MORGANTOWN — Recent evolutions in the treatment of abdominal aortic aneurysms have all but eliminated the need for open surgical procedures to prevent life-threatening ruptures. The technology to treat these aneurysms through catheterization with stents has greatly reduced patient stays and recovery times.
Aneurysms are bulges in blood vessels that are caused by a weakness in the vessel wall. Thoracoabdominal aortic aneurysms involve the portion of the aorta, the main artery carries blood away from the heart, in the chest and abdomen. Traditionally, this condition has required an extensive open surgical approach to treat. New technologies have allowed surgeons to implement a minimally invasive approach through a catheter in the groin. This approach requires stents with holes that align with the vessels that supply blood to those organs.
Pre-made stents to address this problem are currently only available to patients enrolled in clinical trials and in a very few centers in the United States, requiring patients to travel long distances to receive this life-saving care. Additionally, many patients may not meet the criteria for these trials due to other health conditions, age, or their aneurysm anatomy.
In these cases, one of the advanced techniques that is currently being performed at the WVU Heart and Vascular Institute is Physician Modified Endografts (PMEG). This technique allows surgeons to use scans to determine the placement of holes to make into FDA-approved stents that are then placed in the aorta to create a seal above and below the aneurysm. This technique has achieved good patient outcomes and requires a high level of experience and expertise.
“There are only a few places in the country that are part of the clinical trials, and you have to qualify for those trials, so there can be a lot of delay and process,” Sashi Inkollu, M.D., WVU Heart and Vascular Institute Aortic Surgery Center co-director, said. “The other option is a big open procedure, which can get complex when it involves these arteries, even in perfectly healthy patients. Treating them with stents whenever feasible may provide them the best chance for a rapid recovery.”
Ed Flinn, 77 of Parkersburg, was undergoing a routine chest x-ray to monitor him for black lung disease when his doctor saw something unusual. He was told to go directly to the Emergency Department at WVU Medicine Camden Clark Medical Center, where additional scans revealed the size and complexity of his thoracoabdominal aortic aneurysm as well as a large iliac aneurysm. He was transferred to WVU Medicine J.W. Ruby Memorial Hospital, where he received additional advanced imaging, including an EKG-gated CT scan to provide optimal images that are required for planning of such complex aneurysms.
On June 27, Flinn underwent surgery, which was performed by Dr. Inkollu and Luke Marone, M.D., WVU Heart and Vascular Institute co-director and chief of Vascular Interventional Services, in a single stage, addressing structural issues in the iliac arteries that branch from the aorta with stents before placing the physician-modified stent into the aorta itself.
“We have to place the stent so that it extends past the aneurysm so it can be excluded and to significantly reduce the risk for rupture,” Inkollu said. “Lifelong follow up is needed to ensure integrity of these stents. To our knowledge, this is the first successful PMEG procedure for the state. We are excited to provide this advanced technique to patients in the region as we are working to enroll in clinical trials that can bring other advanced techniques to our toolbox.”
The surgery successfully sealed Flinn’s large thoracoabdominal aneurysm.
“They treated me like they knew me all their life,” Flinn said. “Dr. Inkollu’s expertise really helped me understand what was going to happen, and he even drew a picture so he could be sure I understood. I’m very fortunate it didn’t rupture, and I’m looking forward to recovering enough to get back to sitting on my front porch and talking to my friends and neighbors.”
According to Inkollu, Flinn’s aneurysm, at 11 centimeters in diameter, was one of the largest he has treated.
“Innovative and minimally invasive therapies to treat advanced or complex disease are part of our core mission at the WVU Heart and Vascular Institute,” Vinay Badhwar, M.D., WVU Heart and Vascular Institute executive chair, said. “Being able to care for West Virginia’s complex patients like Mr. Flinn and return them to their home environment exemplifies why we are here.”
For more information on the WVU Heart and Vascular Institute, visit WVUMedicine.org/Heart.