Repairing Aortic Aneurysms without Major Open Heart Surgery?

Aortic aneurysms are silent killers. They can drop you in an instant and occur in people of all ages.  Because of this there is a huge push led by John Ritter's wife Amy Yasbeck to increase awareness, improve screening for aortic aneurysms, and most importantly prevent tragedies.

I've been hearing about a procedure to correct aortic aneurysms using stent grafts. Has anyone had an aortic aneurysm repaired using this procedure? I am very satisfied with the open heart surgery I had. I believe I had the best procedure available, by the best surgeon. My aortic valve is tricuspid and had no leakage, therefore the "valve-sparing" surgery Dr. Stewart performed on my seemed like the most logical option.  

Recovery from open heart surgery for any procedure is very difficult, but at this moment in time I don't believe there is an alternative in many cases. One certainly wouldn't want to trade the effectiveness of an open heart surgery, for an inferior procedure done less invasively.  It would be nice though to have a minimally invasive option to repair a major aortic aneurysm. The first question that pops into my head is on the durability of this "stent graft" option. If I understand it correctly they fish a catheter up a vein in your thigh into the aorta, and then they send up a stent which they expand into place forming an artificial channel bypassing the area that is enlarged. I'd like to hear of anyone's experience with this as a patient or doctor. Furthermore has anyone heard of any exciting new developments in repairing aneurysms?


11 comments:

Anonymous said...

I will be having an aortic replacement done in about 1 month. I had a aortic dissection in 1996 and they repaired that, now I have to have the entire aorta replaced.

Allan Stewart, MD said...

Ben:

The thoracic aorta (the part in the chest) is divided into three parts: the ascending aorta, the aortic arch and the descending aorta. The goal in aneurysm repair is to remove the blood pressure from the damaged aortic wall. In many cases of descending aneurysm, this may be accomplished with a stent. The procedure is commonly called a TEVAR. What we do is feed a small wire up the leg and then pass a covered stent across the aneurysm. In order to be a candidate for a stent repair, you need a place to land the stent. What that means is that the two ends of the stent must land on areas of normal aorta. Since there a few important structures in the descending aorta, we can often identify two areas to land a stent.
In cases of arch aneurysms, we often combine a stent graft procedure with open surgery. In essence, the open surgery will create a landing zone for the stent. The surgery moves the blood vessels that go to the brain (the carotid arteries). We then place a stent graft into the surgically created landing zone.
The ascending aorta, however, has too many important structures to land a stent. The aortic root is the place where the aortic valve exists and the coronary arteries branch off. At the top of the ascending aorta, the innominate artery (blood vessel the goes to the brain) branches off. Going back to the requirement that two landing zones are required for a stent, you can appreciate that there isn't a way to land in the root without destroying the valve and blocking the coronary arteries. We are working on alternatives, but they are only trial devices and will not be commercially available for a while.

Dr. Allan Stewart

Burt Cohen said...

Ben -- Thanks for posting a link to my blog. Much appreciated. Regarding the non-surgical procedure for repairing AAA, back in January I posted a story about our mutual friend Kevin, called "Abdominal Aortic Aneurysm Stent Graft Athlete" (http://www.ptca.org/voice/archives/2011/2011_0106.html) and at the end, I put up a video excerpt from my documentary, "Vascular Pioneers". The clip tells the story of the first AAA stent graft by the man who invented the procedure, Juan Parodi. Pretty incredible...that was 1980 and he was shunned by much of the medical profession. In 2006 the stent graft EVAR procedure surpassed the numbers of open surgeries performed for AAA repair!

Benjamin J. Carey said...

I see so this is currently done for Abdominal Aortic Aneurysms (AAA), but not yet for Ascending Aortic Aneurysms.

Burt Cohen said...

Ascending Thoracic Aortic Aneurysms are done surgically usually. Descending can be done with a stent graft -- here's one here: http://www.ptca.org/news/2010/1101_MEDTRONIC.html

But things move quickly and these devices and techniques continually get better.

Kevin T Morgan said...

Hi! Benjamin,
Have you talked to this guy?

http://www.aorticdissection.co.uk/profiles/blogs/carpe-diem-quam-minimum

I have posted your link on their forum. Sound like a good group.

Cheers,

Kevin

Benjamin J. Carey said...

Great site Kevin! Thx for heads up. Very similar mindset to Heartosaurus, with a little Brit flavor :)

Kevin Morgan (Old Dog) said...

Hi! Benjamin,

Where did you come up with the name Heartosaurus, as I didn't see it in your book?

-k

Benjamin J. Carey said...

Kev,
During recovery I decided I wasn't going to lay around and be a depressed lump on a log. I started fighting back into shape determined to do everything I did prior to surgery and more. I set the goal for the NYC Marathon, and during all of this I started writing a blog as part of the healing. "Heartosaurus" came to me initially as the concept of a tyrannosaurus rex type heart patient, determined to get his life back, clawing his way into recovery. I thought of a couple other meanings for the word as well, and it instantly became a Heteronym, having more than 1 meaning. I thought of "Heartosaurus" in the literary sense as well.....ie "Thesaurus" book of synonyms....."Heartosaurus"....site of like minded heart patients........ironically the name turned out to be pretty popular in heart circles. Amy Yasbeck (John Ritter's wife) for example loves the name. At the very least you have to admit, the logo sure does put a humorous twist on what most people make out to be a very glum topic.
See you around Old Dog :)

Kevin Morgan (Old Dog) said...

Hi! Benjamin,
The naming issue is actually critical one, and yours clearly works. It made me think of a little cuddly prehistoric animal, I must admit.
I think the Ironman race is popular because of the name, whereas 'silly people going a very long way on bikes and stuff for no apparent reason' wouldn't work so well. I really like Feldenkrais, and I am convinced that it is the name that puts people off. It has sure helped me in many ways.
One thing that I found was lacking in my AAA treatment, great though it is, was help with the fear. I was pleased to be alive but scared to death that the stent would move or break, and this fear took several months to dissipate. I wonder what could be done about that? And then, of course, there are all the terrified family members. I think the problem is that we are scattered too far and wide to meet up in support groups.
Keep writing.
Do you have another book on the way?
Cheers,
Kevin

Benjamin J. Carey said...

Kevin,
I agree about the "Feldenkrais" name. The name sounds like a bad cup of tea or something! I read the information on your website about this activity and it seems to have some real merits so I'm trying it.

I'll be releasing a schedule of "Heartosaurus Events" later this month. These will be a great opportunity for all of us to connect. Some of the events will be virtual and some in person. [more to follow later this month]

In regard to another book: I was actually working on a different book when I was diagnosed with an aortic aneurysm. I was so impacted by the whole ordeal that I put that book on the back burner and wrote Barefoot in November.

I've currently gone back to working on that original book, which will be released sometime next year. Updates will be sent through www.benjaminjcarey.com.

Thanks for asking!

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