Aortic Aneurysm Repair at Strong Memorial Saves Man’s Life
Wednesday, February 07, 2007
At 74, Francis Blodgett is still active in the family farming business and has strong ties to his community of Lima. In warm weather he is often outdoors, mowing acres of lawn on a riding mower and working with the tractors his sons and nephews use for their soybean, wheat, corn and red bean crops. He also serves as a member of the Lima Board of Assessment Review. He’s a relatively healthy man who is often on the go.
That is why this winter he was surprised to start feeling light-headed. He was at his son’s home in Lima, celebrating the birthday of his daughter-in-law, when he went into the living room. “I sat down on the davenport and felt light-headed,” Blodgett said. “Then I just keeled over onto the rug.”
An ambulance rushed him to Strong Memorial Hospital of the University of Rochester Medical Center, where he was found to have a ruptured abdominal aortic aneurysm. A ruptured aneurysm kills about 90 percent of patients; those who make it to the hospital alive still have only a 50 percent chance of survival.
Members of the Strong Center for Aortic Disease, Jeff Rhodes, M.D., a vascular surgeon in the Division of Vascular Surgery, and David Waldman, M.D., Ph.D., chair of Radiology and an interventional radiologist, rushed Blodgett to the operating room. He was repaired not with open surgery as is usually required for a ruptured aneurysm, but with an endovascular stent-graft, inserted through two small incisions in the groin under local anesthesia. Blodgett never required a breathing tube.
An aortic aneurysm is a bulging of the wall of the aorta, the large blood vessel that carries oxygen-rich blood from the heart to the rest of the body. The condition is largely genetic, and is associated with a family history, lung disease and cigarette smoking, hypertension, and hernias. Such a bulge weakens the wall and the aorta can rupture, resulting in life-threatening bleeding. A very closely related condition, aortic dissection, is what caused the sudden death of actor John Ritter in 2003.
Aortic aneurysms can be repaired using open surgery, but today elective repair in appropriate patients usually consists of using a catheter to place a stent-like device at the vessel’s weakened location in the aorta. Made of flexible metal stents covered by fabric, the device reinforces the vessel wall and, in the case of patients whose aneurysm is at risk for rupture, it protects the aorta from rupturing. Insertion is accomplished by a small incision or even needle stick alone in both groins, and can often be done under local anesthesia. Once the device is in place, there is no further blood pressure acting on the wall of the aneurysm, and the aneurysm will stop growing and may shrink.
Until recently this technique was only available in elective situations. The patient’s aorta must be imaged by CT scanning and a device matched to each situation, a process that can take days. Yet within the past few years techniques have been established to repair ruptured aneurysms in this fashion. Worldwide, approximately 500 such cases have been performed, resulting in a halving of the mortality rate. At Strong Hospital, 15 ruptured aneurysms have been treated using endovascular stent grafts over the past three years (approximately one-third of all ruptured aneurysms) with a correspondingly decreased mortality rate.
Since Ritter’s death, there has been concern that no one medical specialty takes care of diseases of the aorta. To address this problem, surgeons in the divisions of Vascular and Cardiac Surgery and radiologists in the Division of Interventional Radiology joined forces to create the Strong Center for Aortic Disease. It includes dedicated anesthesia and nursing teams who are on call for any aortic emergency, as well as cardiologists, intensive care teams and ancillary care specialists.
“The less-invasive stent option is a well-established technique, but its use in emergencies is becoming more common during the last few years,” Rhodes said. “Nationwide, outcome data suggests that if we can do these using the option of endovascular grafting, mortality drops from 50 percent to 20 percent,” Waldman added.
Approximately 75 percent of aortic aneurysms occur in the abdominal region. Annually, physicians diagnose approximately 200,000 people in the United States with abdominal aortic aneurysms. Of those, nearly 15,000 may have aneurysms threatening enough to cause death from a rupture if left untreated. Ruptured aneurysms are the 13th leading cause of death in America, and, until recently, screening was not reimbursed by any insurance company. Recent Congressional legislation, however, will allow screening in selected patient populations, including smokers, and people 65 or older. Screening will be available in early 2007.