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Vascular surgeons at Monmouth Medical
Center are performing a new, minimally invasive procedure
to repair abdominal aortic aneurysms, giving hope to patients
who were considered too sick to undergo conventional surgery.
Aneurysms are most common in men over
age 50, especially those with hypertension, heart disease
or a family history of the condition. An aortic aneurysm
is a bulge that forms in a weak spot of the aorta, the
body's largest blood vessel, and this new procedure to
repair it, called endovascular stent grafting, is less
traumatic and shortens the patient's recovery time. It
has proven highly successful in the treatment of people
with abdominal aortic aneurysms who are poor surgical
candidates due to existing cardiovascular or other complex
conditions.
For Robert Malone, an 80-year-old resident
of Keansburg, the procedure involved a repair of a six-centimeter
abdominal aortic aneurysm that was at risk for rupture.
Because of his complicated medical history - which includes
chronic obstructive pulmonary disease (COPD), prior heart
attack and stroke, an irregular heart rate and high blood
pressure - he was a poor candidate to undergo general
anesthesia required for traditional surgery.
"This procedure involves using
a catheter to insert a tube about the size of an adult
index finger inside the aorta to mend the weakened section
that is in danger of rupturing," explains vascular
surgeon Kevin Lopyan, M.D., who performed Malone's surgery
and introduced the procedure at Monmouth. "And it
is performed using spinal anesthesia, which really was
key for Mr. Malone, due to his COPD as well as his age.
Under general anesthesia, he would have to be on a respirator
postoperatively."
Abdominal aortic aneurysms often are
discovered by accident, when a patient seeks treatment
for an unrelated condition, or it may be a palpable mass
detected during a routine physical exam, notes vascular
surgeon Alfonso Ciervo, M.D., who assisted with the surgery.
He stresses that these aneurysms pose a serious threat
to the patient's life because they can grow and eventually
rupture. Approximately 15,000 Americans die from ruptured
abdominal aortic aneurysms each year.
"Mr. Malone came to the hospital
for other reasons, and initially the doctors suspected
PVD (peripheral vascular disease -a common circulation
problem in which the arteries that carry blood to the
legs or arms become narrowed or clogged). A magnetic resonance
exam followed by a CT Scan confirmed the diagnosis of
abdominal aortic aneurysm," Dr. Lopyan says. "I
followed up these tests with an arteriogram to measure
key aortic dimensions, and I really felt he was a good
candidate for this new procedure."
For patients with no other serious
health problems, the traditional treatment for abdominal
aortic aneurysms is surgery that involves opening the
abdomen or chest. The blood flow in the aorta is stopped
so the damaged section can be repaired with a synthetic
graft that is sutured into the arterial wall. The patient
generally spends from 5 to 7 days in the hospital, including
several days in intensive care, followed by several weeks
of recovery at home.
The potential for complications among
abdominal aortic aneurysm patients like Mr. Malone - with
other serious medical conditions - led to the development
of the new minimally invasive, catheter-based procedure
now being performed by Dr. Lopyan and Dr. Ciervo and George
Constantinopoulos, M.D.
"The procedure takes about two
and a half hours, usually using sedation and spinal anesthesia,"
Dr. Ciervo says. "And because endovascular stent
graft repair means less cardiovascular stress than conventional
surgery, most patients leave the hospital in a day or
two without being admitted to the ICU. And they are able
to resume normal activities within a week."
For Mr. Malone, discharge came less
than 48 hours after his surgery, and he reported no lingering
pain or discomfort from the procedure, taking nothing
stronger than a single Advil for pain.
The results of endovascular stent grafting,
according to Drs. Lopyan and Ciervo, are comparable to
open repairs. They emphasize that the patients must be
followed closely to monitor the repair for any sign of
leaking. However, they note that this lifesaving procedure
is constantly evolving, and more and more patients are
being identified as good surgical candidates as well.
For more information about endovascular
stent grafting, call Monmouth, an affiliate of the Saint
Barnabas Health Care System, at
732-870-5500.
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