Patient Success Stories
I've had toothaches worse than that," said 77-year-old Donald Campbell, describing the endovascular surgery he underwent to repair a life-threatening abdominal aortic aneurysm (AAA).
Jeanette Chang, MD, and Ronald Nath, MD, FACS, both board-certified vascular surgeons, performed the minimally invasive technique on the retired Medford construction foreman at Lawrence Memorial Hospital (LMH). This technique, known as endovascular AAA repair, was developed in the late 1990s, and has not been available in any community hospital north of Boston until recently. Drs. Chang and Nath have introduced the procedure to this region through LMH.
Leading edge endovascular technique
In her Medford office, Dr. Chang draws a detailed diagram as she often does for her patients. She explains that an AAA, sometimes referred to as a "Triple A," is the abnormal widening of the aorta, the main artery that carries oxygen-rich blood from the heart to the rest of the body. This frequently occurs in the abdomen, just below the kidneys. If left untreated, the aneurysm can burst, resulting in death for 90 percent of patients.
Endovascular techniques call for remote manipulation of wires and catheters, which are inserted into the body through small groin incisions and guided by real-time X-ray imaging. The arteries are made visible by using an injected contrast medium or dye. The surgeon watches the procedure on a monitor displaying the endovascular instruments and the patient's arteries.
Then, the surgeon inserts a prosthesis-an artificial aorta- into the aneurysm. The prosthesis is made of a durable polyester graft material with a flexible outer metallic support structure called a stent. The surgeon deploys the device, and the radial force of the metal makes it spring open, giving good contact with the artery wall. "We insert a spring-loaded graft into the aorta which stays in place, diverts the flow of blood away from the aneurysm sac, and eliminates the risk of rupture," explained Dr. Chang.
An alternative with quicker recovery, less pain
Drs. Chang and Nath regard the new procedure as a valuable alternative to the classic "open" invasive surgery for AAA treatment. The traditional open repair requires a large abdominal incision and several hours under general anesthesia. Despite the magnitude of the operation, it provides a long-lasting, durable repair and is still recommended for younger, healthier patients.
For older patients with other health issues, the endovascular technique has clear advantages. "There's almost no pain, they go home within a day, and they can return to a normal life very quickly," said Dr. Nath who has been performing vascular surgery for 25 years.
"Not everyone is a candidate for endovascular repair," said Dr. Chang. Age, one kidney, and other medical problems made Campbell an ideal candidate for the technique. After an overnight stay at LMH, he went home to recuperate and felt so good that he did not need pain medication. Two days after the operation, he was out and about again, driving to the shops, working in his garden, and walking his daughter's dog.
For a vascular surgeon
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Wednesday, January 14 2015 13:16