Aortic Aneurysm Repair Made Easy
No Incisions with New Method
By Michael Lasalandra
Beth Israel Deaconess Medical Center correspondent
Surgeons at Beth Israel Deaconess Medical Center are repairing dangerous aortic aneurysms using a new technique that not only avoids the need for an abdominal incision, but also does away with having to cut into the groin.
"We do it through a small nick in the skin," says Dr. Allen D. Hamdan, Clinical Director of the Division of Vascular and Endovascular Surgery at BIDMC. "We put a Band-Aid over it when we're done. I performed one recently on a 98-year-old woman. She went home the next day."
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 rupture at any time, causing instant death.
If diagnosed early, such aneurysms can be easily treated. The operation involves placing a prosthetic graft reinforced with metal stents that prevents blood flow from affecting the aneurysm as it flows through the graft instead, eliminating the possibility of a rupture.
In years past, the operation involved making a major incision in the abdomen to get to the aneurysm. In recent years, surgeons have been able 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. These groin incisions can be problematic for patients, causing pain, swelling and possible infection.
The new endovascular approach reduces the mortality rate from as high as 10 percent, depending on the age and sickness of the patient, down to 1 to 2 percent, according to Dr. Hamdan. It also allows for a shorter hospital stay and a quicker return to normal activities.
Now, BIDMC has adopted this new, improved method of endovascular abdominal aortic aneurysm treatment, called Total Percutaneous AAA Repair, which allows access without cutting into the groin.
"We avoid cutting into the groin at all," Dr. Hamdan says. "Instead, we insert a tiny suturing device directly through the skin. There's no incision, no wound, no bleeding. There's a much faster return to activity."
While mortality rates are essentially the same as with the original endovascular repair approach, the new method is easier on the patient in a variety of ways, including less chance of infection and a quicker recovery, Dr. Hamdan says.
"We're doing this in 95 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 March 2013