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Strong Implants Newly Approved Device to Treat Aortic Aneurysms

Hospital first in upstate to offer this less-invasive treatment for thoracic aneurysms

Thursday, May 12, 2005

Physicians at Strong Memorial Hospital are the first in upstate New York to implant a newly approved device that repairs dangerous aortic aneurysms of the chest using a less-invasive method of treatment.

The team of Mark Davies, M.D., vascular surgeon, David Waldman, M.D., Ph.D., interventional radiologist, and George Hicks, M.D., cardiothoracic surgeon, performed an endovascular repair of a thoracic aortic aneurysm May 11 involving patient Shirley Hoey, 69, of Sayre, Pa.

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. A bulging aorta is weakened and can rupture, resulting in life-threatening bleeding. The condition is what caused the death of actor John Ritter in 2003.

The FDA-approved procedure consists of using a catheter to place a stent-like device at the vessel’s weakened location in the thoracic aorta, which carries blood to the upper portion of the body. The device, made of a flexible mesh that is covered in Goretex, reinforces the vessel wall and protects the aorta from rupturing.

Only one incision in the abdomen is made, similar to an appendix incision, and placement of the device is performed using the main vessel to the leg, as is done with cardiac catheterizations to repair blockages in the heart. Once the device is in place, there is no further blood pressure acting on the wall of the aneurysm. The aneurysm will stop growing and may shrink.

Surgeons are excited about the new procedure, which results in a shorter hospital stay – only two or three days, in most cases, minimal time in an intensive care unit, no large incisions, and full recovery within a few weeks instead of months.

“We see a large number of patients in our aortic surgery center with thoracic pathology, and this cutting-edge approach will greatly enhance our ability to treat this difficult disease,” Hicks says.

Davies agrees. “This improved option means a better, safer experience for patients. The end result is that they receive life-saving treatment for their aortic aneurysm and the process throughout is made much easier by this less-invasive approach.”

The concept of using a stent-like device to treat aneurysms has already been applied successfully to those found in the abdominal section of the aorta, which carries blood to the lower portion of the body.

“We are taking the lessons learned from the repair of abdominal aortic aneurysms and applying them now to the chest,” Waldman adds.

Traditional surgery to repair an aortic aneurysm in the chest is the most high-risk vascular operation performed, with high probability of complications and a high mortality rate, more than 10 percent even in the best candidates. With traditional surgery, a large incision in the chest is required, as is done with open-heart surgery, and patients can spend three to six weeks in the hospital, at least two of those in an ICU. Generally recovery is slow and can take up to a year.

There are some risks associated with the newly approved procedure, as with any surgery. In some instances there could be injury to blood vessels, paralysis of the legs, a chance of stroke, and a failure to eliminate the aneurysm.

Annually, thoracic aortic aneurysms affect approximately six individuals per 100,000 population. Thoracic aortic aneurysms typically occur in elderly patients who have hypertension, coronary artery disease and obstructive pulmonary disease, and are heavy smokers. Most of these aneurysms are incidentally diagnosed and are usually asymptomatic. Untreated patients with large thoracic aortic aneurysms have a two-year mortality rate of about 70 percent, with most deaths occurring due to aneurysm rupture.  Causes include inherited conditions that may weaken the aortic wall; aging, since the aorta naturally becomes less elastic as people grow older; infections, which can affect the lining of the heart and aorta; and injury, such as an extremely severe chest injury.

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