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International Physician Update
Taking Minimally Invasive Aneurysm Repair to New Heights, Carefully
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| Surgeon José Parra shows how a patch, fed through a catheter, can seal an aneurysm. |
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Vascular surgeon José Parra makes a 2.5 cm incision in the patient’s groin. Then, using real-time X-ray imaging, he inserts a catheter containing a 15 cm wire tube—a stent graft—and slides the catheter up the femoral artery to the aorta until he reaches an aneurysm threatening to rupture and kill the patient. Once the stent is in place, he pulls a tiny string that releases the self-expanding tube, sealing the balloon-like bulge. Immediately, blood begins to flow through the graft. Not only has the aneurysm been repaired, but another patient has avoided open surgery.
Unfortunately, Parra explains, not all minimally invasive aneurysm approaches have been as successful. In fact, early experience shows that surgeons tended to over- prescribe the procedure.
“When you try to push the envelope with the catheter approach, it doesn’t always work,” Parra says.
Parra explains that it’s a bit tricky to determine whether an aneurysm can best be fixed through a minimally invasive or open surgical approach—the size and location of the aneurysm, as well as the patient’s general health, are among the considerations. In addition, the catheter approach only patches the aneurysm with a graft, much like patching a flat bicycle tire. Surgery removes the aneurysm—and the risk of its returning. That’s why Parra and his colleagues are taking a more conservative approach, carefully assessing the patient’s condition and anatomy, leaning toward surgery when in doubt.
“Now we’re reassessing who should have these grafts,” Parra says. “The important thing is to go to a center where there’s a lot of expertise in both areas.”
Parra adds that Hopkins is planning an endovascular suite with both advanced imaging and operating room equipment. “It will be much better for the patients because it allows us to move more expeditiously and more safely.”
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