1st in Texas: Contained aortic aneurysm rupture repaired with fenestrated stent-graft.
HOUSTON - Surgeons at the Michael E. DeBakey VA Medical Center (MEDVAMC) recently performed an emergency, contained ruptured aneurysm fenestrated graft repair using a special stent configuration to save the life of an 82-year-old, Army Veteran.
Korean War Veteran William Rester from Kinder, La. had a horrible abdominal pain and decided to see his primary care provider at the Alexandria VA Medical Center. Using an ultrasound, the physician found a 6.1 centimeter aneurysm in the artery leading to Rester’s kidneys.
“I had aneurysm repair done before, so I knew exactly what the doctor was talking about,” said Rester. “But, this time they said it was already leaking blood and it was just a matter of time before it split wide open. I knew I was in big trouble.”
An aneurysm is a weakened spot in the aorta, the major pipe-like structure that carries blood from the heart to the rest of the body. The weakened area bulges out and can possibly rupture. When this occurs, a person can bleed to death in minutes. When the aneurysm involves one of the large side branches, repairing the aneurysm with a stent-graft can be extremely difficult. Over the last few years, surgeons have modified existing stent-grafts to preserve flow to these important aortic side branches.
“The procedure we performed on Mr. Rester is extremely rare, mainly because most patients do not make it to the hospital in time for repair,” said George Pisimisis, M.D., MEDVAMC staff vascular surgeon and also an assistant professor of Vascular Surgery at Baylor College of Medicine (BCM). “And if they do, only a very few medical facilities in the country have alternative treatments for patients who are poor candidates for traditional open surgery.”
Rester was rushed by helicopter to the Intensive Care Unit at the MEDVAMC on Thursday afternoon. With advanced imaging equipment, physicians quickly obtained precise measurements of the aneurysm using sophisticated, 3-D image reconstructions and created a customized stent-graft to fit his unique anatomy.
“Mr. Rester had three abdominal surgeries including the aneurysm repair. Luckily, this unique technology allows us to extend aortic surgery to high-risk patients like him who have large aneurysms involving branches to vital organs,” said Carlos Bechara, M.D., M.S., staff vascular surgeon and also an assistant professor of Vascular Surgery and Endovascular Therapy at BCM. “The ‘fenestrated stent-graft’ type is used to treat aortic aneurysms located in the lower chest and upper abdomen. It is constructed by creating small holes or ‘fenestrations’ on the main graft to match the location of the patient’s side branches to vital organs. The side holes are then bridged to the side branches using smaller tubes called stents to preserve the flow.”
On Friday morning, Pisimisis; Bechara; Panos Kougias, M.D., Vascular Surgery Section chief; and their surgery team made one small incision in Rester’s left groin, a small puncture in his left arm, and another in his right groin. Using the Endovascular Surgery Suite, they placed the stent precisely in his abdomen and successfully rerouted his blood through the stent to avoid aneurysm rupture and death by bleeding.
“This case not only required advanced wire and catheter skills; but more importantly, it required a fundamental knowledge of aortic disease, anatomy, and device planning,” said Kougias, who is an assistant professor of Vascular Surgery at BCM.
Just six days after his brush with death, Rester left the hospital. “I am so very grateful for the Houston VA. I can’t say enough about the doctors – I wish I could take them home with me.”
“Not many surgeons have the skill set and training required to successfully perform such a complex procedure,” said David H. Berger, M.D., M.H.C.M., Operative Care Line executive at the MEDVAMC and also a professor of Surgery at BCM. “We are proud the Michael E. DeBakey VA Medical Center has some of the best doctors in the country and offers the latest, minimally invasive alternatives for our Veterans.”
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Awarded re-designation for Magnet Recognition for Excellence in Nursing Services in 2008, the Michael E. DeBakey VA Medical Center serves as the primary health care provider for more than 120,000 veterans in southeast Texas. Veterans from around the country are referred to the MEDVAMC for specialized diagnostic care, radiation therapy, surgery, and medical treatment including cardiovascular surgery, gastrointestinal endoscopy, nuclear medicine, ophthalmology, and treatment of spinal cord injury and diseases. The MEDVAMC is home to a Post Traumatic Stress Disorder Clinic; Network Polytrauma Center; an award-winning Cardiac and General Surgery Program; Liver Transplant Center; VA Epilepsy and Cancer Centers of Excellence; VA Substance Abuse Disorder Quality Enhancement Research Initiative; Health Services Research & Development Center of Excellence; VA Rehabilitation Research of Excellence focusing on mild to moderate traumatic brain injury; Mental Illness Research, Education and Clinical Center; and one of the VA’s six Parkinson’s Disease Research, Education, and Clinical Centers. Including the outpatient clinics in Beaumont, Conroe, Galveston, Houston, Lufkin, and Richmond, MEDVAMC outpatient clinics logged more than one million outpatient visits in fiscal year 2010. For the latest news releases and information about the MEDVAMC, visit www.houston.va.gov.