February 3, 1999
New minimally invasive technique repairs ballooned aorta without major surgery
Doctors at the Veterans Affairs Puget Sound Health Care System and the University of Washington School of Medicine have successfully used an innovative new technique to repair aortic aneurysm, a life threatening ballooning of the body?s main artery. In the past week, three individuals have undergone an innovative and minimally invasive procedure known as “stent grafting” to repair a bulging abdominal aorta. All three are recovering well, says Ted R. Kohler, M.D., chief of vascular surgery at the VA Puget Sound Health Care System in Seattle, and UW professor of surgery. The patients, all veterans, had not previously utilized health care at the VA. Their doctors sought out the VA specifically because of this new innovative procedure said Dr. Charles B. Smith, chief medical officer at the VA, and associate dean of the UW School of Medicine.
Dr. Kohler, and interventional radiologist David J. Glickerman, M.D., chief of interventional radiology at the VA Puget Sound Health Care System 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 VA team was selected to evaluate this device because of their experience with treating aneurysm patients, and because of 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 points out “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 notes, and 15,000 people die when a weakened aorta bursts. Some 20% 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. This new procedure offers enormous potential advantages over traditional surgery to repair the problem, he adds. 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 five percent of all people with symptoms of coronary artery disease and nine 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, and having high blood pressure and family history. 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 endovascular program at the VA is a joint effort of the Divisions of Vascular Surgery and Interventional Radiology. Endovascular therapy consists of repairing blood vessels by working from the inside of the blood vessel. Working collaboratively, the surgeons and radiologists are able to perform minimally invasive procedures in a very sophisticated manner, by combining the unique skills of both specialties. Interventional radiologists are skilled at guiding catheters throughout blood vessels using fluoroscopy (x-ray images) and in using balloons and stents to open blockages in blood vessels. Vascular surgeons are experts in repairing blood vessels using scalpels, sutures and fabric-like graft material and in caring for patients with vascular disease. This innovative procedure will offer new options to veterans throughout the region.
The VA Puget Sound Health Care System and the University of Washington School of Medicine have been effective partners in establishing this program. The VA Puget Sound Health Care System is an affiliated medical center of the University of Washington School of Medicine, one of the country’s leading medical teaching and research institutions. The UW School of Medicine’s surgery and radiology programs are nationally recognized. The Veterans Integrated Service Network funded this new suite. It combines state-of-the-art angiography facilities with a fully equipped operating room. Plans are underway for similar facilities to be built at the University of Washington and Harborview Medical Center.
