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Repairing the aorta

Inside Job

August 2007

by Natalie Gutierrez

Three years ago, 67-year-old Charles Scott underwent a grueling six-hour surgery to repair an aneurysm in his abdominal aorta. He barely survived. Complications during the procedure left him with memory loss. So, two years later when a second aneurysm in his thoracic aorta had grown dangerously large, he and his wife, Sandy, were worried. In addition to having memory loss and hypertension, Mr. Scott had since developed Parkinsonís disease and diabetes.

"The aneurysm needed to be repaired. But we knew Charles would have a very slim chance of surviving another surgery like the one he already had," Mrs. Scott said. "This wasnít a life-or-death situation. It was either death by aneurysm or death by surgery. We were scared. We thought we didnít have a choice."

Fortunately for the Scotts, faculty physicians at The University of Texas Health Science Center at San Antonio had another option.

On June 15, 2006, Mr. Scott became the first patient in San Antonio to undergo a new less-invasive procedure to repair the aneurysm. V. Seenu Reddy, M.D., was the lead surgeon, along with Maureen Sheehan, M.D. They successfully performed the procedure in less than two hours at University Hospital. Drs. Reddy, Sheehan and Boulos Toursarkissian, M.D., of the Health Science Center, are three of only five surgeons in San Antonio certified to perform this procedure.

Working from the inside-out

Instead of the traditional "open" procedure, in which surgeons make an incision in the chest, spread and fracture ribs and retract the lungs to reach and cut away the damaged section of the thoracic aorta, surgeons make a small incision, about 1.5 inches in size, in the patientís groin. A catheter with a stent-graft attached is inserted over a wire into the femoral artery, which normally supplies blood to the leg. Using digital fluoroscopic X-ray monitoring, surgeons guide the stent-graft to the location of the aorta where the aneurysm or injury is located. When in place, the stent-graft is expanded and left to reinforce the aorta and to cut off the blood supply to the aneurysm. This prevents the aneurysm from enlarging, rupturing and killing the patient. The surgery is achieved in half the time or less that it takes to complete the traditional method and involves significantly less blood loss and stress to the patient.

The stent-graft is made of GORE-TEXģ surrounded by a nickel titanium metal scaffold and is about the diameter of a penny and about as long as a pencil. Photo courtesy of W.L. Gore & Associates.

Dr. Reddy said the technique has become more common within the last four years. "In this procedure, weíre repairing from the inside-out," he said. "Itís almost like fixing a bicycle tire. You put the inner tube in and then inflate."

Dr. Reddy said Mr. Scott was an ideal candidate for the procedure because of his existing health problems. "Just a few years ago, patients with chronic illnesses or other health problems didnít have another option," Dr. Reddy said. "Today, the success rate of this technique is greater than 90 percent."

In addition to being less invasive, patients also benefit from decreased postoperative pain, a shorter recovery period and the reduced chance of complications, including pneumonia.

"Within one week, Charles was up and around recovering nicely," Mrs. Scott said. "This was a great improvement from the more than six weeks it took him to recover from the first surgery."

Saving lives

Mr. Scottís aneurysm resulted from atherosclerosis, or hardening of the arteries, caused by the buildup of cholesterol and other fatty deposits in the arteries and by high blood pressure.

Since Mr. Scottís surgery, the team has performed the endovascular procedure to repair the thoracic aorta on 10 patients from throughout Texas, and will average about 12 procedures per year.

"This technique was an answer to our prayers," Mrs. Scott said. "I truly believe that Charles wouldnít be here if it hadnít been for the surgeons at the Health Science Center. Now we can enjoy more precious time together."

ER option

Patients with injuries sustained by falls or motor vehicle accidents may also require surgery to repair the thoracic aorta. The Health Science Centerís thoracic surgery team also has performed the endovascular procedure on numerous trauma victims. Guadalupe Rivera, 39, was one of those.

On May 8, Rivera was working in Junction, Texas, leveling a double-wide mobile home, a task heíd done dozens of times for 15 years. Suddenly, the ground gave way and the 30-ton home came crashing down on top of him. "My co-workers thought I was a dead man," he said. When Rivera arrived at University Hospital by AirLife, he was in bad shape suffering from multiple injuries including broken ribs, collapsed lungs and a torn thoracic aorta.

"His injuries were so severe that an open procedure was out of the question," Dr. Reddy said. "But repairing the damage to his thoracic aorta was necessary for his survival. So, we used the endovascular method."

"I owe my life to Dr. Reddy and his team," Rivera said. "Iíll never know how to thank them enough."

John Myers, M.D., associate professor of trauma and emergency surgery, said that emergency surgeons at University Hospital, one of the teaching hospitals of the Health Science Center, see about 3,000 trauma patients with life-threatening injuries per year. Of those, 700 have chest injuries, and about 10 to 15 suffer aortic injuries.

"The endovascular approach to repairing aortic injuries is a significant advancement in trauma care in San Antonio," Dr. Myers said. "It is most effective when treating patients suffering from a combination of serious injuries because it allows our surgeons to help patients safely, quickly and definitively."

With the skill and experience of Health Science Center faculty members, the next generation of thoracic and vascular surgeons will be well prepared to help the many patients who suffer from aortic injury and disease every year.

For more information about the program, call (210) 567-5617 or (210) 358-4025.

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