Abdominal aortic aneurysms repaired without surgical incisions
Patients seeking treatment for abdominal aortic aneurysms may now undergo a repair procedure that does not require a surgical incision.
Boston Medical Center is one of only two sites in Boston offering the non-invasive, incisionless procedure for abdominal aortic aneurysms. To repair the artery, the surgeon utilizes a small puncture site in the skin, thus obviating the need for an incision. The patient typically goes home the day after surgery and has minimal, if any, discomfort.
"It is truly amazing that the operation to treat an abdominal aortic aneurysm can now be performed without any incisions," said Alik Farber, MD, clinical chief of Vascular Surgery at BMC, and associate professor of surgery at BUSM. "At times, patients find it hard to believe that their aneurysm was repaired because the procedure is so non-invasive."
An abdominal aortic aneurysm occurs when sections of the aortic wall weaken and are unable to support the force of blood flow, causing a bubble on the wall. As these bubbles get larger, they are prone to bursting, often resulting in death. Traditional treatment of aortic aneurysm involved an extensive surgical procedure involving a long abdominal incision until the late 1990s, when the Food and Drug Administration approved endovascular repair of abdominal aortic aneurysms (EVAR). With EVAR, which is minimally invasive, surgeons access the aneurysm through an incision made in the femoral artery.
Several years ago, surgeons began performing EVAR through a small puncture site in the skin above the femoral artery in the groin, rather than through a surgical groin incision. The graft is then inserted through the puncture site, under fluoroscopic guidance, and finally deployed in the aorta. The hole in the artery is closed using a series of percutaneously placed sutures. The skin puncture site is so small that it heals without any sutures.
"Once the graft is released, blood flows through the new graft," Dr. Farber said. "The aneurysm slowly shrinks and is no longer a threat to the patient."
About 80 percent of the patients with an abdominal aortic aneurysm who are evaluated at BMC are eligible for the new technique. Physicians determine eligibility using factors such as the aneurysm's shape and location, and the amount of calcium in the wall of the aorta.
"We have performed incisionless EVAR in ten patients at BMC and have had excellent results," Dr. Farber said. "Not everyone is a candidate for incisionless EVAR, however. Patients have to have large enough femoral arteries and minimal arterial calcification."