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Michael E. DeBakey VA Medical Center - Houston, Texas

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Complex Aneurysm Surgery Saves Air Force Veteran's Life

August 9, 2011

Kougias Pisimisis King and Bechara

Members of the vascular surgery team at the Michael E. DeBakey VA Medical Center, (from left) Panos Kougias, M.D., Vascular Surgery Section chief, George Pisimisis, M.D., staff vascular surgeon, and Carlos Bechara, M.D., M.S., staff vascular surgeon, talk with Air Force Veteran Richard King after his complex aneurysm surgery. King is the first patient to receive a branched stent-graft in the Texas Medical Center.
PHOTO: Mike Nichols, MEDVAMC Media

HOUSTON - Surgeons at the Michael E. DeBakey VA Medical Center (MEDVAMC) recently performed complex aneurysm surgery using a special stent configuration to save the life of a 76-year-old, Air Force Veteran suffering from complex aortoiliac aneurysm.

"When I entered the hospital, I knew I was in bad shape," said Richard King from Sour Lake, Tx. "But the doctors and nurses were great; I was very impressed with the care at the Houston VA."

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.

"There are two types of surgeon-modified stent-grafts we can choose from, depending on the location and extent of the aneurysm," said Carlos Bechara, M.D., M.S., staff vascular surgeon and also an assistant professor of Vascular Surgery and Endovascular Therapy at Baylor College of Medicine (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."

"The 'branched stent-graft’ type we used in Mr King’s operation is appropriate in the treatment of aneurysms that extend all the way to the pelvis, known as aortoiliac aneurysms," said George Pisimisis, M.D., staff vascular surgeon and also an assistant professor of Vascular Surgery at BCM. New to the DeBakey VA staff, Pisimisis has played a pivotal role in the development of a fenestrated aortic program because of his special training in aortic fenestration techniques.

"Using commercially available stent-grafts alone, pelvic circulation in these patients would be sacrificed to treat the aneurysm. The branched stent-graft technology allows us to treat such extensive aneurysms while preserving blood supply to the pelvis," said Pisimisis. "Instead of simply creating side holes, we attach a fabric-made side branch to the main tube graft so it is geometrically oriented to align precisely with the target vessel of the patient."

"Customization and implantation of commercially available stent-grafts to fit each patient’s unique anatomy - although based on a simple concept - can be very challenging and requires attention to detail to avoid serious complications," said Panos Kougias, M.D., Vascular Surgery Section chief and also an assistant professor of Vascular Surgery at BCM. "This includes precise measurements using sophisticated, 3-D imaging reconstructions, high quality radiology equipment, and the presence of a physician team with advanced endovascular skills."

King, the first patient to receive a branched stent-graft in the Texas Medical Center, was discharged from the MEDVAMC soon after the procedure. He is now spending time with his family and returning to normal activities.

Vascular surgeons at the MEDVAMC perform a large number of operations for arterial occlusive disease, aneurysmal disease, and venous occlusive disease. A state-of-the-art hybrid, operating room enables the combination of traditional open surgery with advanced, endovascular techniques in the same setting; therefore, providing minimally invasive treatments addressing complex surgical problems. The result has been a substantial reduction in patient morbidity and the cost of post-operative care at the MEDVAMC.

Recently, the same vascular surgery team successfully placed a visceral, fenestrated stent-graft in another patient who had a large recurrent aneurysm involving the aorta and the arteries supplying blood to his kidneys and the small intestine.

"Not many surgeons have the skill set and training required to successfully perform such complex procedures,"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