New Implant Fixes Life-Threatening Aortic Aneurysms Without Major Surgery
For immediate release: June 12, 2000
University of Maryland Medical Center Performs the Minimally Invasive Repair
Abdominal aortic aneurysm -- a life-threatening condition diagnosed in about 200,000 Americans each year -- now can be repaired without major surgery. Doctors at the University of Maryland Medical Center are using a tube-shaped implant, made of woven polyester fabric, to support the inside walls of the aorta and prevent the vessel from bursting. The device is put in place with a catheter that doctors guide up a blood vessel, starting in the upper leg.
An abdominal aortic aneurysm is a balloon-like enlargement in the main blood vessel that supplies blood to all organs. As the aneurysm grows, the walls of the vessel weaken and can burst. Ruptured aortic aneurysms are fatal in 80 percent of cases.
"People with aortic aneurysms are walking time bombs. Even so, many patients have been reluctant to have the problem repaired because it involves major surgery with a long recovery period," says Marshall Benjamin, M.D., a vascular surgeon at the University of Maryland Medical Center and an assistant professor of surgery at the University of Maryland School of Medicine.
"This new repair method, which requires only two small incisions in the upper leg, enables patients to leave the hospital the next day, and go back to work and do other usual activities within a week," says Dr. Benjamin. "That is much different from a surgical repair, in which patients usually stay in the hospital for about ten days and spend a month recovering."
The new implant being used at the University of Maryland Medical Center is called the Ancure Endograft System, made by the Guidant Corporation. It is the first minimally invasive method to repair abdominal aortic aneurysms, and it received FDA approval last fall. When the device is placed into the aorta, it acts like an inner tube or lining to reinforce the vessel walls and prevent a rupture. Each implant is custom-made to fit the exact size of the aorta of individual patients.
Before the procedure, the implant is folded up inside a narrow catheter. Doctors make a small incision in the patient's groin area and feed the catheter into an artery, sending it to the site of the aneurysm. Then, doctors slide the implant out of the catheter, where it attaches itself to the vessel wall with a series of small hooks. The implant stays in place and adapts to changes in the shape and position of the artery.
The University of Maryland Medical Center team that performs the new procedure includes vascular surgeons and doctors from interventional radiology, the specialty that uses imaging devices to navigate inside the body without large incisions. The doctors use continuous x-ray imaging, called fluoroscopy, to view the catheter in real time as it travels up the artery.
About 45,000 people have surgery each year in the United States to repair abdominal aortic aneurysms. The condition often goes undetected because there are no symptoms unless the vessel ruptures. It usually is discovered when people undergo tests, such as ultrasound or CT scans, for diagnosing other health problems. The risk of rupture is fairly low until the aneurysm grows to five centimeters—about the size of a lemon—when a repair is recommended.
Abdominal aortic aneurysms are four times more common in men than in women. The condition is found predominantly among people over age 60. Ruptured aortic aneurysms are the 13th leading cause of death in the U.S.
Atherosclerosis, or hardening of the arteries, is the major cause of aortic aneurysms because the plaque can weaken the walls of the artery. Smoking and high blood pressure can increase the risk of aortic aneurysms, as well.
"This new way to repair aortic aneurysms is much easier on patients. We expect that more people who are fortunate enough to have the condition diagnosed early will be less apprehensive about having it repaired, now that we are able to do it in this minimally-invasive way," says Dr. Benjamin.
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