New Emergency Treatment for Burst Aortic Aneurysm
Jack Kory of Mokena, Il. was eating his breakfast oatmeal when he suddenly felt the worst pain in his life.
The searing pain came on suddenly in his stomach and spread to his knees. It was caused by an abdominal aortic aneurysm (AAA) that had suddenly burst, causing massive internal bleeding.
Traditionally, few patients have survived such ruptures. But Loyola University Medical Center vascular surgeon Dr. Richard Hershberger was able to repair Kory’s aneurysm with a minimally invasive emergency procedure.
“I’m very happy with how it worked out,” Kory said.
An AAA is a bulge in the large blood vessel that supplies blood to the abdomen. The bulge typically develops slowly over many years. The larger the aneurysm, the more likely it is to rupture and cause massive bleeding. About 80 percent of people who suffer AAA ruptures die before they get to the hospital. Among patients who make it to the hospital in time, only about 50 percent survive traditional open surgery.
But more patients are surviving minimally invasive procedures that Hershberger and other vascular surgeons at Loyola are performing on patients with ruptured AAAs. The newer procedure is called endovascular surgery. About 70 percent of ruptured AAAs now can be repaired with the endovascular technique. In the last four years, Hershberger and other vascular surgeons at Loyola have performed endovascular surgery on 12 patients who suffered ruptured AAAs, and they all survived.
An aortic aneurysm is a bulge that develops in the aorta, the largest artery in the body. While an aortic aneurysm may burst, causing serious health problems, it is also possible for an aneurysm to be in the aorta without rupturing. Many people mistakenly believe that an aneurysm refers to the actual event of a rupture.
Smaller aneurysms are generally monitored by a physician. They can be diagnosed and monitored using a variety of diagnostic tools, such as an x-ray, EKG, MRI or CT scan. If the physician notices the aneurysm getting larger, he may recommend treatment. The larger an aneurysm becomes, the greater the likelihood is that it may burst.
Aortic aneurysms are most commonly located in the area below the kidneys. In this location, an aneurysm is called an abdominal aneurysm. If the aneurysm is located higher up, in the chest cavity, it is called a thoracic aneurysm.
Kory was first taken to a community hospital and then taken by helicopter to Loyola. Fortunately, the blood clotted enough to temporarily stem the bleeding. But his only chance to survive was an emergency repair of the aorta.
In traditional surgery, a surgeon makes a large incision in the abdomen and replaces the damaged portion of the aorta with a Dacron tube.
Hershberger instead used the endovascular technique. He inserted a catheter in a groin artery and guided it through blood vessels to the site of the burst aneurysm.
Aneurysms can form in any blood vessel, but they occur most commonly in the aorta (aortic aneurysm). The aorta is the largest artery in the body. It carries blood from the heart to the rest of the body. Aortic aneurysms can occur in two main places:
1. Abdominal aortic aneurysms occur in the part of the aorta that passes through the middle to low abdomen.
2. Thoracic aortic aneurysms occur on the aorta as it passes through the chest cavity. These are less common than abdominal aneurysms.
Small aneurysms generally pose no threat. However, aneurysms increase the risk for:
* Atherosclerotic plaque formation at the site of the aneurysm. This causes further weakening of the artery wall.
* A blood clot may form at the site and dislodge, increasing the chance of stroke.
* Increase in the size of the aneurysm, causing it to press on other organs. This may cause pain.
* Aneurysm rupture. Because the artery wall thins at this spot, it is fragile and may burst under stress. The rupture of an aortic aneurysm is a catastrophic, life-threatening event.
Hershberger then deployed a device called a stent graft - a GoreTex® tube supported by metal webbing. The stent graft is about 4 inches long and 1 inch wide. After it was deployed from the catheter, the device expanded outward to the walls of the artery. This allowed blood to flow safely through the stent, rather than gushing into the abdominal cavity.
About 15,000 people in the United States die each year from ruptured AAAs. Albert Einstein, Lucille Ball and George C. Scott are among those who have died from ruptured aortic aneurysms.
Risk factors for AAAs include smoking, high blood pressure, High cholesterol, male gender, emphysema, genetic factors and obesity. Hershberger said men 65 and older who have smoked more than 100 cigarettes in their lifetime should be screened for AAAs.
It is much easier and safer to repair an aneurysm before it bursts. Surgery generally is recommended once the aneurysm bulge expands to 5 cm or larger.
Hershberger is part of a team of vascular surgeons at Loyola who are conducting clinical trials on stent grafts and other minimally invasive treatments for aortic aneurysms and other vascular diseases. He is an assistant professor in the Department of Surgery, Division of Vascular Surgery and Endovascular Therapy at Loyola University Chicago Stritch School of Medicine.
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Source: Loyola University Health System