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New minimally invasive stent graft for aortic aneurysms

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Aortic aneurysms are often called silent killers because signs and symptoms of damage to the body’s largest blood vessel often go undetected until it is too late. These protrusions or weaknesses in the wall of the aorta can rupture with fatal consequences if left untreated.

A new, minimally invasive stent graft, recently approved by the FDA and now being used in patients through a study at Emory University Hospital, may make endovascular aneurysm repair (EVAR) accessible to more patients with thoracic aortic aneurysms.

Emory surgeon Karthikeshwar Kasirajan, MD, is among the first few physicians in the United States and the first in Georgia to use the new device, as part of one the largest clinical trials to date involving treatment of aortic aneurysms – enrolling more than 400 patients across the country.

"This is an exciting advancement in endovascular treatment that we are proud to be evaluating in patients in Atlanta and around the region," says Kasirajan, who is lead principal investigator of the study. "This will allow more patients to receive potentially life-saving treatment through a non-invasive method, which means they could have shorter hospitalization times and be back to a normal routine in a few days, rather than weeks."

Thoracic aneurysms affect 10 out of every 100,000 Americans, and are one of the leading causes of death for patients over the age of 55. Thoracic aortic aneurysms often result from weakening of the arteries, hypertension or congenital disorders such as Marfan’s syndrome. Preventive measures include smoking cessation, controlling blood pressure and blood lipid levels, and routine exercise. Detection of thoracic aortic aneurysms is most commonly achieved through computed tomography (CT) scans.

Current treatment for aortic aneurysms involves either an invasive method in which the chest cavity is surgically opened and major organs temporarily moved to access the aorta, or the minimally invasive approach with stent grafts delivered via catheter.

In this new approach, two small incisions are made in the groin and the device is inserted through the femoral artery to reach the aneurysm. By creating a new pathway for blood flow, the stent graft reduces pressure on the aneurysm and, as a result, the risk of rupture.


"We have better treatment options than ever before, but we can only treat the aneurysms we know about," says Dr. Kasirajan, a pioneer in the treatment of EVAR. "People with known risk factors should get screened. The decision to be screened could be a life-saving choice."

Unfortunately, some patients have not been eligible for this less-invasive option due to complications of their anatomy and the limitations of earlier devices, but the new stent grafts make the less-invasive treatment more accessible for patients because of their unique features. A wide range of diameters offer physicians multiple options to customize the devices for their patients’ needs and to treat a wider range of aortic anatomies than with other available stent grafts.

In earlier clinical studies, EVAR has been shown to be an effective therapy for aortic aneurysms, with fewer postoperative complications and shorter recovery times than open surgical repair. A study published earlier this year in the New England Journal of Medicine indicates that perioperative mortality was significantly lower after EVAR than after open repair for abdominal aortic aneurysms.

According to Kasirajan, the recently-implemented federal SAAVE Act will also help more potentially at-risk Medicare patients receive a free one-time ultrasound screening for aneurysms, including men who have ever smoked and men and women with a family history of abdominal aortic aneurysms, which occur lower in the aortic region than thoracic aortic aneurysms, which occur in the chest region.

"Having this free and simple test available for at-risk patients will save many lives in the long run, because so many patients with risk factors have no idea they may have this deadly condition," says Kasirajan. "With such preventative screening measures in place, in addition to the new, less-invasive techniques science is now pioneering, aortic aneurysms should no longer be considered a silent killer."  

(Source: Emory University Hospital: June 2009)


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Posted On: 22 June, 2009
Modified On: 16 January, 2014

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