Endovascular Stent-Graft for Thoracic Aortic Aneurysm
Endovascular aortic surgery is a rapidly evolving technology that has been proven to have significant clinical benefits in the treatment of abdominal aortic aneurysm (bulging of the largest artery that carries blood from the heart to the rest of the body, the aorta). One device is FDA approved for human use in the United States. We are fortunate to have the opportunity to partner with our new peripheral endovascular surgeon, Dr. Chandra Cherukupalli, to offer this new treatment option to patients with thoracic aortic aneurysm.
In September 2007, the first aortic arch aneurysm repair by endovascular stent-graft technology in Brooklyn was performed at SUNY Downstate. Traditionally, cases like this would have required deep hypothermic circulatory arrest (use of the heart-lung machine) to repair the complex aortic arch aneurysm in the conventional way. With the latest technology, we were able to accomplish the repair by transposing the great vessels of the aortic arch to the aortic root followed by the placement of two large stent-grafts in series to exclude the arch aneurysm. This was done with a beating heart without cardiopulmonary bypass. Incidentally, the patient also had a double coronary artery bypass for left main coronary artery disease. This approach represents a quantum leap from the traditional method of deep hypothermic circulatory arrest that is associated with hemorrhage (bleeding) and neurologic (nerve system) complications.
Our second patient was a multi-trauma patient with disruption of the thoracic aorta (the largest artery above the diaphragm that carries blood from the heart to the rest of the body) at the isthmus (narrowed part), associated with other major blunt injuries including bilateral lung contusions (bruising of he lungs), unstable pelvic fracture and with on-going and brisk internal hemorrhage. We were able to place a stent-graft to contain the aortic disruption from within, without an open chest procedure, and without turning his body to position it on the operating table, which would have worsened his hemorrhage from the unstable pelvic fracture. In April 2008, another patient was successfully treated with endovascular stent-graft with the beating heart technique without the use of the heart-lung machine at SUNY Downstate Medical Center. This patient has many other medical conditions that could post high peri-operative risks, if the traditional surgical approach is used with the heart-lung machine. With the option of the new advanced technology of endovascular stent-graft, we were able to treat the patient and avoid all the complications associated with the traditional approach.
» Click here to view Department of Surgery grand round for the above case presentation
At SUNY Downstate, we expect this new program will continue to grow and at minimum be able to offer surgery to patients with prohibitive operative risk for open chest procedure or those who require the use of partial or total cardiopulmonary bypass. |
