Reducing Mortality Through Minimally Invasive Endovascular Treatment of Aortic Disease

Oct 14, 2011, 11:52 ET from University Hospitals Case Medical Center

CLEVELAND, Oct. 14, 2011 /PRNewswire/ -- Aortic pathologies such as aneurysms, arterial penetrating ulcers, intramural hematomas and dissections are potentially life-threatening since the aorta is the major artery that allows blood to leave the heart. Historically, the surgical treatment for aortic pathologies has been thoracotomy, repair or replacement of the thoracic aorta, which has a high rate of postoperative complications and a nearly 40 percent rate of mortality in emergency cases.

Minimally invasive surgery now is often the best way to correct aortic pathologies in many patients who cannot withstand major chest and abdomen surgery. University Hospitals Case Medical Center is one of a handful of institutions to offer a cutting edge, minimally invasive procedure TEVAR (thoracic endovascular aortic repair) to restore blood flow to the aorta.

"Traditional treatment is major surgery, which includes opening the chest and sometimes opening the abdomen and sewing in a graft," says Vikram S. Kashyap, MD, Chief, Division of Vascular Surgery and Endovascular Therapy, University Hospitals (UH) Case Medical Center, Co-Director, UH Harrington-McLaughlin Heart & Vascular Institute, and Professor of Surgery, Case Western Reserve University School of Medicine. "However, what we have been doing, along with select institutions around the country, is using a stent graft to restore the normal continuity of blood flow to the aorta. The advantage is that the stent graft can be introduced through a small incision in the groin."

"TEVAR is a procedure in which an endovascular stent graft is directed to the site of the aortic pathology by way of a catheter introduced through a small incision in a femoral artery," said Dr. Kashyap. "This minimally invasive technique to repair aortic pathologies has reduced mortality significantly compared to traditional open surgical techniques nationwide. The graft performs much like an inner tube in a tire with a bulge to protect the damaged blood vessel."

TEVAR can be used in select patients to repair type B dissections and thoracic aneurysms. While most patients continue to require lifelong blood pressure medications and careful follow-up care, they often return to pre-illness levels of activity.

Many endovascular procedures require special training, skills, teams and facilities that are not available at every hospital. The endovascular surgery team at UH Case Medical Center includes critical care physicians, intensive care physicians, radiologists, anesthesiologists, cardiologists, vascular surgeons and the nursing staff.

"We bring a great team of caregivers to a given procedure to optimize patient outcomes," said Dr. Kashyap, who is a board-certified vascular surgeon, a registered vascular technologist, and principal investigator of a study of endothelial function in peripheral arteries as well as several studies of new vascular stents, grafts and prostheses.

Detailing the Risks

Although an aortic aneurysm – a bulge on the wall of the aorta – can be monitored by a physician over many years before surgical intervention is necessary, the danger with regard to an aortic aneurysm is related to its size.

"If the bulge or balloon in the vessel wall becomes too large, there is a chance that it will rupture," said Dr. Kashyap.

Risk factors and other associated conditions for the development of aortic aneurysms include high blood pressure, smoking, emphysema, certain genetic factors and male gender.

Aortic ulcers, intramural hematomas and dissections can have rapid and devastating consequences. Penetrating aortic ulcers and hematomas (solidified blood) can cause ruptures of the aortic wall and bleeding. An aortic dissection, a tear in the inner wall of the aorta, results in bleeding into the inner and middle layers of the wall of the aorta that causes them to separate.

Although the exact cause of aortic dissection is unknown, risk factors include high blood pressure and some genetic abnormalities of the aorta, including Marfan syndrome. Other aortic pathologies are related to traumatic injury to the chest and atherosclerosis – hardening of the arteries. Left untreated, aortic diseases can rapidly lead to death by exsanguination.

It is vitally important physicians and patients understand not all chest pain is caused by heart attack.

"Severe chest and back pain can also be caused by aortic pathologies that, if recognized early, can often be treated successfully using minimally invasive techniques with a low incidence of postoperative complications," said Dr. Kashyap.

SOURCE University Hospitals Case Medical Center