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Monmouth Medical Center
Unveils New Minimally Invasive Treatment
for Life-Threatening Aortic Anneurysms
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 Barnabas Health,
at
732-870-5500.
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