Battle of the Bulge
|His aneurysm repaired, Clyde
Stephens keeps busy playing
golf and working part-time at
nearby Beechwood Golf Course.
His aneurysm repaired, Clyde Stephens keeps busy playing golf and working part-time at nearby Beechwood Golf Course.
After emergency surgery to repair a bowel obstruction and eight days in the hospital, Clyde Stephens went home with a good-sized scar and some worrying news.
“My surgeon said he found an aortic aneurysm, and I’d better get it taken care of,” recalls the 67-year-old retired construction manager. “If it was to bust, I’d be gone.”
Aortic aneurysm is a bulge in a weak area of the wall of the aorta, the body’s major blood vessel. Most are caused by a build-up of plaque (atherosclerosis) in the arteries, which can cause the elastic fibers in the walls of the aorta to weaken and stretch.
Like Clyde’s, many aneurysms are discovered when a patient is treated for another medical issue. A ruptured aortic aneurysm can cause life-threatening bleeding.
As he healed from one surgery, Clyde told his surgeon exactly what he wanted for his next. “I didn’t want to be practiced on,” the Arcanum resident told his doctor. “I don’t want someone who’s done this once in a while. I want the best.”
His doctor recommended Eugene Simoni, MD, endovascular surgeon at the Dayton Heart and Vascular Hospital at Good Samaritan Hospital and chief of the vascular surgery department at Wright State University.
“When Dr. Simoni told me he did 50 or 60 of these a year,” Clyde recalls, “I said, ‘You’re the one that I want.’
“Then he said I’d probably be out of the hospital the next day, and I liked that a lot.”
Faster Recovery, Fewer Risks
Clyde is the beneficiary of recent advances in endovascular grafts for repairing aortic aneurysms. These innovations significantly reduce a patient’s surgical and recovery time, as well as risks of near- and long-term complications.
To repair the aneurysm, Clyde was in the hospital one morning, had a percutaneous procedure under local anesthetic with sedation, and was discharged the next morning.
“I wasn’t ready to do a sprint, but I had no pain,” he recalls.
|Using X-rays that appear as moving
images on the screen, Dr. Eugene
Simoni guides a stent graft into place,
assisted by Radiology Technologist
Open Surgery vs. Minimally-invasive Endovascular Procedures
Using X-rays that appear as moving images on the screen, Dr. Eugene Simoni guides a stent graft into place, assisted by Radiology Technologist Tesa App.
That’s a major contrast to the five- to seven-day hospital stay and four to six weeks of recovery for a traditional open chest or open abdominal surgery.
Both the open and minimally-invasive approaches use a synthetic graft at the site of the aneurysm, a fabric tube covered by a metal mesh support. In open surgery, the surgeon works through a large incision to replace the damaged section of the aorta and sew the graft into place.
In a minimally-invasive endovascular procedure, Dr. Simoni accesses the aneurysm using a device that allows him to create a tiny opening in the skin and the femoral artery through which he can thread a catheter to the aorta. The graft – this one with hooks – is on the end of the catheter. Guided by X-ray imaging in real time, Dr. Simoni moves the graft into position. He releases the graft which then secures to the wall of the aorta with the hooks.
Patients are under local anesthetic with sedation, so they can speak to Dr. Simoni if necessary. He typically completes the procedure within two hours.
“Patients are usually out of bed in six to eight hours, and spend one night in the hospital,” Dr. Simoni said. “There are no restrictions after 24 hours.”
For follow-up care, Dr. Simoni also inserts a tiny pressure-monitoring device into the space between the graft and the bulging aortic wall.
Patients return in a month for a CT scan and to have a wand passed over the device to measure the pressure within the clotted aneurysm sac that surrounds the graft. The aneurysm is monitored for endoleaks or movement of the graft to see if further action is necessary.
“The patient’s recovery is remarkably improved,” Dr. Simoni said of endovascular advances. The endograft procedure significantly reduces the risk of complications and death compared to open surgeries. A new long-term study of endografting found fewer patients returned to the hospital with bowel obstructions when compared with patients who had open surgeries.
“It’s because we’re not operating on the abdomen and causing scar tissue to form,” he explains.
The Society for Vascular Surgery notes that the shape, size and location of the aneurysm, as well as the patient’s medical condition, can determine whether endovascular repair or open surgery is the best approach to treat an abdominal aortic aneurysm. Your doctor will help you decide what’s right for you.
For Clyde Stephens, who works part-time at a nearby golf course, things went as smoothly as planned. “I was real pleased. I was in one day, out the next.”
Learn more about the area’s most advanced cardiovascular care.
Content Updated: December 4, 2014