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Release: July 31, 2000

New surgical treatment for aortic aneurysms available at UI

IOWA CITY, Iowa -- University of Iowa Health Care surgeons are now certified to perform a minimally invasive procedure, recently approved by the Food and Drug Administration (FDA), to treat abdominal aortic aneurysms (AAA).

The aorta is the main blood vessel from the heart and delivers blood to the rest of the body. When the walls of the aorta are weakened a bulge, or aneurysm, forms. The effect is similar to what happens to old inner tubes, which balloon at weak points in the tubing. Left untreated an aneurysm can burst, resulting in massive internal bleeding which is often fatal. AAA is the13th-leading cause of death in the U.S.

The traditional treatment for repairing aneurysms requires a major surgical procedure. A large incision is made in the patient's abdomen, cutting through layers of muscle and moving aside the internal organs to get to the diseased aorta. The aorta is then clamped on either side of the aneurysm and the weakened section replaced with a piece of artificial tubing, called a graft, which is sewn into place.

This procedure has stood the test of time and has a high survival rate. The patient, however, usually needs prolonged hospitalization and several weeks of recovery time.

"Because many of the patients requiring this form of surgery are older individuals, the traditional open surgery can prove to be a big stress to the system and full recovery can be a slow and painful process," said Jamal J. Hoballah, M.D., UI associate professor of surgery.

The new procedure, on the other hand, is much easier on the patients. Rather than opening the patient's abdomen, two small incisions are made in the groin area and a catheter is used to deliver one of two devices, called endografts, into the aorta. The endograft is then guided through the blood vessel to the site of the aneurysm. These new self-supporting grafts do not require sutures (stitches) to stay in place.

"The main benefit to patients is that this new procedure is much less stressful and allows for quicker recovery," said William J. Sharp, M.D., UI associate professor of surgery. "In fact, this

procedure is much preferred for older patients with other medical problems for whom conventional surgery is highly risky."

As a condition of the FDA approval, the devices' manufacturers require that surgeons using their products receive special training. Hoballah and Sharp have undergone this training and will now lead teams of UI surgeons using this new procedure. They successfully implanted the first FDA-approved endograft at the UI Hospitals and Clinics on July 14, 2000.

"Very often after the traditional open procedure, the patient will be supported with a ventilator for a day after surgery. In this new procedure, the patient is usually breathing independently after the procedure and ready to go home by the second or third day after the minimally invasive surgery," said Hoballah. In some patients the new procedure can even be done under regional anesthesia without having to put the patient to sleep.

Not everyone will be a suitable candidate for this new procedure. The anatomy of the blood vessels will indicate if the patient is a good candidate. It is estimated that 40-60 percent of the patients have the required anatomy for this new technique.

AAAs may cause a deep, pain in the lower back region. Aneurysms that are rapidly enlarging and on the verge of rupture are often tender. However, many aneurysms do not produce any symptoms. Arteriosclerosis, or hardening of the arteries, is the disease most commonly associated with weakening of the aorta. Approximately 5 percent of men over age 60 develop an abdominal aortic aneurysm

Aneurysms are primarily detected during a routine physical examination or as a result of patients having abdominal X-rays, ultrasound scans or computer tomography (CT) scans for unrelated reasons. UI also offers a screening program, through the Vascular Laboratory, and physicians can refer their patients or patients can refer themselves or their relatives for screening. Screening may be an especially important precaution when there is a family history of the development of aneurysmal disease.

The UI has been involved in the development of techniques for endovascular surgery over the last decade, but have been cautious about offering the treatments to patients.

"We have seen different endograft devices come and go and we have waited until we felt there were good devices to offer to our patients," Sharp said.

The FDA will require the manufacturers to continue to assess the long-term safety and effectiveness of these devices. However, given the patient benefits in terms of recovery speed and the less invasive nature of the surgery, this procedure is set to become routine for suitable candidates at the UI.


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