Endovascular Thoracic Aortic Aneurysm Repairs Save More Lives

Seventy-year-old patient Emil Almon believes the difference between life and death for him was a device no longer than a pencil and the skilled hands of a University of Cincinnati (UC) surgeon. 

Almon — who suffered a previous stroke and kidney problems — recently became the first person in the Tristate to undergo minimally invasive endovascular surgery to repair a thoracic aortic aneurysm using the GORE TAG Thoracic Endoprosthesis, the only FDA-approved device of its kind.

The procedure — which eliminates the need for a major chest incision — is a significant advance for patients who are not viable candidates for traditional open surgery because of advanced vascular disease and other health complications.

Almon underwent the procedure on Oct. 31, and was released from University Hospital this week.

Aortic aneurysms develop when a section of the aorta—the largest artery in the human body — becomes weak and expands to form a “bulge.” As the bulge loses strength, it can rupture and cause massive internal bleeding and near-instant death. Thoracic aortic aneurysms occur in the section of the aorta that travels through the chest and supplies oxygen-rich blood throughout the body.

“Many patients who suffer from thoracic aortic aneurysms also have serious health problems that make traditional open surgery too risky,” says Joseph Giglia, MD, interim director of UC’s division of vascular surgery. “Endovascular repair is very promising because it gives those high-risk patients a better chance for survival.”

The procedure requires only a few small incisions in the groin where a catheter is inserted. 

Guided by live X-ray images and a video screen, Dr. Giglia locates the aneurysm and threads the catheter through blood vessels to the exact location. He then deploys the GORE TAG Thoracic Endoprosthesis “stent-graft” — an implantable tube-shaped device made up of a metallic support structure (stent) covered in synthetic fabric (graft) — to “patch” the interior of the diseased artery.

The stent-graft is held in place against the vessel walls once it expands to full size, up to 20 cm in length and approximately 37 mm in diameter. Once in place, the stent-graft supports the weakened vessel walls and allows blood to continue flowing through the aorta without applying pressure to the aneurysm. Without a blood supply, the aneurysm is less likely to rupture and will begin to shrink over time.

Repairing the diseased artery from the inside the body, says Dr. Giglia, minimizes the complications associated with open surgery and gives more patients an option for survival. The procedure also takes a quarter of the time required for open surgery—typically one to three hours—and minimizes blood loss.

“Endovascular grafts allow us to repair an aneurysm without a major chest incision,” says Dr. Giglia. “That translates to less risk for infection, a shorter hospital stay and faster recovery time.”

Patients rarely experience any symptoms, so the condition is often diagnosed through an X-ray, ultrasound or echocardiogram being conducted for another reason. When symptoms do occur, patients often report pain in the upper body and abdomen. 

Aortic aneurysms are caused by a number of factors, including hardened arteries (atherosclerosis), massive chest injury and genetics. Research shows that cigarette smoking is a large contributing factor to the disease: 90 percent of all the people diagnosed with an aortic aneurysm smoke. Male smokers over age 65 with hypertension (high blood pressure) and a family history of vascular disease are at highest risk.