October 1, 2006 A new, minimally invasive procedure allows cardiothoracic surgeons to treat aortic aneurysm patients for whom open-chest surgery would pose serious risks. A stent endograft, inserted endoscopically from the leg or abdomen with an X-ray guiding technique, reinforces the aortic walls and helps prevent aortic rupture.
ANN ARBOR, Mich. -- Spinning 360 degrees every two seconds, Bob Barden knows how to make your heart stop! He's been flying stunt planes for four decades, with "Eddie the Grip" hanging on for dear life!
"We hope we never call him 'Eddie the Slip,'" Barden says.
But it wasn't one of these death-defying tricks that almost stopped Barden's heart. It was an aneurysm in his aorta. He says, "I felt like there was an elephant standing on my chest."
Tens of thousands of Americans live with a ticking time-bomb in their chests, and 15,000 Americans die from ruptured thoracic aortic aneurysms.
"If it ruptures, patients don't make it to the hospital," Himanshu Patel, a cardiothoracic surgeon at University of Michigan in Ann Arbor, tells DBIS.
A stent endograft lets cardiothoracic surgeons repair problems in the upper part of the aorta without splitting open a patient's chest.
"It's really a very minimally invasive approach," Dr. Patel says.
The intense force of blood pulsing through the aorta can rip the aorta's walls wide apart. The stent graft can now be inserted to re-enforce the wall. A long tube -- guided by X-ray technique -- is snaked up into the aorta from a small incision in the leg or belly.
Dr. Patel says, "That whole aorta is now paved with an endograph, so the blood now flows all within the endograph."
Recovery time is much quicker, and for patients who might not survive open-chest surgery, it could save their life.
The procedure is now available at hospitals around the country. The long-term effects have not yet been established, so follow-up monitoring is needed to detect any problems. The open chest surgery is still considered to be the better long-term option if the patient is healthy.
BACKGROUND: A new University of Michigan study demonstrates that many of the tens of thousands of Americans with aneurysms might not need open-chest surgery in order to defuse the ticking time bomb in their chest. Instead, they can rely on a minimally invasive procedure that uses a stent graft made to work best in the upper part of the aorta. The FDA approved the procedure late year and it is now available at hospitals around the country.
HOW ETAR WORKS: Endovascular thoracic repair (ETAR) shores up the aorta without surgery. A device called a stent graft -- a tube of fabric supported by a metal mesh -- is inserted by snaking a long tube up into the aorta from a small incision in the leg or belly. Once it reaches the aneurysm, the tube is withdrawn and the graft expands to fit snugly in the aorta. The stent holds open the walls of the artery and keeps the blood flowing freely -- and the walls of the aorta from bursting. Of the 73 Michigan patients who had ETAR over the last 12 years, 96 percent of the procedures were carried out successfully.
WHAT ARE ANEURYSMS? The aorta is the largest artery in the human body. It carries blood away from the heart to other parts of the body. Part of it runs through the chest; this is called the thoracic aorta. Once it reaches the abdomen, it is known as the abdominal aorta. An aneurysm is a bulge in a blood vessel, like an over-inflated inner tube. They can develop if the wall of the aorta is weakened by the build-up of fatty deposits called plaque (atherosclerosis). The larger an aneurysm becomes, the greater the likelihood that it will burst.
BENEFITS: ETAR could revolutionize the way many aneurysm patients are treated. The procedure can be safely used on a wide range of aorta problems and can add years to patients' lives, even those who can't withstand tricky open-chest surgery. The thoracic aorta is one of the most sensitive areas of the artery. The intense force of blood pulsing out of the heart can rip the aorta's walls apart or cause them to balloon outward, eventually causing a fatal rupture.
Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.