Aortic Aneurysm Repair Made Easy: No Incisions with New Method
By Michael Lasalandra
Beth Israel Deaconess Medical Center Correspondent
Vascular surgeons at Beth Israel Deaconess Medical Center are repairing dangerous aortic aneurysms using a new, minimally-invasive technique that avoids the need for an abdominal incision.
Aneurysms of the aorta, the main artery of the chest and abdomen, are caused by a weakening of the aortic wall. The result is a “ballooning” of the vessel that grows progressively larger and can eventually rupture (burst), causing bleeding that usually leads to death. Aneurysms typically go unnoticed until the time of rupture unless discovered by tests such as ultrasound.
“Aortic aneurysms are seen in about 5% of people over age 60, and are more common in men, people who have ever smoked, and those with a family history of aneurysm,” says Dr. Marc Schermerhorn, Chief of the Section of Endovascular Surgery at the CardioVascular Institute at BIDMC. Medicare now covers screening tests for aortic aneurysm.
If diagnosed early, such aneurysms can usually be treated. The operation involves replacing the damaged aorta with a graft that allows blood flow to go through the graft instead of into the aneurysm, eliminating the possibility of a rupture.
In years past, the operation required making a major incision in the abdomen to get to the aneurysm. In recent years, surgeons have been able to use a less invasive technique to access the aneurysm by placing catheters into two femoral arteries, accessing them through incisions in the groin. Using X-rays for proper positioning, the graft is secured in place by inflating a balloon to expand the graft to the size needed to prevent blood flow into the aneurysm.
A recent paper in the New England Journal of Medicine, authored by Dr. Schermerhorn, has shown that the minimally invasive, “endovascular” approach reduces the mortality rate from a national average of about 5% (up to over 10 percent, depending on the age and sickness of the patient) down to one-to-two percent. It also allows for a shorter hospital stay, and patients are more likely to go directly home rather than to a rehabilitation facility. In addition, patients typically experience fewer complications and are able to return to their normal activities more quickly.
Now, the Division of Vascular and Endovascular Surgery, including chairman Dr. Frank Pomposelli and Dr Allen Hamdan, Dr. Schermerhorn and Dr. Mark Wyers, has adopted a new, improved method of endovascular abdominal aortic aneurysm treatment called Total Percutaneous AAA Repair, which allows access without cutting into the groin.
“We can now repair the aneurysm even without an incision in the groin,” Dr. Schermerhorn says. “We find the artery with ultrasound and use a small needle to puncture the artery and insert the devices through this small puncture. We then use a special device to allow us to tie a suture on the artery directly through the skin.”
“We cover the puncture site with a band aid and send most people home the following morning,” he says. “This allows an even faster return to normal activity and cuts down on pain and infection risk.”
“We’re doing this in over 90 percent of our patients,” he says.
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted January 2009
