Saving lives Featured

7:00pm EDT February 28, 2007

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 occurrences.

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 lives.”

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 community?

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 wmcahearts@ihhioc.com or visit the Web site www.westernmedanaheim.com.