state-of-the-art vascular disease management, Hoag’s multidisciplinary team of cardiovascular experts provides the most advanced vascular disease treatment options available with clinical outcomes that rival national figures.

At Hoag, conventional vascular surgical techniques are being replaced by an expanding set of non-surgical, endovascular procedures that consist primarily of state-of-the-art catheter-based procedures and percutaneous stent procedures. In addition, Hoag is the first in Orange County to provide ground-breaking hybrid techniques.

Two of the minimally invasice innovative procedures used in repairing aortic aneurysms include Endovascular Stent Graft Repair and Fenestrated Aortic Endograft. Both are discussed below.

Endovascular Stent Graft Repair

Instead of open aneurysm repair, if your aneurysm location and shape is suitable, your vascular surgeon may consider a promising, newer procedure called an endovascular stent graft.

Endovascular means that the treatment is performed inside your body using long, thin tubes called catheters. The catheters are inserted in small incisions in the groin or arms, and are guided through the blood vessels. During the procedure, the surgeon utilizes live x-ray pictures viewed on a video screen to guide a stent-graft to the site of the aneurysm. Like the graft used in open surgery, this stent-graft allows blood to flow through the aorta without putting pressure on the damaged wall of the aneurysm. This keeps the aneurysm from rupturing. As a result of this procedure, over time, the aneurysm usually will shrink.

Endovascular repair of thoracic aneurysms is generally less painful and has a lower risk of complications than traditional open surgery because the incisions are smaller. In addition, endovascular procedures also allow you to leave the hospital sooner and recover more quickly.

With the endovascular stent-graft repair, it is particularly important that long-term follow-up with periodic scans of the aortic repair be done to be sure that the stent-graft is functioning properly. Sometimes further procedures are required to maintain the stent-graft if leaks develop or if it moves out of position.

Hoag Cardiovascular surgeons are also in the process of using Fenestrated Aortic Endografts to treat more complex thoracic aneurysms involving the aortic arch and thoracoabdominal aneurysms (those which involve the aorta both in the chest and the abdomen). Additionally, branched and fenestrated grafts are used to extend thoracic grafts to repair those aneurysms that involve the vessels leading to the intestines or the brain and arms. (For more about Fenestrated Aortic Endograft, see below.)

For those patients with extensive aortic or multiple aneurysms, the best approach may require a combination of open surgery and endovascular repair. This combined therapy is referred to as a hybrid approach.

Your surgeon will discuss the benefits and potential risks of the procedure with you.

Fenestrated Aortic Endograft

At Hoag, most aneurysms are repaired using a standard endovascular stent graft when the aneurysm neck is long. However, in some patients, endovascular techniques were not an option in the past. Some needed open abdominal aortic surgery, and in some cases re-implantation of the renal arteries, which is quite a complex procedure.

Today though, thanks to the Cook fenestrated aortic endograft, which was FDA approved in June 2012, nearly all abdominal aneurysms with a short-neck can now be repaired using Cook fenestrated endograft. This treatment option is only available in 30 centers nationwide and two centers in Southern California, of which Hoag Heart and Vascular Institute is one of them.

The fenestrated aortic endograft procedure requires advanced imaging technology only available at Hoag's cardiovascular hybrid surgical room​. Hoag Heart & Vascular Institute, through an expert team of physicians can determine if you are suitable for such a device or any other standard endoaortic devices currently available.

Experience You Can Trust

Hoag’s cardiovascular surgeons are among the highest-volume surgeons in Southern California. They are both highly experienced and highly skilled in the latest techniques and procedures for treating aortic aneurysm, as well as dedicated to providing the most advanced patient-centered care.

Learn more about Jeffrey M. Carlton Heart & Vascular Institute's top rated vascular disease program: