UMC Offers New, Minimally Invasive Repair of Aortic Aneurysms

Surgeons at University Medical Center are performing a new procedure to repair abdominal aortic aneurysms that drastically reduces a patient's recovery time from approximately two months to two weeks.

To repair an abdominal aortic aneurysm, doctors traditionally have to cut open the entire abdomen to reach the blood vessel. Now, they can get to the aneurysm through two tiny incisions.

"When compared to the conventional surgical procedure, the new, minimally invasive endovascular repair of an abdominal aortic aneurysm offers a shorter hospital stay, a rapid return to normal physical activity and a reduction in mortality and complications," explains Dr. Joseph L. Mills Sr., professor and section chief of vascular surgery in the UA College of Medicine.

An aortic aneurysm is the ballooning of the walls of the aorta, the major artery from the heart. It can rupture if left untreated, and less than 50 percent of all people with a ruptured abdominal aortic aneurysm survive.

Approximately 40,000 patients undergo elective repair of abdominal aortic aneurysm in the United States each year. Bob Dole, the 1996 Republican presidential candidate, underwent this new procedure last month in Cleveland.

To repair an aneurysm, the traditional technique of open surgery requires a large incision be made in the patient's abdomen. "The operation lasts from two to five hours," Dr. Mills says. "Patients are in the hospital for five to 11 days and it takes two to three months before the patient is fully recovered. Open aneurysm surgery is a very major operation."

The "endovascular" procedure involves inserting an expandable Y-shaped tube into the inside of the aneurysm through the femoral artery in the groin. Using the new technique, Dr. Mills is able to repair the aortic aneurysm through two small groin incisions. The graft is placed in position using very careful and accurate X-ray guidance and fixed in place above and below the aneurysm. The patient usually can return home in just two days.

Although endovascular repair of abdominal aortic aneurysms using a stent-graft is an important advance in modern surgery, it does not completely replace open surgery, says Dr. Mills.

"With open repair, the likelihood that we'll ever have trouble with the aneurysm again is very low," Dr. Mills says. "With endovascular repair, there is some possibility that over time the graft will shift, allowing the aneurysm to become active. For that reason, it is important that patients who have endovascular repair be followed with CT scans every six months."

Dr. Mills says the procedure is ideal for patients who, because of their age or health status, are not candidates for the more traumatic surgery.