April 9, 2010

Taking Vascular Care to a New Level

Genesis invests $2.9 million for region's first angiographic suite

Genesis Medical Center, Davenport will soon provide faster, safer and more accurate vascular care to the Quad Cities area with the region's first state-of-the-art, angiographic operating room suite.

The $2.9 million hybrid surgical suite will take vascular diagnosis and treatment to a new level, hospital officials recently announced. Genesis will be the first hospital in the region to provide the Philips Allura Xper FD 20 to its patients and the first in Iowa to place the technology in a surgical department

Endovascular procedures performed on the system are typically carried out with the use of small, X-ray-guided catheters threaded inside blood vessels. The system, which arrived this week, offers sharper x-ray images, a reduced radiation dose and faster imaging times.

There will be nothing comparable to this technology within an 150-mile radius of the Quad Cities.

"We're very excited to offer the Quad Cities this unique operating room environment. This is huge," said Elaine Martin, Director of Surgical Administration, Genesis Medical Center, Davenport. "Acquiring the technology was a great collaboration of different physician specialists, including  vascular and cardiac surgeons, interventional radiologists and cardiac anesthesiologists, and our operating room and radiology staff."

Among the vascular and cardiac surgeons who anticipate using the room and the new technology are: Erik Abdullah, M.D.; John Klosak, M.D.; Richard Sadler, M.D.; Nicholas Augelli, M.D., and Robert Fietsam, M.D.

Erik Abdullah, M.D	Nicholas Augelli, M.D.	Robert Fietsam, M.D.
John Klosak, M.D.	Richard Sadler, M.D.	SURGEONS These vascular and cardiac surgeons anticipate using the Allura Xper FD 20 at Genesis Medical Center, Davenport

Improved visualization

The hallmark of the new technology is its excellent visualization. Physicians can capture and view extremely detailed, three-dimensional images of a patient's blood vessels.

"It will be like going from an old analogue TV to a new high-definition, 240-hertz TV where you can actually see a pore on a person's face that before looked like a smudge," said cardiac surgeon Nicholas Augelli, M.D.

"You will have improved visualization of the edges of the vessel, as well as a wire inside the vessel that then allows the passage of life-saving stents, both for coronary arteries, the aorta and other vessels, and eventually heart valves. They all need that catheter wire as a guide, and you need to see that wire."

"The images will be phenomenal," added Robert Fietsam, M.D. "It will be like getting a better pair of glasses."

In May, Genesis Medical Center, Davenport will begin conducting minimally invasive procedures on the new system. The Allura treats a wide range of clinical problems, including carotid artery disease, abdominal aortic aneurysms, thoracic aortic aneurysms, percutaneous valve procedures, hybrid open heart surgery and stenting procedures.

Primarily, the technology will be used for infra-abdominal and infra-renal procedures and thoracic and abdominal aortic aneurysms.

"We should see additional growth once the technology spreads to other areas and matures from the endovascular stents to valves that will be deliverable in this fashion," Dr. Augelli said. "The use of this technology for valves is still under investigation, and there are 11 sites in the U.S. actually doing these procedures already. We're waiting for the FDA's evaluation."

Charles Krogmeier, director of the Iowa Department of Human Services, toured the construction area April 2 and was introduced to other technologies available at Genesis to enhance patient care and safety.

"As technology advances and practice protocols evolve, this helps drive costs down and improve patient outcomes at the same time," Krogmeier said at a news conference to announce the Allura technology's arrival to Genesis. "We hope to see more of this in the next few years."

Aneurysm repair

For example, the new technology will make aortic aneurysm repair far easier -- for the patient and the physicians.

Today, the trend is to treat aneurysms without major surgery using a new generation of aortic stents. The stent -- a fabric tube supported by metal framework -- reinforces the weakened wall; reduces the pressure on the aneurysm; and, provides a new pathway for blood flow. It's a little like putting a new pipe within an old pipe.

Although endovascular stent grafting is currently being done in Genesis operating rooms, the procedure will be much easier and safer to perform with the superior visualization of the Allura technology. 

"Today, about 80 percent of aneurysm repairs in the nation are done with the endovascular procedure, and 20 percent are still being done with an open procedure," Dr. Augelli said.

The aorta is the largest artery and carries blood away from the heart to all parts of the body. Much like an overinflated balloon, an aneurysm can stretch the aorta beyond its safety margin, he explained. Traditionally, patients with an aortic aneurysm had to undergo use of a heart-lung bypass machine if it was located in the chest or have their abdomen opened up if it was located in the abdomen.

"Before, the patient could have a 15-20 cm. incision," Dr. Fietsam said. "With a thoracic aneurysm, we would have to open up the chest and rib cage and put the heart on bypass. Patients spent a week in the Intensive Care Unit, and endured a lot of pain from the major incision that cut through muscles."

With the endovascular stent, there are no major incisions. Instead, a small incision is made in the groin and a catheter is  threaded into the thoracic or abdominal area to place the aortic graft.

"It's just huge progress. It means we don't have open up the chest or abdomen to fix a bulge in the major artery," Dr. Fietsam said. "We're changing what potentially is a $100,000-$120,000 procedure for patients to a $15,000-$20,000 procedure and reducing a hospital stay from two weeks to two days. The patients are in a lot less pain, too."

Without a large incision, catheter-based procedures reduce the need for blood products, have a lower risk of infection and bring patients a shorter hospital stay and reduced recovery time.

The combination of the catheterization lab-quality 3D imaging capabilities and operating room amenities allows for optimum versatility and provides the flexibility to perform hybrid procedures and to easily transition between surgical and catheter-based therapies.

"You always have to prepare for the worst, and if there is an emergency situation, for example, where the aneurysm ruptures, you have to be prepared to do an open procedure," Dr. Augelli said.

"The great value in this suite is that we can convert this into a real operating room under sterile conditions and proceed with a standard operation," Dr. Fietsam said.

With 1 in 5 Americans suffering from one or more forms of cardiovascular disease, advancing medical technology to diagnose and treat these conditions is critical.

"Both our patients and clinicians will benefit from the speed and excellent 3D image accuracy of this new X-ray system," Martin concluded. "Our new hybrid endovascular suite will allow our physicians to complete a variety of diagnostic and therapeutic procedures faster, and that means the patient is off the table and on their way to recovery and discharge from the hospital much sooner.  It also means less radiation exposure for the patient and is a safer alternative to surgery."

Genesis has partnered with Philips Medical Systems to provide this enhanced technology to its patients.