Written by Rebecca Budde • Photography by Jason Johnson
They’re known as "silent killers." They give little or no warning as they sit in the abdomen, waiting to burst. When they do, it’s often fatal.
Imaging showed that Daviet Henderson, age 74, had a small abdominal aneurysm. After a few months of observation, a follow-up scan indicated the aneurysm’s growth. His physicians began to discuss his options to repair the aneurysm before it burst.
An abdominal aortic aneurysm (AAA) is an abnormal ballooning of the artery in the abdomen that supplies blood to the lower half of the body. AAAs often produce no symptoms or the symptoms are vague and can be attributed to other health concerns. According to Kim Hodgson, MD, professor and chair of the Division of Vascular Surgery, most AAAs are found by accident, showing up on imaging taken for another health reason.
The majority of AAAs can be successfully treated if they are repaired before rupture. Abdominal aortic aneurysm repair originated with open surgery and has evolved into a less-invasive endovascular aneurysm repair (EVAR) using grafts called endografts or stent-grafts. "Patients with abdominal aortic aneurysms are best served by a vascular surgeon who can do both procedures and help the patient understand the options and what is best for the circumstance," says Dr. Hodgson. The surgeons in SIU’s Division of Vascular Surgery are in a unique position because they can offer open AAA repair or EVAR, depending on the needs of the patient.
To repair an AAA with open surgery, the surgeon makes an incision in the abdomen, opens the aneurysm and sews a fabric graft into the opened aneurysm. After it is in place, the aneurysm is wrapped around the graft. The fabric graft doesn’t need the metal stent structure, hooks or barbs that endografts do because it is sutured directly to the vessel. Recovery involves a four to six day hospital stay. "Once the surgery is complete, there’s very little long-term maintenance involved," says Dr. Hodgson.
For most patients, AAA can be fixed through the minimally invasive EVAR procedure, often performed under deep sedation. The vascular surgeon makes two small incisions in the groin area and threads a long, thin tube through the femoral arteries in each leg. Using special instruments and imaging, an endovascular stent-graft will be guided to the site of the aneurysm. Once at the site of the aneurysm, the stent-graft will be opened and attach to the wall of the aorta.
Henderson was one of the lucky ones. Dr. Hodgson abated the silent killer, fixing the aneurysm through an endovascular repair.
Medical technology has allowed for customization of the endografts for each patient by taking measurements from 3-D images from the patient’s CT scans. It is made of fabric and metal with small hooks or barbs at the end to hold it in place. In time, the aneurysm will contract around the stent-graft.
Though less-invasive and requiring a shorter recovery time, patients who have had EVARs require more frequent follow-up visits. "The only way we know that the stent-graft is doing what it’s supposed to – taking all the blood flow and pressure – is to continually re-evaluate," Dr. Hodgson says. "Patients need to come in at least once a year for imaging following a stent-graft repair."
Patients understandably want the minimally invasive procedure, but Dr. Hodgson says it is not always the best treatment for them. He estimates that open surgery is a better treatment option for approximately 20 percent of those with AAA.
Research, including clinical trials, has helped make advances like EVAR. SIU’s Division of Vascular Surgery has a rich history of participation in clinical trials. Dating back to the mid-1990s, clinical investigations have researched new devices and procedures for vascular disease, including the improvement in the design of endovascular stent-grafts. (pictured right) "These design changes have improved outcomes for abdominal aortic aneurysm repairs and allowed vascular surgeons to treat a greater range of patients with better results," Dr. Hodgson says.
Clinical trials have allowed stents like these (enlarged for viewing) to improve outcomes for patients with vascular issues.