Twelve years ago, a routine ultrasound found what Chicago resident Lou Casa could not feel — a tiny, pulsating, potentially fatal bulge in the part of the aorta passing through his stomach region called an abdominal aortic aneurysm (AAA). AAA is the most common type of aortic aneurysm and most often occurs in people over 65 years of age. While they often exist without symptoms and may go undetected, there is a risk of rupture that can lead to death within minutes.
Casa was vigilant about follow-up care, checking in annually with doctors to see if the AAA was changing size or shape. In May 2013, Northwestern Medicine® doctors told him it was time for surgery and suggested he have a new, minimally invasive procedure using a device that would be custom-made for him.
“When we put a graft inside the aneurysm it creates a new lining for the aorta, the main artery carrying blood from the heart to the rest of the body,” said Andrew Hoel, MD, a vascular surgeon who performed Casa’s surgery. “The grafts take pressure off the aneurysms so they are not at risk for rupturing.”
Traditional open surgery to repair AAA requires an abdominal incision and stopping the flow of blood through the aorta during surgery. Patients typically spend at least one night in intensive care and up to nine days in the hospital recovering.
Northwestern Medicine surgeons are now using a new device called the Zenith Fenestrated AAA Endovascular Graft, which is custom made for each patient. With the new endovascular procedure, the entire repair is performed through the femoral arteries, which are located at the level of each hip where the abdomen and the thigh meet. With the surgeon using X-ray for placement, the grafts are inserted through the arteries into the patient’s blood stream, moving to the blood vessels where the aneurysm is located. The aneurysm is sealed off, allowing blood to flow freely through the grafts that remain in the body. There are no incisions on the abdomen and no stitches.
“This device is particularly useful for treating patients, like Mr. Casa, with an aneurysm next to the renal arteries,” said Hoel, who is also an assistant professor of vascular surgery at Northwestern University Feinberg School of Medicine. “In the past, patients with an aneurysm near their kidneys would have required an open surgical repair. With this device, we can now treat these aneurysms with a minimally invasive approach. For patients, this can mean less time in the hospital and a much shorter total recovery time.”
Casa, 79, a retired businessman, long-time advocate of children with special needs and active grandfather of five who has been married for 55 years, said he was back to his get-up-and-go lifestyle days after the surgery.
“I’m feeling great,” Casa said. “I felt no pain before, during or after. That’s why they call it a silent killer. When that thing bursts you don’t have much time before you meet your creator.”
Northwestern has been at the forefront of the treatment of aortic aneurysms, with surgeons here performing the first endovascular aneurysm repair in Chicago in 1993. In the 20 years since, endovascular aneurysm repair has become the most common treatment for aortic aneurysms, accounting for nearly 80 percent of aneurysm repairs in the United States.
The Center for Vascular Disease is part of the Bluhm Cardiovascular Institute, ranked first in Chicago and Illinois and twelfth in the country on the U.S. News & World Report 2013-14 Best Hospitals specialty ranking for cardiology and heart surgery.
For more information about abdominal aortic aneurysms and the Zenith Fenestrated AAA Endovascular Grafts, or to schedule an appointment, call (312) NMHEART or request a first time appointment at heart.nmh.org.
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