Minimally Invasive Procedure Repairs Abdominal Aortic Aneurysms
November 10th, 2007
When part of the wall of the largest blood vessel in your body weakens to the point where it could burst, appropriate intervention can mean the difference between life and sudden death. And now, for many patients, there is a minimally invasive option to major open surgical repair of abdominal aortic aneurysms, or AAAs.
“The aorta carries blood directly from the heart down to the legs,” explained Waheed Ahmad, MD, vascular surgeon and medical director of the Vascular Lab at Floyd Memorial. “An AAA is a ballooning in the portion of the aorta that passes through the abdomen. There is a danger that the pressure of the blood flowing through it will cause the weakened section to rupture.”
“When an AAA reaches a diameter of about five centimeters,” said Thoracic and Vascular Surgeon, Franco Rea, MD, “the risk of rupture begins to increase dramatically. It is very important to repair the aneurysm because if it does burst, the mortality rate is over 75 percent.” He added that most AAAs have no symptoms and are discovered incidentally during an examination for an unrelated condition. However, a simple screening to detect them is available.
Open Surgery Versus Minimally Invasive Repair
“In the past,” explained Dr. Ahmad, “the only way to repair an AAA was through a major open surgical procedure that required a large incision in the abdomen, a weeklong stay in the hospital, and a lengthy recovery period. While open surgical repair is a proven procedure with lasting results, not all patients can tolerate such major surgery.” He added, “A technique called endovascular stent grafting has been developed that is much less invasive. We are fortunate that Floyd Memorial has the latest equipment and state-of-the-art facilities for the procedure.”
How Endovascular Stent Grafting Works
Kevin White, MD, a specialist in interventional radiology, often works with AAA patients. As he explained, “When an AAA is discovered, we usually perform a CT angiogram. It is a radiologic study that helps determine whether or not the AAA is favorable for the endovascular placement of a stent graft. A lot is dependent on the anatomy of the aneurysm.” “During the stent graft procedure,” said Dr. Rea, “instead of opening the abdomen, we make one small incision in each groin to reach the femoral arteries. We insert the surgical tools and stent graft into the tiny incisions, thread the graft through the artery and position it inside the aneurysm, all with the guidance of real-time X-ray equipment. Blood then flows through the stent graft, excluding the aneurysm. The patient can usually get up and walk the next morning, with no tubes in the nose or bladder. The hospital stay is only a couple of days. It’s much more comfortable and convenient post-operatively than the open surgery.” Not only is the endovascular surgery more comfortable and convenient, it may be the only option for some patients with numerous medical conditions. According to Dr. White, “Before a major, open surgical procedure, patients must go through a clearance process. Patients with multiple coexisting health problems, a history of prior abdominal surgeries or heart and lung disease, may not be able to tolerate the traditional open procedure. Without the endovascular option, they would be at increased risk of developing complications, or may not be able to have their aneurysm repaired.”
Follow-up is Essential
An endovascular stent graft requires long-term follow-up. According to Interventional Radiologist Seyhan Senler, MD, “Patients usually have a specialized CAT scan called a CT Angiogram, or CTA, at one month, six months and a year, and at yearly intervals thereafter. This imaging surveillance is to check for problems people cannot feel. One is an endoleak, which occurs when blood from the aorta continues to leak into the aneurysm. The other is graft migration, in which the position of the stent graft in your body can shift over time. When these problems occur, the vast majority can be treated minimally invasively.”
“Most abdominal aortic aneurysms have no symptoms. Ultrasound is an excellent way to screen for them. It’s a simple and inexpensive way to test.” Waheed Ahmad, MD
Recent Legislation Provides Fully Covered AAA Screenings for Eligible New Medicare Beneficiaries
Many new Medicare beneficiaries are unaware of the Screening Abdominal Aortic Aneurysms Very Efficiently Act (SAAAVE), enacted in early 2007 to provide coverage under Medicare part B to patients at risk for AAA. Under the SAAAVE Act, fully covered AAA screenings are available to seniors who have certain risk factors and complete their “Welcome to Medicare” physical within the first six months of Medicare eligibility. The covered patient population includes men age 65 and over who have smoked more than 100 cigarettes in their lives, and both men and women with a family history of abdominal aortic aneurysms. Contact your physician for information on your coverage eligibility.
Vascular Lab Receives Recognition for High Quality Patient Care and Testing
In 2001, the Vascular Laboratory at Floyd Memorial became the first in Southern Indiana to be accredited by the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL). Since then, the lab has maintained the level of excellence required for re-accreditation. As Waheed Ahmad, MD, medical director of the lab explained, “Floyd Memorial’s Vascular Laboratory is one of only a select number in the United States that meets the accreditation standards set forth by the ICAVL. The accreditation process closely evaluates all aspects of the lab’s operations, including patient care, safety issues and testing for vascular disease. We are extremely proud of this accomplishment and feel it is a true testament to the level of care we provide our vascular patients.”
Among the tests performed in the Vascular Lab are carotid artery studies, which provide information useful in preventing strokes; arterial Doppler studies, which help detect peripheral vascular disease in the limbs; venous studies to detect blood clots that could potentially move into the lungs; and testing for abdominal aortic aneurysms.