GoodHealth.com – August 13, 2008
Not many people have aortic aneurysms, but those who do have a high risk of dying from them. The aorta is the main artery that carries blood from the heart to all the rest of the body. An aneurysm is a weak spot in the artery wall that can balloon out, thin the tissue and possibly rupture. Of those who suffer a ruptured aortic aneurysm, 50 percent die before they get to the hospital and a significant additional number may die during treatment or in recovery.
Luckily for many today, aortic aneurysms often are discovered before they reach a size where rupture is imminent. Better internal imaging techniques including CT scans and ultrasound make it possible to identify even very small aneurysms.
Because aortic aneurysms are relatively rare, there is no recommended screening protocol. Most are found during imaging for other conditions such as gall bladder problems or kidney stones. Patients are referred to cardiovascular specialists for follow up, generally known as ‘watchful’ waiting. Imaging studies are scheduled at regular intervals to monitor changes in the aneurysm and once it grows large enough, the patient is referred for elective surgery to repair it.
Since 1999, Central Texas surgeons at Cardiothoracic and Vascular Surgeons (CTVS) in Austin have increasingly been using a new, minimally invasive technique that significantly reduces the length of the surgery, pain and recovery time for the patient.
For many years, repair of the aneurysm required major open body cavity surgery and a long recovery, although it usually is successful. Surgeons substitute a Dacron graft for the weakened part of the artery.
A cardiothoracic surgeon, who repairs the part of the aorta that runs through the chest, or a peripheral vascular surgeon, who works on the part of the aorta that runs through the abdomen, generally performs surgery.
“Aneurysms are an important cause of death in people over 65,” says vascular surgeon Joe K.Wells, MD, of Cardiothoracic and Vascular Surgeons (CTVS) in Austin. “A typical patient will have other types of cardiovascular disease, high blood pressure, high cholesterol or may be smokers. Previously, the standard treatment was to watch an aneurysm until it grew to five centimeters, about the size of an orange (a normal aorta is about the width of a small garden hose). When they reach that size, there is a significant risk that it could burst, resulting in internal bleeding and possibly death.”
“Open surgery would be planned during which the aneurysmal section of the aorta is essentially cut out and replaced with a synthetic graft.”
If a patient is too sick to survive a lengthy open surgery, minimally invasive surgery offers choices.
“This new method opens up surgical treatment to people who may not have been candidates before,” comments cardiothoracic surgeon Mark C. Felger, MD, of CTVS. “A 70-year-old man with terrible pulmonary disease would be told to go home and hope the aneurysm didn’t rupture. It’s a ticking time bomb.”
“Now we can fix it. Although that patient might die from something, it won’t be from an aneurysm rupture.”
How it Works
The technique is similar to heart catheterization. A tiny catheter is inserted into the aorta through two small incisions in the groin area, where it’s progress is monitored with imaging.
“The graft is deployed within the aorta. It looks like a piece of cylindrical chicken wire covered by a synthetic material coiled onto a stick,” says Dr. Felger. “Once it reaches the right location, it is released and deployed to cover the inside of the aneurysm.”
“It’s like a tube within a tube,” he continues. “Imagine if you were running water through a hose with an outpouching, how the water would swirl around. The slightly smaller tube fits inside and seals off the swirling, causing the blood to flow properly. This is a much more elegant solution and a very good fix compared to major surgery.”
There is no statistical difference in survival rates between minimally invasive surgery and an open procedure.
“The real difference is the speed of recovery and the patient’s quality of life in the months after repair,” adds Dr. Wells. Patients may spend one night in the hospital, be able to eat and drink right away, be able to walk right away and experience little or no blood loss. This is a remarkable step forward compared to a week in the hospital, more pain and lengthy recovery.”
Who is at Risk
Aortic aneurysm risk factors include:
- Age (over 60)
- High blood pressure
- Atherosclerosis (build-up of plaque in the blood vessels)
- Gender (men are more likely to have it than women)
- Race (more common in whites)
- Family history
- Marfan syndrome (genetic condition that affects connective tissue throughout the body)
Aneurysms are often symptom-free, but there are certain signs that warrant checking with your doctor. They include:
- Pulsing sensation in chest or abdomen
- Tenderness or pain in chest or abdomen
- Back pain
You can reduce your risk of developing an aneurysm by keeping your blood pressure under control, getting regular exercise and reducing the amount of fat and cholesterol in your diet. If you are a smoker, quit.
Joe K. Wells, III, MD, FACS
Vascular and Endovascular Surgeon
Cardiothoracic and Vascular Surgeons, PA
Dr. Wells is a Texas native, originally from Austin. He earned his medical degree from the University of Texas Southwestern Medical School in Dallas, where he also completed his residency in General Surgery. He completed his fellowship in Vascular Surgery at Baylor University Medical Center in Dallas. Dr. Wells has practiced with Cardiothoracic and Vascular Surgeons since 2000. Dr. Wells is a Diplomate of the American Board of Surgery and holds a certificate of Special Qualifications in Vascular Surgery. Dr. Wells also specializes in minimally invasive vascular procedures, such as endoluminal abdominal aneurysm repair, arterial balloon angioplasty and stent placement.
Mark C. Felger, MD
Cardiothoracic and Vascular Surgeons, PA
Mark C. Felger, M.D., is a Texas native, originally from San Antonio. He graduated from Baylor College of Medicine in Houston. He completed his General Surgery internship and residency at Emory University in Atlanta and his Cardiothoracic Surgery residency at the University of Texas Health Science Center in San Antonio. He has practiced with Cardiothoracic and Vascular Surgeons since 1997. He is a Diplomate of the American Board of Surgery and the American Board of Thoracic Surgery. Dr. Felger specializes in Adult Cardiothoracic Surgery including heart transplantation, mitral valve repair, and minimally invasive coronary artery bypass surgery.