U.Va.'s First Emergency Stent-Graft Procedure Saves Life of Waynesboro Resident

February 26, 2008

February 26, 2008 — An 81-year-old Augusta County resident has returned home from the University of Virginia Health System after surviving what is frequently a fatal event — massive internal bleeding from a ruptured aortic aneurysm in his abdomen.

James Taylor of Waynesboro became the recipient of U.Va.'s first-ever emergency stent graft for an abdominal aortic aneurysm earlier this month after being transferred from Augusta Medical Center. Doctors there diagnosed his condition after taking a CT scan and quickly decided to send him to U.Va.

At U.Va., Taylor was met by a multidisciplinary vascular team, including Dr. Nancy Harthun, a vascular surgeon, and Dr. Warren Swee, an interventional radiologist.

According to Harthun, collaboration with doctors at AMC saved time and contributed to the success of Taylor's procedure. "[Augusta Medical Center's] CT images demonstrated that Mr. Taylor's aortic anatomy was appropriate for a stent-graft," she said. "The images also allowed us to select the correct size of the device, so that we were set up and ready to operate when he arrived."

The aorta is the largest artery in the body, and its walls can develop aneurysms, or bubble-like bulges, when they weaken due to aging and vascular disease. When these bulges rupture, patients experience severe pain and rapid, extensive blood loss.

In treating Taylor, U.Va. physicians knew they were racing against time. Instead of conventional surgery, they opted to perform a quicker, minimally invasive procedure known as endovascular — inside blood vessels — surgery. Using imaging equipment and catheters to guide their work, Harthun and Swee repaired his rupture and restored his blood flow by placing a fabric and metal mesh tube, or stent-graft, inside his aorta.

Developed more than a decade ago, stent-grafts are typically used in elective surgical procedures to prevent aneurysms from bursting. U.Va. performs more than 60 elective abdominal aortic aneurysm procedures each year.

Because they require small incisions or none at all, endovascular treatments offer key patient advantages. Compared to those who undergo traditional surgery, endovascular patients usually have shorter hospital stays, quicker recovery times, less pain and a lower risk of post-procedure complications.

"The current standard of care is to repair [abdominal aortic aneurysm] ruptures with open surgery," said Swee. "Normally, it takes time to get a CT scan, review it, do all the measurements, and make sure we have the correctly-sized devices. Because [abdominal aortic aneurysm] patients are very unstable, the extra time it takes to do all of that may be fatal."

Encouraged by the success of Taylor's repair, U.Va. physicians have already completed a second emergency stent-graft, saving another life by doing so. Swee and Dr. Kenneth J. Cherry, head of U.Va.'s Division of Vascular Surgery, performed that procedure.