Loyola University Medical Center in Maywood, Ill., is the first Chicago-area hospital to use a new device that will allow physicians to repair more abdominal aortic aneurysms with a minimally invasive endovascular technique.
Jae Sung Cho, MD, used a catheter to deploy the custom-made device in a patient, Frank Pearson, 76, of Elmwood Park, Ill. The device’s trade name is Zenith® Fenestrated Endograft.
The new device, which was recently approved by the Food and Drug Administration, allowed Pearson to avoid major surgery. He went home with just two small incisions in his groin. He marvels at how easy his surgery was compared with two friends who underwent open surgery for abdominal aneurysms.
An abdominal aortic aneurysm (AAA) is a life-threatening bulge in the aorta, the major blood vessel that extends down to the abdomen. If the aneurysm bursts, the patient could bleed to death.
The new device benefits patients such as Pearson who have an aneurysm that encroaches on the kidney arteries, known as a juxtarenal AAA. Holes (called fenestrations) are cut into the device at the precise locations where the arteries branch off. (Before surgery, Cho orders a 3-D CT scan to determine exactly where the manufacturer should cut these holes in the custom-made device.) Through these holes, additional devices are placed into the kidneys and intestine vessels to repair the aneurysm and maintain blood flow.
Aneurysms that are well below the kidney arteries (known as infrarenal AAAs) have been repaired with the less-invasive endovascular technique since the late 1990s. But until now, juxtarenal AAAs have required open surgeries. The new technology will enable more patients with complex aneurysms to qualify for endovascular surgery.
About 60 percent of AAAs have been treated with the conventional endovascular technique. “This new technology will significantly increase this percentage, allowing more patients to benefit from endovascular repair, which is much less invasive than open surgery,” Cho said.
An aneurysm can be repaired with open surgery or the newer endovascular technique. In the endovascular technique, Cho uses a catheter to place a stent graft in the aorta. A stent graft is a Dacron® tube supported by metal webbing. Cho inserts the catheter in a groin artery and uses the catheter to guide the stent graft to the aneurysm. After he deploys the stent graft from the catheter, the device expands outward to line the walls of the artery. Blood now flows safely through the stent, rather than through the bulging aneurysm.
A patient treated with the endovascular technique typically goes home after a day or two in the hospital and returns to normal activities in a week. By comparison, an AAA patient who undergoes open surgery typically stays in the hospital for a week, and it takes about three months to fully recover.
Risk factors for AAAs include smoking, high blood pressure, family history, being age 60 or older and being a male. The U.S. Preventive Services Task Force recommends one-time ultrasound screening for AAAs in men ages 65 to 75 who have ever smoked.
Cho, a nationally known specialist in the treatment of vascular disease, is Loyola’s director of Vascular Surgery and Endovascular Therapy. He is an innovator in minimally invasive approaches to vascular disease, especially of the abdominal and thoracic aorta. He is a professor in the Departments of Surgery and Thoracic & Cardiovascular Surgery at Loyola University Chicago Stritch School of Medicine.