Technological advances have allowed
procedures that were formerly conducted exclusively at teaching hospitals to be performed at local community
hospitals, providing many benefits to
patients, their families and employers.
The endovascular stent graft procedure,
used primarily to treat abdominal aortic
aneurysms and thoracic aortic aneurysms,
is an example of a minimally invasive procedure that extends life and replaces the
maximally invasive surgery that was formerly used to treat these fairly common
Not only does “localization of the procedure” make it more readily available to
those who need it, there’s reduced recovery time and a lower risk of side effects
associated with the surgery. All of that
translates to lower costs in the form of
reduced hospital stays, shorter disability
periods and lower medical bills, says Dr.
John Eugene, chair of cardiac surgery at
Western Medical Center Anaheim.
“Because a patient often needs this surgery later in life, many were too ill to undergo the procedure when it was conventional surgery,” says Eugene. “Now we are able
to treat more patients and extend their
Smart Business spoke with Eugene
about the endovascular stent procedure
and how it benefits patients.
Who is at risk for an aneurysm?
An aneurysm is a sac formed by the dilation of the wall of an artery, a vein, or the
heart. Aneurysms can occur in the aorta
either in the abdomen (abdominal aortic
aneurysm or AAA) or in the thorax (thoracic aortic aneurysm).
Those at greatest risk are males older
than 60 years, people with an immediate
relative who has had AAA, people with
high blood pressure and smokers.
What is an endovascular stent graph?
An endovascular stent graft is a tube
composed of fabric supported by a metal
mesh called a stent. It can be used for a
variety of conditions involving the blood vessels, but most commonly to reinforce a
weak spot in an artery called an aneurysm.
Over time, blood pressure and other factors can cause this weak area to bulge like
a balloon and eventually enlarge and rupture. The stent graft seals tightly with your
artery above and below the aneurysm. The
graft, which is stronger than the weakened
artery, allows blood to pass through it without pushing on the bulge.
What does the procedure involve and why is
it less invasive?
Aortic aneurysms are potentially serious
health problems since a burst aorta results
in massive internal bleeding that can be
fatal unless treated rapidly by an experienced emergency medical team. Endovascular stent graft repair is designed to
help prevent an aneurysm from bursting.
The term ‘endovascular’ means ‘inside
blood vessels.’ To perform endovascular
procedures, vascular surgeons use special
technologies and instruments.
These procedures require only a small
incision or puncture in an artery or vein.
Through these punctures, a vascular surgeon inserts long thin tubes, called
catheters, which carry the devices through
your blood vessels to the location of the aneurysm. Generally, endovascular treatments allow you to leave the hospital sooner and recover more quickly, with less pain
and a lower risk of complications (including death) than traditional surgery, because
the incisions are smaller.
Sometimes traditional surgery is required
if the shape or the location of the aneurysm
is not favorable for an endovascular treatment.
How should I select a surgeon?
It is important to select a cardiovascular
surgeon who has a great deal of experience
with the procedure. With greater experience, competency increases and complication rates decrease. All medical centers
benchmark their outcomes, so be certain
to ask about the center’s and the cardiovascular surgeon’s performance. Also,
write down all of your questions, so you
remember to ask them when you visit the
surgeon for your consultation.
The cardiovascular surgeon should be
willing to discuss every detail of the surgery with you. There are great sources of
information available to help patients
understand their options, the procedures
and any risks.
How does having the availability of this procedure here in Orange County benefit the
Prior to this procedure becoming available locally, many patients had to travel to
find hospitals that could accommodate
them. The waiting lists were long. Also, the
cardiovascular surgeons were located by
the facilities, so travel was required for follow-up visits, and in the event of an emergency no local physician was available
who was trained to provide treatment.
DR. JOHN EUGENE is chair of cardiac surgery at Western
Medical Center Anaheim. For more information about cardiothoracic surgery at Western Medical Center Anaheim, phone (714)
502-2668, e-mail [email protected] or visit the Web site