Sep. 25, 1997 By Melanie Fridl Ross
Shands Public Relations
GAINESVILLE, Fla.---A 64-year-old Florida man is recovering after University of Florida surgeons and radiologists used a tiny metallic and fabric device to bolster the weakened wall of a major artery in his abdomen.
The man had been diagnosed with an aortic aneurysm, a balloon-like swelling of the aorta caused by the pressure of blood flowing through it. The aorta is the main vessel supplying blood to the lower body. Over time, an aneurysm can rupture and cause fatal blood loss.
During the experimental procedure, UF surgeons and radiologists inserted a small, flexible wire through a vessel in the man's leg, threading it toward the weak spot in the aorta, said Dr. James G. Caridi, an assistant professor of radiology at UF's College of Medicine. They then deployed the device, known as a stent-graft, through a small tube called a catheter. The heat-sensitive stent expands and attaches the fabric bypass graft to the artery by friction, sealing off the problem area while permitting normal blood flow to continue through the artery.
UF surgeons are studying whether they can safely and effectively repair abdominal aortic aneurysms through this minimally invasive approach with fewer complications than major surgery, which involves replacing the weakened section of the affected artery with an artificial bypass graft. The new method could potentially lower the risk of death, eliminate the need for intensive care, shorten hospital stays and decrease health-care costs.
"Surgery effectively repairs aneurysms without any question," said Dr. James M. Seeger, chief of vascular surgery at UF's College of Medicine. "The concern with the minimally invasive approach is how effective it will be in the long-term. No one knows the answer to that yet.
"The advantages of this new approach seem obvious," he added. "This can be done through a small incision in the groin and potentially the patient can go home in a couple days, having avoided the stress of major surgery, which can lead to heart attack, kidney failure or even death."
Up to 10 percent of patients experience significant complications after the standard surgery. Some are hospitalized for as much as 10 days and face up to a two-month recovery period afterward.
A subset of patients requiring aneurysm repair are at significantly increased risk because of associated heart, lung and kidney disease, or advanced age. Up to 10 percent of these patients may die from the surgery, and complications rates can be as high as 50 percent, Seeger said.
For the next five years, surgeons from UF and other universities nationwide will track 90 patients who undergo conventional surgery and 235 who receive the stent-graft to repair aortic aneurysms. The study is sponsored by Meadox.
The risk of rupture increases with the aneurysm's size and with time. Virtually 100 percent of aneurysms greater than 7 cm to 8 cm in size rupture within five years. The death rate associated with aneurysm rupture is 80 to 90 percent. To qualify for the study, patients must have aortic aneurysms that are at least 4 cm in diameter.
"Abdominal aneurysms are a common problem and not an uncommon cause of death," said Seeger, who estimated 30 to 66 people per 1,000 will be diagnosed with an aneurysm. "Unfortunately, patients with aneurysms often have no symptoms and the aneurysms are found by accident.
"The risk of developing an aneurysm increases with age without any question; it's a disease of the elderly," he added. "That is one of the reasons to look for less invasive ways of treating aneurysms. Most people who have aneurysmal disease are elderly and have other medical problems that increase the risk of surgery."
Seeger and Caridi are working with UF College of Medicine colleagues Dr. Thomas S. Huber, assistant professor of surgery; Dr.Timothy C. Flynn, professor of surgery; and Dr. Dick Hawkins, professor of radiology.
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