Watch O.R. Action on the Web

Surgeon treats thoracic aortic aneurysm with minimally invasive approach at Genesis

DAVENPORT, Iowa - When an aneurysm in her chest ruptured a year ago, it took an emergency helicopter ride and a rapidly mobilized Genesis surgical team to save the life of Marilyn Glaudel. The dramatic rescue showed the Genesis system of care at its best.

Now, with the detection of yet another thoracic aortic aneurysm in his patient, cardiothoracic surgeon Dr. Richard Sadler knew he had to find a way to repair it before another life-threatening rupture.

He also knew that the rigors of a high-risk open procedure would be too difficult for 79-year-old Mrs. Glaudel to endure.

The solution: a minimally invasive approach using a revolutionary device to treat a thoracic aortic aneurysm. Once again, Mrs. Glaudel’s surgery would have its own unique element of drama.

This time the drama involved video cameras in the Genesis Operating Room and a producer giving orders from a mini studio nearby. It was all to make the surgery come alive with video, audio and animation for a 50-minute webcast that will air next week on the Genesis Web site.

It will be the third of four webcasts sponsored by Genesis to showcase unique procedures at its hospitals. The procedure, one of fewer than 10 that have been done in the state of Iowa, will be webcast Tuesday, Feb. 13, at 7 p.m. on the Genesis Health System Web site, www.genesishealth.com. Click on "Watch a Surgery," in the rotating ad box.

Wearing an earpiece and a microphone underneath his surgical scrubs, Dr. Sadler, M.D., FACS, Chest & Vascular Surgery, P.C., Davenport, performs the procedure. He is assisted by Erik Abdullah, M.D., Vascular & Thoracic Associates, Ltd., Bettendorf.

Minimally invasive

A thoracic aortic aneurysm is the swelling or ballooning of the aorta, the largest artery in the body, which carries oxygenated blood from the heart. The thoracic aorta’s diameter normally ranges from 1 to 1.5 inches. An aneurysm can cause it to grow several times its normal size. If not treated, the aneurysm can rupture, leading to internal bleeding which often is fatal.

"The estimated mortality of a ruptured thoracic aneurysm is 90 percent for the first 48 hours," said Dr. Sadler. "Often, there are no symptoms, so most people won’t know if they have an aortic aneurysm until it ruptures. Typically, they are detected when chest x-rays, CT scans or MRI tests are being obtained for other health problems. Approximately 40 percent of aneurysms in the aorta occur in the chest."

Thoracic aortic aneurysms have traditionally been repaired through a high-risk operation requiring a large chest incision to remove the diseased portion of the artery and replace it with a synthetic graft. This method can result in long hospital stays and painful recoveries. "The method is generally highly effective, but unfortunately, the patient has to have a very large and sometimes dangerous operation," Dr. Sadler said.

Lucky for Mrs. Glaudel, an implantable graft now gives doctors a less-invasive alternative to the major open surgical approach.

The GORE TAG® endoprosthesis, developed by W. L. Gore & Associates, Inc., is the only Food and Drug Administration-approved thoracic endograft.

During the procedure, Dr. Sadler makes small incisions in the patient’s groin. Then the graft, which is compressed into the end of a long, thin, tube-like device called a delivery catheter, is guided up the leg artery, through the abdomen, into the chest, positioned inside the diseased section of the aorta and released, or deployed.

The device self-expands to the inside diameter of the aorta, creating a tight fit and seal against the aorta wall. The graft re-lines the aorta, making a new path for blood flow. Once the graft is in place, a balloon catheter is used to profile the device – a step that ensures the graft has achieved good compression and optimal diameter inside the aorta.

"We’ve been very satisfied with the track record of its effectiveness and its ability to get a patient ambulating, moving and enjoying life again," Dr. Sader said.

The procedure usually takes one to three hours. Patients stay in the hospital for only a few days following the procedure and can return to normal activity within two to six weeks.

"In clinical trials comparing the GORE TAG® Device to open surgical repair, GORE TAG® Device patients experienced fewer complications and significantly less procedural blood loss," said Gary Buehler of Gore Medical Products Division. "Patients also have a shortened hospital stay and a two times faster return to normal activity."

Quick action

Mrs. Glaudel of Silvis is no stranger to thoracic aortic aneurysms. She already had had two repaired by Dr. Sadler. The first was 11 years ago. The second one, in February of 2006, ruptured, and nearly took her life. Nurses at Genesis called her their "miracle patient."

On that day a year ago, Robert Glaudel sensed he had a real emergency on his hands when his wife complained of a sharp pain in her back. Previously, she had a thoracic aortic aneurysm that was detected and surgically repaired before it ruptured.

This time, however, his wife’s abrupt back pain signaled to him that something was terrible wrong. He called 911, and an ambulance rushed her to the Illini Campus, where he urged emergency room staff to call Dr. Sadler.

What unfolded over the next hour would show the Genesis system of care at its best. She was assessed and resuscitated at the Illini Campus, then flown quickly by Med-Force helicopter and taken to the Operating Room at Genesis, Davenport, where a surgical team was quickly mobilized to respond to the extreme medical emergency.

"She presented in shock, had to be resuscitated and only had an hour at the most," recalls Dr. Sadler. "Thanks to excellent air ambulance, Emergency and Operating Room staff, we managed to achieve a good outcome. But at her age, Mrs. Glaudel could not tolerate another major surgery like that again. That’s why we’ve opted for this minimally invasive approach. It’s really her only option."

Robert Glaudel and his wife are grateful to have a less-invasive option to remove his wife’s aneurysm. With the minimally invasive procedure, Mrs. Glaudel avoided a long hospital stay.

"She never could have gone through what she did last time with the open procedure," Mr. Glaudel said. "All we have is praise for Dr. Sadler for exploring this less-invasive option. Some people say you have to go to Mayo Clinic or Iowa City for innovative heart care, but we know from experience that you can get that here at Genesis and from Dr. Sadler."

Dr. Sadler added that the long legacy of heart care and professional experience at Genesis leads to more new technology and innovative procedures. "Genesis is the oldest heart hospital in the Quad Cities. We been functioning since the early ‘70s, and there are literally tens of thousands of cases that have been done. In many instances, our O.R. crews have been the same present for the past 15-20 years. They are highly experienced and adept and have a mindset of adapting new technologies and staying up on the latest. I think that is the real difference."

Assisting Drs. Sadler and Abdullah during the webcast procedure are: Paula Streed, RN, First Assist, CNOR; Kelly Heppe, RN; Sheila Hoskins, RN, CNOR; Rose Cuevas, CST; and Barb Tobias, RTR, Cardiovascular Imaging Specialist.

Genesis is one of at least 40 hospitals across the nation working with Internet health care broadcaster slp3D, a Connecticut company pioneering surgical webcasts. Its Web site OR-Live.com attracts an average of nearly 500,000 unique visitors each month for all over the world.

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