Research

Researchers develop new stents for complex aortic aneurysms

Mayo Clinic vascular surgeon Gustavo S. Oderich, M.D., and his team are helping to develop stents for complex aortic aneurysms.

Hi, Mr. Hall. How are you doing, sir?

I could have tripped over dead. That's what would have happened. If it would have burst, I would have probably been dead.

Take a small breath and hold.

He said it was [INAUDIBLE] a ticking bomb. It could rupture at any time.

What I would like to do now is to show you this CT scan.

An aneurysm is a weakening, a dilatation of the artery. They are a major life-threatening event with a very high risk of death. Actually in fact, 90% of the patients end up passing away.

These are illustrations of Mr. Hall's aneurysm. And what we are seeing is the aorta and a series of arteries. This is the artery to the liver, intestine, right kidney — which is here — left kidney. They can be repaired. Traditionally, the aneurysm is being repaired by open surgery. And techniques that we do open surgery have been around since the 1950s basically. Nowadays they can also be treated by means of stents. The stents are done with little punctures in the groin and working the inside of the artery.

But most of the stents that we have available right now they are for simpler aneurysms, not the aneurysms that involve the arteries to the kidneys, intestines, and liver.

We would have had to have waited two months, I think they said, to get the other type of stent that they'd been using. Well, he said I couldn't wait.

I just knew we couldn't wait, so we had to — we just had to put our faith in him and go ahead and do it.

Two days, really, and I was in there to be operated on.

So these are stents that are not commercially available. They have to be used under specific research studies.

So we develop a relationship with radiology and the 3D print lab that is available here at Mayo. And we're able to print, actually, the aorta off the patient that has to be treated.

This 3D print brings the reality of that patient's anatomy. We actually have to do all the steps of the operation as they are. And it anticipates difficulties, challenges, sometimes it helps answer questions. Connect this to a pump of fluid that has normal temperature that we have, about 35 to 36 degrees Celsius, and blood pressure, pulsatility.

We created a recipe of, so to speak, of how to create a stent that is off the shelf, that would fit most of the patients. And is the picture now after the aneurysm was treated. And this is actually many pieces, this is not one stent.

It's modules that we put together. So first there is one stent in the aorta. A long one that has docking sides. There is a stent inside the vessel and that stent has side arms to the liver, intestine, and to both kidneys. And then working inside the vessels with X-ray and wires and catheters, we're able to place the stent in that location.

I mean, this is an operation that he spent one night in the intensive care unit and three days in the hospital. So that would be almost unheard with an open surgery.

I just think it's absolutely — it's just unbelievable. For him to be doing as well as he's done it, I'm just so thankful.

Mayo Clinic's collaborative atmosphere enables its education, research and clinical practice staffs to innovate and improve patient care. The physician-scientists of the vascular centers regularly publish books, chapters and journal articles to advance the science. They present at local, national and international meetings and serve on the boards of specialty medical societies. And they conduct research to improve diagnosis and prevention and develop new treatment options.

Areas of particular interest include:

  • Perfecting techniques of open and endovascular surgery to treat chronic mesenteric ischemia
  • Improving care of people hospitalized with aortic dissection
  • Comparing different surgical approaches to repairing aortic aneurysms
  • Advancing the understanding of an underdiagnosed and undertreated cause of leg pain called peripheral artery disease
  • Improving care for people with vascular malformations, such as Klippel-Trenaunay syndrome
  • Finding new applications for robotic vascular surgery

Publications

See a list of publications about vascular medicine by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine.

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Jan. 12, 2022
  1. Huang Y, et al. Outcome after open and endovascular repairs of abdominal aortic aneurysms in matched cohorts using propensity score modeling. Journal of Vascular Surgery. 2015; doi:10.1016/j.jvs.2015.02.039.
  2. Kullo IJ, et al. Peripheral artery disease. The New England Journal of Medicine. 2016; doi:10.1056/NEJMcp1507631.
  3. Malgor RD, et al. Surgical treatment of varicose veins and venous malformations in Klippel-Trenaunay syndrome. Phlebology. 2016; doi:10.1177/0268355515577322.
  4. Fischer JE, ed. Techniques of open and endovascular revascularization to treat chronic mesenteric ischemia. In: Fischer's Mastery of Surgery. 7th ed. Lippincott Williams & Wilkins; 2018.
  5. Office of Patient Education. Thoracic outlet syndrome. Mayo Clinic; 2007.
  6. Vlietstra RE, et al. Balloon angioplasty in multivessel coronary disease. Mayo Clinic Proceedings. 1983;58:563.
  7. Sullivan TM. Current status of endovascular surgery. The Guthrie Journal. 1992;61:101.
  8. Jensen NA. Allscripts EPSi. Mayo Clinic. July 23, 2021.
  9. Overview of aortic aneurysms. Merck Manual Professional Version. https://www.merckmanuals.com/professional/cardiovascular-disorders/diseases-of-the-aorta-and-its-branches/overview-of-aortic-aneurysms. Accessed Feb. 21, 2017.
  10. Atherosclerosis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/cardiovascular-disorders/arteriosclerosis/atherosclerosis. Accessed Feb. 21, 2017.
  11. Anderson KR, et al. Increasing incidence of infantile hemangiomas (IH) over the past 35 years: Correlation with decreasing gestational age at birth and birth weight. Journal of the American Academy of Dermatology. 2015; doi:10.1016/j.jaad.2015.08.024.
  12. Davila VJ (expert opinion). Mayo Clinic. Nov. 26, 2018.
  13. Erben Y, et al. Loop technique: Addressing celiac artery dissection in a branched and fenestrated endograft for the treatment of a type III thoracoabdominal aneurysm. Journal of Endovascular Therapy. 2016; doi:10.1177/1526602816649372.
  14. Meyer LA. Vascular Center finance. Mayo Clinic. Aug. 20, 2018.
  15. Chau AH, et al. Robotic-assisted left renal vein transposition as a novel surgical technique for the treatment of renal nutcracker syndrome. Journal of Vascular Surgery Cases Innovative Techniques. 2018; doi:10.1016/j.jvscit.2017.09.008.
  16. Oderich GS (expert opinion). Mayo Clinic. Nov. 28, 2018.
  17. Shamoun FE (expert opinion). Mayo Clinic. Nov. 20, 2020.
  18. McBane RD (expert opinion). Mayo Clinic. Feb. 18, 2019.
  19. Jayaraj A, et al. Outcomes of transaxillary approach to cervical and first-rib resection for neurogenic thoracic outlet syndrome. Annals of Vascular Surgery. 2018; doi:10.1016/j.avsg.2018.02.029.
  20. Moriarty JM, et al. ACR appropriateness criteria imaging in the diagnosis of thoracic outlet syndrome. Journal of the American College of Radiology. 2015; doi:10.1016/j.jacr.2015.01.016.
  21. Arya S, et al. Carotid endarterectomy is superior to carotid angioplasty and stenting for perioperative and long-term results. Vascular and endovascular surgery. 2011; doi:10.1177/1538574411407083.