Minimally Invasive Treatment for Thoracic Aortic Aneurysm
“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. However, 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. The tube-shaped endovascular graft is comprised of a biocompatible ePTFE (expanded polytetrafluoroethylene) graft with an outer self-expanding nitinol (a combination of nickel and titanium) metallic support stent.
During the procedure, Dr. Sadler will make small incisions in the patient’s groins. 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.
The procedure usually takes 1 to 3 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, Endovascular Products Representative, Gore Medical Products Division. “Patients also have a shortened hospital stay and a two-times faster return to normal activity.”
The patient for this procedure, a 75-year-old female, already has had two aortic aneurysms repaired by Dr. Sadler. The first was 10 years ago. The second one, in February of last year, ruptured, and nearly took her life.
“ 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, she could not tolerate another major surgery like that. That’s why we’ve opted for this minimally invasive approach. It’s really her only option.”
Assisting Drs. Sadler and Abdullah during the 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.
The thoracic endograft is the third surgical procedure Genesis has webcast with OR-Live. Previous webcasts have spotlighted minimally invasive Transforaminal Lumbar Interbody Fusion to eliminate back pain, and laparoscopic Roux-en-Y gastric bypass, a surgical procedure for weight loss.