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ECU surgeons use new device to treat thoracic aortic aneurysms
(Oct. 28, 2005)
Vascular surgeons at the Brody School of Medicine at East Carolina University have successfully used a first-of-its-kind minimally invasive device to treat thoracic aortic aneurysms twice in the past six weeks.
The most recent patient, a woman in her mid-60s, was not a candidate for traditional, open-chest surgery to repair the abnormal bulge in the wall of her thoracic aorta, the main artery that carries blood to the body. If not treated, aneurysms can rupture leading to life-threatening internal bleeding.
The new minimally invasive technique is performed under general anesthesia using a four-inch incision in the groin to gain access to the femoral artery, according to Dr. Steven Powell, chief of vascular surgery at the Brody School of Medicine. Surgeons thread a small tube containing the graft, made of expanded polytetrafluoroethylene and a metallic support structure, up through the artery to the thoracic aorta near the heart. There the graft is positioned using X-ray guidance and then deployed inside the aneurysm to reinforce the weakened aortic wall and relieve the pressure that could cause a rupture.
The surgery lasted approximately one hour and was performed Oct. 25 at Pitt County Memorial Hospital by ECU vascular surgeon Michael Stoner with assistance from Dr. Frank Parker, ECU vascular surgeon, and Dr. Curt Anderson, ECU cardiothoracic surgeon. The patient spent one night in the hospital after the procedure and should return to her normal activities by mid-November, Stoner said.
The traditional, open-chest approach involves an incision at least 14 inches in length, five to seven days in the hospital and at least six weeks of recuperation, he said.
"The new minimally invasive procedure dramatically reduces the magnitude of the operation required to treat these life threatening diseases of the thoracic aorta. Recovery is much quicker too," Stoner said.
The new endovascular graft, manufactured by the W.L. Gore company, gained approval from the Food and Drug Administration in late March for use in patients with thoracic aneurysms and other potentially life threatening disorders of the thoracic aorta.
Before the Gore endovascular graft was approved, Powell said, many of these patients were not considered candidates for surgery because the risk of complications was so high, so they were treated with medications and a "watch and see" approach.
"We are going to see more and more of these patients, probably 30 or more a year," said Powell, who is also a professor of surgery. "Because the open-approach surgery is so complex with high risks, it wasn't done for many patients. Now we have a better surgical device so we can offer the surgery to a large population of patients with thoracic aortic aneurysms and thoracic aortic dissecting aneurysms, which is the device's primary use."
Thoracic aortic dissecting aneurysms occur when a tear begins in the wall of the aorta, causing the three layers of tissue to separate and walls of the aorta to weaken and enlarge. If left untreated and allowed to rupture, these relatively rare conditions are fatal. This caused the death of actor John Ritter, Powell said.
ECU surgeons were involved in early clinical trials for minimally invasive techniques to repair aneurysms that are lower in the abdominal aorta and have performed that procedure for several years, hundreds of times, Powell said. "But this endovascular thoracic device is new and represents cutting edge technology for patients with thoracic aortic problems in eastern North Carolina," he said.
Stoner, who completed his vascular surgery specialty training in July at the Massachusetts General Hospital, was involved in a number of minimally invasive thoracic grafting procedures during his fellowship. He joined the ECU faculty this summer. Centers such as MGH and the Cleveland Clinic, where Anderson trained, performed