Until recently, major abdominal surgery was necessary to treat certain abdominal aortic aneurysms. NewYork-Presbyterian Hospital/Columbia University Medical Center is now one of only three hospitals in the nation to provide a “safer, less stressful way of treating patients, some of whom may not be eligible for open surgery.” That is according to James F. McKinsey, MD, Chief, Division of Vascular Surgery and Endovascular Interventions, speaking about treating abdominal aortic aneurysms with a minimally invasive procedure using the fenestrated endograft.
When the wall of the aorta (the largest artery in the body) is weakened, it can give way to the high pressure within it, ballooning out in what is called an aneurysm. One treatment for this life-threatening condition is to shore up the affected area of the aorta by placing a stent (a sheath of protective scaffolding) inside the vessel, shielding the dangerously weak section from the high-pressured flow of blood. Until recently, it wasn’t possible to wall off large sections of the aorta to treat aneurysms located close the kidneys, where multiple major arteries branch out.
The fenestrated endograft gets around the problem by using extensive CT imaging to create custom stents with fenestrations, or holes that align with the arteries branching off from the aorta. A custom-made stent graft can be placed in the abdominal aorta to prevent an aneurysm from worsening, with its fenestrations lined up with the various arteries to preserve their blood flow. The minimally invasive, endovascular procedure can be carried out under local anesthesia and involves just two small cuts in the groin to access the arteries; patients can leave the hospital within a day or two afterward.
Reducing the stress put on the patient during a procedure is always a step in the right direction, and Dr. McKinsey notes, “Aneurysms often occur in elderly patients, who may have extra risks during open surgery.” Because the endovascular procedure using the fenestrated endograft is so much easier on the patient, those who could not undergo major surgery for an aneurysm now have a life-saving option. The ongoing use and development of the fenestrated endograft at NewYork-Presbyterian/Columbia is turning ‘untreatable’ into an outdated diagnosis.
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