May 23, 2005
Veteran Mike Westberry asks Peter Lin, M.D., chief of the MEDVAMC Vascular Surgery Section and Ruth Bush, M.D., MEDVAMC vascular physician a few questions about his thoracic stent graft system procedure. The MEDVAMC is among the first hospitals in the country to use an FDA-approved endovascular device to treat patients with thoracic aortic aneurysm.
photo: by Bobbi Gruner
HOUSTON - The Michael E. DeBakey VA Medical Center (MEDVAMC) is among the first hospitals in the country to use an FDA-approved endovascular device to treat patients with thoracic aortic aneurysm.
Each year, more than 21,000 Americans are diagnosed with thoracic aortic aneurysms, which is a condition resulting in a ballooning of a large artery inside the chest caused by a weakening or stretching of the vessel wall. The aorta is the body's main blood vessel that carries blood from the heart through many branch arteries to the rest of body. When an aneurysm occurs in the thoracic aorta, the results can be fatal because of the risk of rupture.
Thoracic aortic aneurysms are known as a silent killer since patients typically have no symptoms until the aneurysm begins to leak or expand. Aneurysms can occur at any age, although they are more common in people who smoke, have family histories of aneurysms, and among people over age 60. Many of these patients also have other serious conditions such as heart disease, lung problems, high blood pressure, and diabetes, making it difficult for them to survive an open chest operation, which is the traditional treatment of choice.
In an open chest operation, the thoracic aortic aneurysm is repaired by cutting open the aneurysm and replacing it with a synthetic vessel tube. This operation can be risky and can lead to death in many frail and elderly patients. For those patients considered ineligible for open surgical repair, conservative medical management or "watchful waiting" is often used as a treatment option and can lead to increased mortality and morbidity in many elderly patients.
In March 2005, the Food and Drug Administration (FDA) approved the Gore thoracic endovascular device for treatment of patients with aneurysm of the descending thoracic aorta. In this new treatment approach, a small incision is made in the patient’s groin area, and physicians deliver a small device called a stent-graft inside the thoracic aorta. The stent graft is expanded and fixed in place to repair the aneurysm. This new procedure does not require an open chest incision so most patients can return home in as little as one or two days following the procedure.
“The Michael E. DeBakey VA Medical Center is the first VA hospital in the country to offer a minimally-invasive treatment approach for patients with thoracic aortic aneurysm using this FDA-approved device. This is extremely exciting because of the long tradition of excellent care our medical center provides to veterans with cardiothoracic and vascular diseases. In addition, this new therapy offers new treatment options to many patients with thoracic aortic aneurysms who are too sick to undergo an open chest operation,” said Peter Lin, M.D., chief of the MEDVAMC Vascular Surgery Section.
Lin and two other MEDVAMC vascular physicians, Alan Lumsden, M.D. and Ruth Bush, M.D. have extensive experience in using the endovascular stent-graft devices to treat patients with aortic aneurysms. Since 1998, they have collectively performed more than 1,000 endovascular procedures in the treatment of aortic aneurysms, including the thoracic and abdominal aorta, and this represents the largest experience in a VA facility.
“The approval by the FDA of this new technology is based on a large clinical study which showed that endovascular treatment of thoracic aortic aneurysm provided excellent treatment results with faster recovery periods when compared to traditional open chest operations,” said Lumsden.
“Patients who undergo the thoracic stent graft procedure can typically resume their normal activities within several days following the operation. This is in contrast to the two to three months of recovery if they undergo the conventional open chest operation. With patients who have underlying lung disease and do not tolerate general anesthesia, this procedure can be performed under local anesthesia,” said Bush.
Designated as a Cardiothoracic Center of Excellence, the MEDVAMC is widely known for its unsurpassed record in caring for veterans with cardiothoracic diseases. Joseph Huh, M.D., a MEDVAMC cardiac surgery physician, has received national recognition for his expertise and excellent outcomes in patients undergoing heart and chest operations at the MEDVAMC. Working in conjunction with these cardiac surgery physicians, Lin, Bush, and Lumsden are eager to combine their expertise to offer this minimally invasive therapy to veterans with thoracic aneurysms in this clinical trial. Veterans may contact the MEDVAMC Vascular Surgery Service at 713-794-7895 for more information about this new endovascular treatment of thoracic aortic aneurysm.