Endovascular Surgery for Abdominal Aortic Aneurysms
Shortens Recovery

Abdominal aortic aneurysm (bulging blood vessels) are part of an unfortunate genetic inheritance for Henry Domanski, age 84,and his seven siblings. All but one of Mr. Domanski’s siblings have had them, and his eldest sister suffered damage to her lower limbs as a result of an aneurysm that burst.

In 1988, Mr. Domanski underwent an open procedure in southern New Jersey to remove an abdominal aortic aneurysm. After a nine-day hospital stay, he went home and ate too much at his first meal. He ended up back in the hospital for 37 days with complications.

In the summer of 2005, Mr. Domanski learned that he had developed two new abdominal aortic iliac aneurysms and he was not anxious to undergo and recover from another extensive surgery. Physicians in his hometown told him he was not a candidate for the minimally invasive endovascular surgery which uses a stent to exclude the abnormal blood vessel and has a much less extensive recovery.

“They told me it would have to be done the old way, and I was concerned,” says Mr. Domanski. “They also said they could only take one of the aneursyms out now, which made me nervous. I wanted to have them both taken out.”

Mr. Domanski traveled to Saint Barnabas Medical Center and met with Michael Addis, M.D., attending vascular surgeon. Dr. Addis felt that both of Mr. Domanski’s aneurysms could be treated through endovascular surgery. The procedure was performed and a stent was placed in the arteries to open them. Mr. Domanski had a full recovery after two days in the hospital and made sure to eat a small first meal upon returning home.

“I am very happy about the way it came out,” adds Mr. Domanski. “He did a good job and I am very satisfied. Dr. Addis was great to talk to and he called me quite a few times to see how I was doing.”

Endovascular Surgery a Welcome Option for Some Patients

For many patients, endovascular surgery is the therapy of choice for the repair of abdominal aortic aneurysms. The biggest difference between the traditional open procedure and the endovascular procedure is the scope of the operation.

In a traditional (open) repair, a cut is made the full length of the abdomen while the patient is under general anesthetic. The abnormal vessel is replaced with a graft. Patients are generally hospitalized for 5-7 days following an open procedure and the recovery period takes several months.

For the endovascular procedure, the surgeon makes two small incisions in the groin area while the patient is under either general, spinal or local anesthetic. Thin, hollow tubes called catheters are inserted through arteries in the groin. These tubes allow a stent, or small metallic device, to be placed inside the artery to exclude the abnormal artery. Stents are placed without making a large cut in the abdomen. Patients are home from the hospital in 24-48 hours and the recovery time is one to two weeks.

“For the right patient, endovascular surgery is an excellent procedure,” says Mark Kumar, M.D., attending vascular surgeon with Saint Barnabas Medical Center.

Who is a Candidate?

For patients with an aneurysm that has the appropriate anatomy –– it must be located below the renal arteries and not be too large –– endovascular surgery may be an option. It may also be a good fit for patients who have other health considerations that make the open procedure too risky.

"I generally recommend the endovascular procedure for patients who are older and have more medical problems,"says Dr. Kumar."The elderly patients look so good after the procedure because it is a lot less for them to go through. They have no period of rehabilitation and can walk and eat more rapidly. That same elderly patient would be in the Intensive Care Unit after an open procedure."

The endovascular procedure does require more medical surveillance than the open procedure, and the patient must be monitored every six months to look for any leaks in the stent. Some 15 to 20 percent of patients with stents require the placement of another stent. Also, physicians do not have data beyond about 10 years on the long-term effectiveness of stents, says Dr. Kumar.

The greatest advantage of the endovascular surgery, says Dr. Kumar, is that it has allowed patients who would have been considered too high risk for surgery to be candidates.

When to seek treatment

Surgery is recommended for patients with aneurysms bigger than 5 centimeters in diameter and aneurysms that rapidly increase in size. The goal is to perform surgery before complications develop.

If an aneurysm grows beyond 5 centimeters, it has a 20 percent chance of rupturing within five years. The larger the aneurysm, the greater chance of rupture. A ruptured aneurysm is a grave medical emergency.

“If the patient actually makes it to the hospital alive, he or she has a 50 percent chance of survival,” says Dr. Kumar. “Ideally we would deal with it before it ruptures.” Dr. Kumar and Dr. Addis have been able to treat some patients with ruptured aneursyms using stents to repair the damaged area.

Mr. Domanski says he is pleased that both of his aneurysms were removed because, “you never know when they might burst.”

To reach an attending vascular surgeon at Saint Barnabas Medical Center, please call 1-888-SBHS-123.