Stent-grafts used for aortic aneurysm

Physicians at the UW School of Medicine and Veterans Affairs Puget Sound Health Care System have successfully used an innovative new technique to repair aortic aneurysm, a life-threatening ballooning of the body’s main artery. In late January, three individuals had an innovative and minimally invasive procedure known as “stent grafting” to repair a bulging abdominal aorta. All three are recovering well, said Dr. Ted R. Kohler, professor of surgery and chief of vascular surgery at the VA. The patients, all veterans, had not previously utilized health care at the VA. Their doctors sought out the VA specifically because of this new procedure, said Dr. Charles B. Smith, chief medical officer at the VA and associate dean of the School of Medicine.

Kohler and interventional radiologist Dr. David J. Glickerman, chief of interventional radiology at the VA and UW associate professor of radiology, head the interdisciplinary team that used this new technique to treat the aortic aneurysms. These patients were treated as part of a trial to test a stent graft manufactured by Medtronic, Inc. The team was selected to evaluate this device because of their experience with treating aneurysm patients and their expertise in using other endovascular treatment techniques.

“Traditional surgical repair involves major risks, particularly in older patients. It requires general anesthesia, a long abdominal incision, days in the hospital’s intensive care unit and several months for complete recovery,” Kohler noted. “Instead of needing a major operation, we can now do this through a small incision in the groin. Everybody has just been floored at how fast our stent-graft patients are up and around and can leave the hospital.”

Each year about 100,000 Americans are diagnosed with aortic aneurysms, Kohler noted, and 15,000 people die when a weakened aorta bursts. Some 20 percent either die or suffer serious complications following traditional surgery. Although it targets a much larger artery, the new “stent graft” technique resembles that used in angiography and balloon angioplasty, mainstays in diagnosis and treatment of blood vessels.

The graft consists of a polyester tube supported by wire mesh folded tightly inside a catheter. During the procedure, the patient is awake (under spinal anesthesia) as physicians thread the catheter into the femoral artery through a small incision in the groin. Guided by fluoroscopy, they then maneuver the catheter up to the aorta and release the graft. The tube pops open, bridging the diseased artery segment.

The body’s largest artery, the aorta emerges from the heart and branches into the abdomen, supplying the vast network of arteries carrying blood to the tissues. Its normally strong walls can be badly damaged by atherosclerosis. Constantly hammered by the heart’s forceful beat, the weakened aorta may then begin to bulge and eventually burst. An estimated 5 percent of all people with symptoms of coronary artery disease and 9 percent of those with artery disease in vessels outside of the heart (such as the neck’s carotid arteries) have aortic aneurysms. Contributing factors include a history of smoking, being male, having high blood pressure and a family history of the condition. Although some patients have symptoms such as backache or a pulsing sensation in the abdomen, many aortic aneurisms are “silent” potential killers. Careful physical examination and ultrasound are used to detect the condition.

The Veterans Integrated Service Network funded the new suite used for the procedure. It combines state-of-the-art angiography facilities with an operating room. ¶