At Home with Chris Jessen 2018 - 73
MEET THE EXPERT
Rachel Bell has
been a consultant
at Guy's and
St Thomas' NHS
London, for 11 years.
She is the deputy
clinical director for
division and also the network director of
the South East Vascular Network.
Rachel qualified from Guy's and
St. Thomas' Medical School in 1994
before completing surgical training in
London and the south east.
She is secretary of the British Society
for Endovascular Therapy and has
been a council member of the Vascular
Society of Great Britain and Ireland.
Rachel's specialist interests are in
endovascular aortic aneurysm repair
(EVAR and TEVAR), open surgical
repair of aneurysms, carotid surgery and
minimally invasive treatment of varicose
veins. In the NHS, she leads a team
that specialises in the management of
patients with infected aortic grafts.
SURGERY OR A MINIMALLY INVASIVE
PROCEDURE IS THE ONLY WAY TO GET RID OF
THOSE VARICOSE VEINS FOR GOOD
An aneurysm occurs when an artery in
the body is much bigger than it should
be. When abdominal aortic aneurysms
are larger than 5.5cm in diameter, the
aorta is at risk of bursting - however,
the good news is that surgeons can
repair them before this happens.
There are two main ways of repairing
an aneurysm. One is open surgery,
where a cut is made in the abdomen
and a synthetic graft is stitched in place
to repair the damaged section of the
aorta. The alternative is a minimally
invasive procedure using a stent graft
to reline and reinforce the wall of
the aorta - this is called endovascular
aneurysm repair (EVAR).
It's a clever use of technology - a tube
of material with an outer metal skeleton
(the stent graft) is created to line the
damaged part of the aorta and then
collapsed down and inserted into
a delivery catheter, or tube. Then, the
delivery tube is inserted into the body
via a small cut in the artery at the groin
and then pushed up inside the aorta.
The stent graft is positioned in the aorta
with the help of X-rays, before being
released from the delivery tube. The
aorta is depressurised and the risk of the
aneurysm bursting prevented.
Most patients opt for EVAR over open
surgery because it is safer and requires
a shorter hospital stay of around two
days. Additionally, the procedure can
be completed under epidural or a local
anaesthetic, which is safer than a
general anaesthetic. Rachel says
patients also choose EVAR because
the recovery time is quicker.
EVAR has a low mortality rate - less
than 1% compared to open surgery,
which has a mortality rate of around 4%.
And with increasingly sophisticated
technology, almost any aneurysm can
be treated with a stent graft.
However, after the repair, EVAR
patients will need to be kept under
surveillance for a short time. It's just a
routine precaution, to keep an eye on
the graft in case any concerns arise that
might need further intervention.
FOR MORE INFORMATION
Call 020 7407 3100