SmartCare: Repairing Aortic Aneurysms

New generation of aortic stents makes surgery less invasive

Each year, 200,000 Americans like Dwight Anderson of Davenport are diagnosed with an aortic aneurysm -- a dangerous bulge in the largest blood vessel in the body.

If untreated, some can rupture causing fatal consequences.

Genesis Heart Surgeon, Robert
Fietsam, M.D., shows how an
endovascular stent is used to
reinforce the weakened wall of
the aorta. The stent reduces
the pressure on an aneurysm
and provides a new pathway
for blood flow.

Lucky for Anderson, there's a trend toward treating aneurysms without major surgery using a new generation of aortic stents.

It's all part of Genesis SmartCare, the array of minimally invasive and non-invasive procedures that get patients back to their normal activity level sooner.

During the procedure, Genesis heart surgeon Robert Fietsam, M.D., used live x-ray pictures viewed on a video screen to move a compressed stent to the site of Anderson's abdominal aortic aneurysm.

Guided by catheters inserted into a small incision in the groin, the stent  -- a fabric tube supported by a metal framework -- was expanded inside the aorta to reinforce the weakened section.

The stent reduces the pressure on the aneurysm and provides a new pathway for blood flow.

This kind of aortic aneurysm repair is one of the most significant milestones in his 18 years of heart surgery, Dr. Fietsam says.

"Now, we don't have to open up the chest or abdomen to fix a bulge in the major artery. It's absolutely amazing to see patients go home in two days vs. spending several days in the hospital and undergoing a long recovery."

Preventing rupture

The aorta is the largest artery and carries blood away from the heart to all parts of the body. The part of the aorta that runs through the chest is called the thoracic aorta and, when the aorta reaches the abdomen, it's called the abdominal aorta.

Much like an over-inflated balloon, an aneurysm can stretch the aorta beyond its safety margin, Dr. Fietsam explains. A ruptured aneurysm can cause severe internal bleeding, which can rapidly lead to shock or death. Only about 40 percent of people who make it to the hospital survive.

Traditionally, patients with aortic aneurysms in the chest had to undergo open-heart surgery.  Not anymore.

"With the new approach, there's only a 4 cm. incision in the groin. The patient is out of bed the same afternoon, certainly by the next day," Dr. Fietsam says. "Before, the patient would have a 15-20 cm. incision. We had to open up the chest and rib cage and put the heart on bypass. About 1 in 10 patients didn't make it.  Patients spent a week in the Intensive Care Unit."

He adds, "This technology has turned a 3-to-6 hour operation into a 1-to 2 1/2-hour operation. It has allowed us to work with potentially sick patients who we formerly wouldn't have been able to operate on. Now, we make a small incision in the groin and thread into the thoracic or abdominal area to place the aortic graft."

The less-invasive stent procedure also means a lower risk of complications.

Early detection is key

Twenty-five percent of aneurysms occur in the chest; the rest involve the abdominal aorta.

Most often, aortic aneurysms are found during a medical test, such as a CT scan or ultrasound, for another unrelated health reason.

Dwight Anderson's abdominal aortic aneurysm was discovered during a radiological study for something else. He went to the doctor for increasing shortness of breath, which led to a stress test and ultimately a diagnosis of coronary artery disease.

In the midst of testing in the Cardiac Catheterization Lab, his cardiologist, Nicolas Shammas, M.D., found that Anderson had an abdominal aortic aneurysm measuring 5.5 cm.

If an aneurysm reaches 5 cm. in diameter, treatment is recommended to prevent a rupture.

Before his aneurysm was repaired, Anderson first had to undergo quadruple bypass surgery and have an aortic valve replaced.  A couple of weeks later, in a separate procedure, he had the aortic aneurysm fixed.

"The aneurysm repair was a pretty easy procedure, and I was a little amazed myself.  The progress in medicine is astounding," says Anderson, 71, who appreciated not having to undergo another major surgery on the heels of having bypass surgery.

"If I hadn't had the worsening shortness of breath, I probably wouldn't have gone to the doctor. Nor would I have had the tests that led to the discovery of my abdominal aortic aneurysm."

Abdominal aortic aneurysms typically do not have symptoms. Some patients may feel a throbbing in their abdomen. 

A majority of aortic aneurysms occur mainly from atherosclerosis, or fatty deposits in the walls of arteries that cause them to become less elastic and weaker.

People who smoke have a much greater chance of forming one than non-smokers. Other risk factors include:  high blood pressure, being male; age 55 or older; having diabetes or having a family history of abdominal aortic aneurysms.