The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on endovascular stent-graft placement in thoracic aortic aneurysms and dissections.
This procedure is used to treat aneurysms of the descending aorta within the thorax. Weakening of the wall of the aorta, due to atheroma, high blood pressure, or, less commonly, infection, can lead to an aneurysm. Aneurysms may rupture, causing internal bleeding.
Aneurysms of the thoracic aorta are potentially serious. Untreated, five year survival is 10 to 15%. Ruptured thoracic aneurysm is almost always fatal, even with treatment.
Aneurysms of the thoracic aorta are relatively uncommon. Conventional surgery involves replacing the affected part of the aorta with a graft. The operation usually takes several hours and postoperative recovery can be prolonged.
Stenting involves placing a tube inside the aorta under X-ray control. Specialized catheters and wires are used to introduce the stent, most commonly through the femoral artery.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.