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Aortic Aneurysm Repair Made Easy: No Incisions With New Method

By Michael Lasalandra
Beth Israel Deaconess Medical Center Correspondent

Surgeons at Beth Israel Deaconess Medical Center are repairing dangerous aortic aneurysms using a new technique that not only avoids the need for an abdominal incision but also does away with having to cut into the groin.

“We do it through a poke in the skin,” says Dr. Allen D. Hamdan,, Clinical Director of the Division of Vascular and Endovascular Surgery. “We put a band-aid over it when we are done. I performed one last night on a 98-year-old woman. She’s probably going home today.”

Aneurysms of the aorta, the main artery of the chest and abdomen, are caused by a weakening of the aortic wall. The result is a “ballooning” of the vessel that grows progressively larger and can rupture at any time, causing instant death.

If diagnosed early, such aneurysms can be easily treated. The operation involves placing a Dacron graft reinforced with metal stents that allows blood flow to go around the bubble and through the graft instead, eliminating the possibility of a rupture.

“It’s like a tunnel going through a mountain,” Dr. Hamdan says.

In years past, the operation involved making a major incision in the abdomen to get to the aneurysm. In recent years, surgeons have been able to access the aneurysm by placing catheters into two femoral arteries, accessing them through incisions in the groin. Using X-rays for proper positioning, the graft is secured in place by inflating a balloon to expand the graft to the size needed to prevent blood flow into the aneurysm.

The endovascular approach reduces the mortality rate from as high as 10 percent, depending on the age and sickness of the patient, down to one-to-two percent, according to Dr. Hamdan. It also allows for a shorter hospital stay and a quicker return to normal activities.

Now, the Division of Vascular and Endovascular Surgery, including chairman Dr. Frank Pomposelli and Dr Hamdan’s partners, Dr. Marc Schermerhorn and Dr. Mark Wyers, has adopted a new, improved method of endovascular abdominal aortic aneurysm treatment, called Total Percutaneous AAA Repair, which allows access without cutting into the groin.

“We avoid cutting into the groin at all,” he says. “Instead, we insert a tiny suturing device directly through the skin. There’s no incision, no wound, no bleeding. There’s a much faster return to activity.”

While mortality rates are essentially the same as with the original endovascular repair approach, the new method is easier on the patient in a variety of ways, including less chance of infection and a quicker recovery, he says.

“We’re doing this in 90 percent of our patients,” he says.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted October 2008