Repairing Abdominal Aortic Aneurysm with a Minimally Invasive Procedure

It's called endovascular stent grafting and it represents a minimally invasive alternative to a traditional surgery that has been performed pretty much the same way for the last half century.

The stent procedure, however, is new and leading edge. Instead of a large incision in the abdomen, the procedure requires only a two-inch incision on each side of the groin. From there, a catheter is inserted in the patient's arteries and delivers a stent graft that excludes the aneurysm from the flow of blood.

Predictably, the endovascular procedure is being met with remarkable patient satisfaction. While the traditional surgery usually calls for a five-to seven-day hospital stay, the average for endovascular patients is just 1.2 days. "There is a huge difference in patient comfort," explains Richard B. Doering, M.D., one of several vascular surgeons at Hoag who has performed these procedures.

Abdominal aortic aneurysms affect three percent of people over age 65 and can be deadly. The aorta is the largest blood vessel in the body, leading from the heart to the abdomen, where it divides into the major arteries that enter the legs. The abdominal aorta supplies blood to all the organs below the diaphragm. An aneurysm occurs when the aorta, affected by atherosclerosis, begins to expand like a balloon. If an AAA bursts, the patient has only a 50 percent chance of surviving if he or she goes immediately to the ER. It is the 13th leading cause of death in the U.S.

What makes AAA additionally dangerous is that it's not typically accompanied by symptoms. "It usually comes to us by surprise when we're doing an X-ray for another reason such as a kidney stone or some other abdominal discomfort or back problem," says Dr. Doering.

Men are four times more likely to get AAA than women, and most cases develop after the age of 60. The most common cause of AAA is atherosclerosis, which is a hardening of the arteries. As cholesterol and other substances build up in the artery walls, the aorta swells and becomes weaker. High blood pressure can excellerate the process. Smoking is also strongly linked to aneurysms.

Today, 70 percent of Dr. Doering's AAA patients are undergoing the endovascular treatment instead of traditional surgery. To identify which patients are appropriate for the endograft treatment, advanced three-dimensional computerized imaging is performed which allows precise measurement of the patient's anatomy. Although the new procedure is easier on patients, it does require closer follow up, including CT scans at one month, six months and then once a year following the surgery.

The endovascular procedure is completed in a state-of-the-art setting. One look inside the endovascular operating suite at Hoag Heart and Vascular Institute shows how firmly committed the hospital is to the vascular component of its services. The endovascular suite is equipped with the latest imaging technology to better enable physicians to navigate the tiny arteries within the body.

The doctors also work together very closely. "Hoag is unique in that we have reorganized various surgical and medical departments that deal with heart and vascular disorders into a single department for cardiovascular services," explains Dr. Doering. "That's the reason the program has been so successful. Previously, we were all treating the complications of atherosclerosis, but we were in separate departments. Now, we all meet together, which eradicates some of the divisions that might exist elsewhere. For the endograft procedure, we sometimes have specialists from four different disciplines at the operating table working together."

That's important because endovascular stent grafting is intricate work. "It's very complex," admits Dr. Doering. "We're gaining access to the aorta through very narrow vessels. It takes great precision to position the stent in exactly the right place."

The two manufacturers of FDA-approved AAA stent grafts have plenty of faith in Hoag's ability to do just that. "Hoag's team has been selected by both manufacturers," he explains. "Not every hospital performs this procedure."

Dr. Doering knows why Hoag was chosen. "Our multidisciplinary approach is unique and we are the highest volume Orange County hospital performing the endograft procedure," he asserts. "Hoag Heart and Vascular Institute is on a par with the best medical centers in the western United States."

For more about endovascular stent grafting, call Hoag Heart and Vascular Institute at 949/764-5871.