From a presentation by Christopher Cunningham, MD McLeod Vascular Associates
The aorta, a large artery that carries blood from the heart, can enlarge and rupture with life-threatening results. Thanks to surgical developments, repairing the enlargement or aneurysm is usually a simple operation, says McLeod Vascular Surgeon Christopher Cunningham, MD:
Here’s a summary of Dr. Cunningham’s comments:
Repairing an aortic aneurysm is interesting because, it use to be a massive operation – most of the time. Now, it is usually a small operation.
Advancements in repairing aortic aneurysms are similar to the advances they’ve made in fixing water mains in old cities like Philadelphia. Either you can tear up the road, tear up the railroad tracks, turn off the utilities, get a backhoe, tear everything up and put in a new pipe. That’s the equivalent to my making an incision from where your chest starts to the breastbone, then get inside, clamp it off the artery and put in a new pipe.
That’s a huge operation. It requires a couple of days in intensive care for recovery. A week in the hospital. It’s roughly equivalent to a coronary bypass operation.
However most of the time now, we can fix them like that clever engineer in Philadelphia, who shoved a PVC sleeve inside that old mess of a pipe, didn’t have to dig up anything – but make a new pipe from within. We call that an endovascular repair.
For endovascular repair, a small incision is made on the top of the leg, because the artery comes right up close to the skin. I don’t’ have to cut any muscles or tendons or enter any body cavities.
Then, I’ll put in a stent graft, which goes from above the aneurysm to below where the “Y” splits going to the legs. I can go up both sides in the legs. Going up one leg, I put in the stent graft that looks like a pair of pants. The “waist” sits above the aneurysm and one “leg” goes all the way down. The second “leg” of the pants is shorter. So, I build out the rest of the leg.
There’s minimal blood loss. It can be done under spinal anesthetics, so patients with weak hearts don’t have to struggle with general anesthetic. There is very little discomfort. Patients can be up eating dinner, walking around that night. They are discharged from the hospital the next morning. A week later they’re back swinging golf clubs.
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