Mayo Clinic surgeons perform 100 endovascular aneurysm repairs

Tuesday, July 10, 2001

JACKSONVILLE, Fla., July 10, 2001 — Mayo Clinic surgeons, led by Dr. Albert Hakaim, director of endovascular surgery, have performed their 100th minimally invasive procedure to repair an aneurysm. An aneurysm is a bulging or ballooning of a blood vessel. Usually caused by atherosclerosis (the buildup of cholesterol and other substances that damage arteries), aneurysms occur most often in the abdominal portion of the aorta, the body's main artery.

At least 15,000 Americans die each year from ruptured abdominal aortic aneurysms. Back pain and abdominal pain, both symptoms of an abdominal aortic aneurysm, often do not appear until the aneurysm is about to rupture, a condition that is usually fatal. Fortunately, doctors detect many aneurysms during routine medical tests and physical exams.

Such was the case with former senator and presidential candidate Bob Dole. At Cleveland Clinic last month, Dole underwent the endovascular procedure known as stent grafting to repair an abdominal aortic aneurysm. The procedure is an alternative to the standard treatment, which is major invasive, open abdominal surgery.

Hakaim performs both procedures but says, given the option, his patients prefer the stent graft. "The main advantage for the patient is less hospital time," he says. "The great majority of patients stay two days in the hospital with no ICU (intensive care unit) stay. They resume normal activities within a month. Compare that to the open repair, which requires one to two days in the ICU, seven days in the hospital and a month until they start to feel normal."

The stent graft procedure takes about 90 minutes and is done in the operating room, with the patient under general anesthesia. A catheter is inserted into the femoral artery of the patient's leg. Under fluoroscopy, an imaging process that uses X-rays and a radiologic dye injected into the artery, doctors can see the catheter as they thread it up to the patient's aorta. Under fluoroscopy, doctors then guide a stent on the tip of a wire through the catheter to the aneurysmal section of the aorta. Stent-grafts are essentially wire mesh tubes with fabric coating that bypass weakened or damaged arteries. Eventually the aneurysm contracts around the stent.

Hakaim says the majority of patients with abdominal aortic aneurysms can successfully be treated with stent grafts. Those that can't do not have enough length of healthy aorta below their renal arteries to allow the stent to be positioned properly.

Normally, the aorta is about 2 centimeters in diameter. (A centimeter is about the width of a large paper clip.) Hakaim says surgeons typically won't consider any type of surgery until an aneurysm has grown to about 5 centimeters in diameter. Then the risk of rupturing becomes a factor. "The probability of a 5- centimeter aneurysm rupturing in a five-year period is about 20 percent," Hakaim says. "Then we have to consider the risk of surgery, general anesthesia and the patient's cardiac and pulmonary function vs. the risk of the aneurysm rupturing. If patients are a good risk for surgery, we'll repair them with either open repair or endovascular repair."

The Food and Drug Administration (FDA) considered stent grafting an investigational procedure for aneurysm repair until September 1999. Hakaim began performing stent grafts, with FDA approval, as an investigational procedure in June 1999 using custom-made stents he constructed himself.

In 100 procedures, Mayo Clinic surgeons have used FDA-approved stents, as well as Hakaim's and other investigational designs. Hakaim used one investigational stent last December to perform North Florida's first thoracic aortic aneurysm repair. Aneurysms infrequently occur in the thoracic (chest) portion of the aorta. Due to the risk of blocking arteries that branch off from the thoracic aorta, patients who develop these types of aneurysms are usually not candidates for endovascular repair.

Media contact: Erik Kaldor 904-953-2299 kaldor.erik@mayo.edu

###

To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. MayoClinic.com is available as a resource for your health stories.