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Minimally invasive aortic aneurysm repair

When Barbara Robinson, 69, had a CT scan to investigate a medical condition, her doctors spotted a previously unknown problem.

RobinsonBarbara’s condition was caught early and she was quickly referred to John B. Fobia, MD, vascular surgeon at the Vascular Center at Mercy Philadelphia Hospital.

When Barbara Robinson, 69, had a CT scan to investigate a medical condition, her doctors spotted a previously unknown problem. The scan showed a small abdominal aortic aneurysm—a weakened, bulging area in her aorta, the largest artery. An enlarged aneurysm can rupture, putting the patient in grave danger. “I had no symptoms, so this came as quite a surprise,” Barbara recalls.

Barbara’s scenario is common, since an abdominal aortic aneurysm (AAA) typically grows slowly and without distinct symptoms. Fortunately, Barbara’s condition was caught early and she was quickly referred to John B. Fobia, MD, vascular surgeon at the Vascular Center at Mercy Philadelphia Hospital. Dr. Fobia monitored the growth of the aneurysm and eventually determined Barbara was an ideal candidate for noninvasive endovascular repair.

“We need to repair the aneurysm preemptively—before it becomes life threatening,” says Dr. Fobia. “That’s why it’s important that primary care physicians screen their patients for a possible aneurysm. Patients should ask their doctor whether they are a candidate for screening.”

Endovascular repair, an advanced, minimally invasive procedure, requires only local anesthesia with intravenous sedation, since everything is done inside the vessel and without open surgery. The surgeon threads a catheter through a small incision near the groin, into the femoral artery and then into the diseased aorta. A stent (metal coil) and graft are positioned to replace the vessel. “With no cutting, blood loss or need to clamp the aorta, this procedure is quick and complications are rare. Patients can fully recover in a few days,” Dr. Fobia explains. “This procedure has changed the way we treat AAA disease. Previously, repair required major surgery followed by a long recovery period.”

Preparation is Key

To ensure the best possible results, Barbara saw a cardiologist, a vascular surgeon and an interventional radiologist prior to the endovascular repair. “We treat every patient with a multidisciplinary approach, because when diagnosed with disease in one vessel there is likely disease in other vessels.

It’s systemic,” says Paul Khoury, MD, medical director of the Vascular Center and Interventional Radiology at Mercy Philadelphia Hospital. “In Barbara’s case, she also suffered from cardiovascular disease, so she needed to be cleared by a cardiologist in order to increase the procedure’s chance for complete success.”

Because Barbara’s aneurysm was small, there was time to work with David J. Addley, DO, FACC, cardiologist and internist at Mercy Philadelphia Hospital, to further lower risk of complication during the endovascular repair. “Barbara came to me with diabetes, hypertension and high cholesterol, which all increase risk for heart attack or stroke,” Dr. Addley says. “My job is to identify these sorts of risks, educate the patient and make recommendations to Dr. Khoury and Dr. Fobia so they are fully informed and can best protect the patient in the operating room.”

Barbara’s endovascular repair was a success. She continues to work with the Vascular Center team. “We’re helping Barbara reduce additional risks for cardiovascular disease,” Dr. Addley says. “We’ve found that helping patients understand risk factors and consequences is a strong motivator for change. Barbara is a wonderful example of how much patients can help themselves.”

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