SURGEONS IMPLANT 100
TH GRAFT: LESS INVASIVE OPTION USES STENTS TO FIX ABDOMINAL ANEURYSMS
GREENVILLE—Once the only surgical treatment for a weakening, or aneurysm, in the main artery from the heart to the lower body involved a 10-inch incision and weeks of recuperation. Since the mid-1990s, a minimally invasive surgical approach has been proving itself to be a viable option for vascular surgeons in their repairs of abdominal aortic aneurysms.
On Feb. 12, a Rocky Mount man received the 100th minimally invasive endovascular graft to repair an abdominal aortic aneurysm by vascular surgeons at the Brody School of Medicine at East Carolina University. In 1996, ECU was one of 20 medical centers chosen to test the then revolutionary less-invasive approach.
Dr. Frank Parker, ECU assistant professor of surgery, performed the procedure, now almost commonplace, to correct the bulging aortic aneurysm in the 77-year-old man’s abdomen.
In the process, known as endovascular grafting, the aortic aneurysm is reached through a catheter inserted into a blood vessel in the groin area instead of through a large abdominal incision. The graft, a polyester mesh tube, is then delivered to the site of the aneurysm in the aorta; metal attachment devices on each end of the graft fix it in place, excluding the bulging aneurysm.
The patient, Chuck Muller, was discharged from Pitt County Memorial Hospital Wednesday. “The operation went fantastic. He awoke from surgery with no pain and was doing fine on the afternoon of the procedure,” Parker said.
Muller will need three or four days of “light duty” around the house to recuperate from his surgery, Parker said. “I usually tell my patients they can go out and work in their gardens, do light housework or cook, but no heavy lifting for about a week. Then, they can go back to their normal activity level in about two weeks if they feel up to it,” Parker said.
An abdominal aortic aneurysm involves the widening or stretching of the aorta, the main artery carrying blood from the heart to the lower half of the body. At the site of the aneurysm, the aorta bulges like a weak spot in a tire.
Left untreated, abdominal aortic aneurysms can leak or rupture causing serious bleeding and death. Half of all persons with untreated abdominal aortic aneurysms that are greater than two inches in diameter will die of rupture within five years. Albert Einstein, Lucille Ball, Conway Twitty and George C. Scott died from ruptured abdominal aortic aneurysms.
Abdominal aortic aneurysms are most common after the age of 60. Males are five times more likely than females to be affected. Approximately five percent of men over age 60 develop an abdominal aortic aneurysm with the most common cause being hardening of the arteries, or arteriosclerosis.
Traditionally, repair of an aortic aneurysm involves an abdominal incision of 10 or more inches to allow full access to the abdominal cavity by the surgeon. During the procedure, the surgeon removes the aneurysm and sews a synthetic tube in its place to allow proper blood flow. For patients who don’t qualify for the minimally invasive surgery, the traditional approach is still used with excellent results, Parker said.
For endovascular grafting to work, the patient’s aorta must have enough healthy tissue above and below the aneurysm for the graft to be attached and for a seal to form. The graft cuts off the blood supply to the aneurysm but allows blood to flow through the graft to the aorta below the aneurysm.
In November 1996, vascular surgeons from the ECU medical school were chosen by the Food and Drug Administration to test the minimally invasive endovascular graft approach. That device, Ancure made by the Guidant Corporation, is one of two such devices approved by the FDA; the other is AneuRx, made by Medtronic. ECU vascular surgeons can use either graft depending on the best anatomic match to the patient. Dr. Bill Bogey, who has been a vascular surgeon for more than 10 years, was part of the FDA Phase II clinical trial testing the Ancure device.
“The only option 10 years ago was an open repair which involves a large abdominal incision, a week in the hospital with one or two of those nights in the intensive care unit, and then a three- to four-week convalescence at home,” said Bogey, ECU professor of surgery. “Basically, a rough estimate is six weeks before the patient is functioning at their pre-surgery level of activity.”
Parker said that the less-invasive endovascular repair is an option for 30 to 40 percent of the abdominal aortic aneurysm patients whom he and his fellow vascular surgeons see at the Brody School of Medicine. “New devices are coming out in the next year that will increase that number another 10 to 15 percent,” he said. A restricting factor now is the size of the patient’s normal aorta above the aneurysm—in other words the size of the stent needed to perform the repair. The current device allows for an aorta 26 mm (roughly one inch) in diameter to be repaired; the newer devices will allow repair of aortas measuring 30 mm. “It is only four millimeters but it will make a big difference. It will allow even more of the population to have this less-invasive approach as an option,” Parker said.
The two approaches to repair an aneurysm—open and less invasive—both take about one-and-one-half to two hours in the operating room barring any complicating factors, Parker said. The real benefit is evident in the less blood loss, shorter hospital stays and recovery times.
“We’ve had some patients on the afternoon of the procedure say that they are ready to go home,” Parker said. “As a precaution, we make them stay in the hospital at least one night. That’s a big difference between the endovascular-repair patients and the open-repair patients who are still in the intensive care unit on the first day after surgery.”
