Thursday, February 09, 2006

Minimally invasive aorta surgery

A minimally-invasive procedure can repair a wide range of problems in the upper part of the aorta, the giant blood vessel leading out of the heart. In this region, called the thoracic aorta, the intense force of blood pulsing out of the heart can rip the aorta's walls apart or cause them to balloon outward, eventually leading to a rupture that brings almost certain death.

For decades, patients have had a choice between open-chest surgery and waiting for the "time bomb" to explode. Some haven't had a choice, because their age or health makes them too high-risk for surgery. More than 15,000 Americans die each year from ruptured thoracic aortic aneurysms, dissections and other problems.

An experimental procedure called endovascular thoracic aortic repair, or ETAR, has now been shown to shore up the aorta without surgery. Devices called stent-grafts are inserted by snaking a long tube up into the aorta from a small incision in the leg or belly. Only in the last year has the U.S. Food and Drug Administration approved the first device designed for this purpose, paving the way for more hospitals to offer it.

Earlier this week, in a presentation at the Society of Thoracic Surgeons meeting, a multi-specialty University of Michigan Cardiovascular Center team gave data from 73 patients who had ETAR at U-M over the last 12 years. Three-quarters of them were considered too high-risk to have surgery. The average survival was nearly four years, and almost half of the patients are still alive today and have not needed additional procedures, though the researchers say close monitoring is needed after a patient has ETAR.

"The minimally invasive approach to major aortic problems promises to revolutionize the way a broad spectrum of patients are treated," says Himanshu Patel, M.D., the lead author of the STS scientific poster. "Even in high-risk patients who would not otherwise be treatable, we see acceptable, encouraging results.

Thoracic aneurysms occur in the ascending aorta (25% of the time), the aortic arch (25% of the time), or the descending thoracic aorta (50% of the time).

An aneurysm is an abnormal widening or ballooning of a portion of a blood vessel. The blood vessel wall becomes weaker in this location. The most common cause of aneurysm? Atherosclerosis.

See a picture of a thoracic aorta aneurysm.

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