Diffusing a time-bomb in the body: New aneurysm graft

Aneurysms can strike with virtually no symptoms or pain. If it ruptures, it can kill nine out of ten people who develop it. Now, a surgeon has developed a device to help save people with this condition and who have run out of options.

In the last five years Bill Cardwell has encountered more challenges than he could ever face on the golf course. First, it was serious heart problems. Then a ticking time bomb bulging in his belly that could burst at any time.

An abdominal aortic aneurysm is caused by a weakening in the lining of the body's main artery that carries blood from the heart to the rest of the body. If this kind of aneurysm ruptures, the risk of death is up to 90%. Bill needed help fast but his heart condition and the location of the aneurysm meant he could not have surgery or get a traditional endograft to repair the problem.

Dr. Joseph J. Ricotta, director of vascular surgery at Emory University School of Medicine, says, "If we put a standard endograft in we would have covered his kidney arteries so he would have no blood flow to his kidneys and he would lose his kidneys. Essentially, there's really no other option."

So Dr. Ricotta developed a lifesaving endovascular graft customized to fit a patient's anatomy. Small windows in a fenestrated stent graft allow major vessels to connect to the repaired aneurysm, allowing normal blood flow to the kidneys and other vital organs.

Five months after his procedure, Bill is back on the green with a new appreciation for life and golf.

Dr, Ricotta's fenestrated graft can be used in emergency situations for patients with complex aneurysms that have ruptured or may be about to rupture. Some of the major risk factors of these potentially deadly aneurysms are smoking and high blood pressure.

RESEARCH SUMMARY

BACKGROUND: An aneurysm is an abnormal bulge in the wall of an artery. Normally, the walls of arteries are thick and muscular, allowing them to withstand a large amount of pressure. Occasionally, a weak area develops in the wall of an artery. This allows the pressure within the artery to push outwards, creating a bulge or ballooned area called an "aneurysm." An abdominal aortic aneurysm is when the large blood vessel that supplies blood to the abdomen, pelvis, and legs becomes abnormally large or balloons outward. (SOURCE: www.webmd.com, www.ncbi.nlm.nih.gov/pubmedhealth)

SYMPTOMS: Abdominal aortic aneurysms often grow slowly and usually without symptoms, making them difficult to detect. As an aortic aneurysm enlarges, some people may notice:
* A pulsating feeling near the navel
* Tenderness or pain in the abdomen, back, or chest - severe, sudden, persistent, or constant. The pain may radiate to the groin, buttocks, or legs.
* Clammy skin
* Nausea and vomiting
* Rapid heart rate
* Shock

(SOURCE: www.mayoclinic.com, www.ncbi.nlm.nih.gov/pubmedhealth)

THINGS YOU DIDN'T KNOW: An abdominal aortic aneurysm can develop in anyone, but is most often seen in males over 60 who have one or more risk factors. The larger the aneurysm, the more likely it is to rupture and break open. (SOURCE: www.ncbi.nlm.nih.gov/pubmedhealth)

TREATMENT: If bleeding occurs inside the body from an aortic aneurysm, the abdominal aortic aneurysm has opened and needs repair. Surgery is usually recommended for patients who have aneurysms bigger than 2 inches (5.5 cm) across and aneurysms that are growing quickly. The goal is to perform surgery before complications or symptoms develop. In a traditional (open) repair, a large cut is made in the abdomen. The abnormal vessel is replaced with a graft made of man-made material, such as Dacron. (SOURCE: www.ncbi.nlm.nih.gov/pubmedhealth)

LATEST BREAKTHROUGHS: Another form of surgery is endovascular stent grafting. An endovascular stent graft is a tube composed of fabric supported by a metal mesh called a stent. The graft is stronger than the weakened artery and it allows your blood to pass through it without pushing on the bulge. This procedure can be done without making a large cut in the abdomen, making recovery time faster. Endovascular repair is rarely done for a leaking or bleeding aneurysm. However, it is the safest approach when the patient is suffering from other medical conditions.


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