DES MOINES – MARCH 10, 2014 –Mercy Medical Center–Des Moines is the first and only hospital in Iowa and among a select group of hospitals in the United States offering endovascular abdominal aortic aneurysm repairs using a fenestrated stent graft system. Where patients would previously require open aneurysm surgery and weeks of recovery time, they can now have a two-to-three day recovery time with fewer potential complications.
An abdominal aortic aneurysm (AAA) is a bulge in the large artery, the aorta, which carries blood away from the heart and can be immediately life-threatening if it grows large enough to rupture. The chance of survival when it ruptures is less than 10 percent.
Iowa Heart Center Vascular Surgeon, David Chew, performed the first procedure at Mercy on January 20, 2014, on 80-year-old Kenneth Limke from Urbandale, whose aneurysm had grown to 5.4 cm in diameter. The Zenith fenestrated stent graft was customized to fit his anatomy.
“The structure of Mr. Limke’s aneurysm was not favorable for conventional stent graft repair, and he was at high risk for open repair due to other health conditions,” Chew said. “He was a good candidate for this new fenestrated stent graft, and we used anatomical information from CTA [computed tomography angiography] to custom make this graft just for him.”
The new graft looks similar to the traditional endovascular graft made of polyester fabric encased by a stainless steel scaffold. However, it is different from the off-the-shelf graft because of fenestrations — two tiny holes fabricated in the graft to accommodate the renal arteries, helping to keep the kidneys perfused, as well as a scallop-shaped cut to supply blood to the superior mesenteric artery, which carries blood to the intestines.
AAAs develop over years and often without any symptoms. Men over 60, those with high blood pressure, family history of aneurysm, and a history of smoking are at greatest risk. Women get this disease less frequently and usually at an older age than men.
“I had no symptoms, but they said it could rupture anytime and then I would be in trouble,” Limke said. “It was a good option for me and I am thankful they were able to do this less invasive procedure and prevent it from rupturing.”
The manufacture of each graft takes about five weeks, but for patients it’s worth the wait to have a less invasive repair. They can go home from the hospital one-to-two days later and get back to their normal activities in two weeks compared with a four- to eight-week recovery following open surgery. Patients have a CT scan one to two months after the procedure and then are followed annually.
Patients who are eligible for the new customized fenestrated graft repair include those whose aneurysms approach within 5 millimeters of the renal arteries and have large enough vessels to deliver the stent-graft to the appropriate location.
"At Mercy, we perform close to 60 open abdominal aortic aneurysm repairs each year for patients who are not eligible for the minimally invasive option," says Chew. "With the new fenestrated stent-graft, we will be able to spare many of those patients a big operation and a long recovery."
About Iowa Heart Center
Iowa Heart Center, one of the nation’s premier cardiovascular medicine practices, is an integrated service of Mercy Medical Center—Des Moines. For more than 40 years, Iowa Heart Center physicians and staff have provided world-class heart and vascular care and disease prevention services to Iowans and their families. The Center provides services in eight offices and more than 25 outreach clinics across the state. Iowa Heart is also involved in clinical research at the national and international level of emerging medical technologies.
Mercy Medical Center—Des Moines is an 802-bed Iowa acute care facility and part of Catholic Health Initiatives (CHI), a national nonprofit health organization with headquarters in Engelwood, Colo. The faith-based system operates in 18 states and includes 80 hospitals; 40 long-term care, assisted- and residential-living facilities; two community health-services organizations; two accredited nursing colleges; and home health agencies.