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Standing the Test of Time

Endovascular technique helps couple battle aortic aneurysms

The Knaacks are cooking up plans for the future now that their abdominal aneurysms hae been successfully repaired.

The phrase "'til the end of time" is engraved inside their wedding rings. It's the name of the movie they saw on their first date, and it's the way they still feel 57 years after they said, "I do."

Robert and Elaine Knaack have shared good times and bad, and they get serious when they talk about the same life-threatening diagnosis they both had; an abdominal aortic aneurysm. Elaine actually had two of them, diagnosed more than thirty years ago.

"Our children were relatively young, and I was so scared that I was going to die and leave him to raise the two kids alone," she says.

Aneurysms smaller than five centimeters in diameter have only a 2 percent risk of rupturing, so doctors usually recommend patients have an ultrasound every six months to see if the aneurysm is growing. Elaine did this diligently, since her aneurysms weren't large enough to repair.

As the years went by, she got used to watching and waiting. In 2000, a CT scan showed her two aneurysms had grown together, forming one, nearly 5-centimeter bulge. Elaine remembers the impersonal surgeon she was referred to.

"He wasn't with us three minutes," she says. "'I'll make arrangements,' he said, and out he went. I took one look at Bob, burst into tears and said 'I'm not going to him. There's got to be something different. I will not go to that doctor if I drop dead.'"

Two years earlier, she had seen a story on the news about an endovascular approach to repairing abdominal aortic aneurysms. She went home and called the TV station to ask the reporter for more information.

After two more phone calls, she had an appointment to see Mayo Clinic vascular surgeon Dr. Albert Hakaim.

Hakaim explained the endovascular stent graft procedure that he was performing as part of a clinical trial seeking FDA approval for the procedure.

"He put us at ease through the whole thing," Robert says. "He showed us on the computer what he was going to do and how he was going to do it."

Elaine not only opted to participate, but she was out of the hospital in three days and back rafting in the ocean in six weeks.

Surgery to prevent aneurysm rupture involves inserting a stent graft that strengthens the artery.

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The aorta is the body's main artery. It arcs up as it leaves the heart and then and descends through the chest, and into the abdomen. Over time, the buildup of fatty plaque can weaken the blood vessel, causing it to balloon, forming an aneurysm. People can die from a ruptured aneurysm without ever knowing they had one.

"In the majority of patients, the aneurysm isn't diagnosed because of symptoms," says Hakaim. "They're usually found incidentally looking for other conditions."

The traditional repair surgery involves an abdominal incision to expose the aorta. The surgeon replaces the damaged section with a synthetic fabric graft that is hand sewn into the blood vessel. Hospitalization may take a week or more and recovery, months.

With the endovascular procedure, surgeons make an incision in a leg artery and thread a catheter up into the aneurysm under X-ray guidance. The catheter is then withdrawn, leaving behind the stent graft, which is inflated and hooks onto healthy sections of the aorta above and below the aneurysm.

"This diverts the blood flow down through the stent graft so the weakness in the artery, which is the aneurysm sack, no longer has blood pressure in it," Hakaim says. "So the pressure decreases and the sack shrinks."

Robert says it took him awhile to realize he could stop worrying about Elaine. Ironically, even though his father and an uncle died from ruptured aneurysms, he never worried about getting one himself. While being followed for a spot on his kidney, a CT scan revealed a bulge in his abdominal aorta. But before Hakaim could repair the aneurysm, Robert was diagnosed with Hodgkin's lymphoma. His Mayo Clinic oncologists treated the cancer, and it went into remission. Robert finally had the endovascular procedure in March 2006.

While he's not rafting in the ocean — he's never cared for the water — he's resumed woodworking projects in the garage, grilling Italian sausage and letting Elaine know how much he loves her.

"She gets wished a happy anniversary every day," he says with his arm around her shoulder. "Today is 57 years, four weeks and three days."

Then he looks into her eyes and adds, "Tomorrow, it will be four days."

Info
Division of Vascular Surgery
(904) 953-2077