The aorta is as thick as a garden hose. Over time or with diseases such as atherosclerosis, parts of the aorta can deteriorate, creating an aneurysm—a bubble or weak spot in the hose. When the aorta is straight, it maintains steady, even blood ﬂow. Many aortic aneurysms are repaired through endovascular aneurysm repair (EVAR) instead of traditional surgery. During the procedure, a stent graft is inserted into the aneurysm through the groin to the femoral artery.
“When we use aortic stents to treat aneurysms, it has to be a nice, long, straight segment of aorta for the stent to work best,” explained ravikumar veeraswamy, M.D., vascular surgeon at MUSC. “The blood goes through the stent and doesn’t hit the aneurysm below it.”
But some patients don’t have a straight enough stretch of aorta for this treatment. When a typical stent is placed into a bent aorta, it can’t push up against the walls of the aorta to form a seal, so it leaks. Vascular surgeons can ﬁx this by stapling the area to secure or change the stent’s location, but then they have to ensure it isn’t adversely affecting other areas, such as the kidneys.
“There needs to be a balance,” explained Veeraswamy. “The stent has to be strong enough to stay sealed and stay in place but ﬂexible enough to bend.”
As part of the GORE® EXCLUDER® Conformable AAA Endoprosthesis study, MUSC will assess the safety and effectiveness of this particular stent in treating abdominal aortic aneurysms below the kidney in patients withchallenging anatomy.
This study evaluates two types of patients who have angled aortic anatomies: those whose aorta is angled at 0 to 60 degrees and those with an aortic angle of 61 to 90 degrees. The stent includes angulation control, which gives the vascular surgeon the ability to bend the device to a patient’s unique anatomy.The procedure is performed similarly to EVAR. Veeraswamy says preliminary results show quick procedure and recovery times in participants.
“It simpliﬁes a complex anatomy, which is a great advantage to patients,” he added. “They appreciate a fairly straightforward procedure versus having a complex and longer stay.”
Because MUSC provides tertiary care for all of South Carolina, many patients come to the Heart & Vascular Center for exceptionally challenging aortic concerns. “We are seeing more and more patients with complex problems,” he said. “And we work internally and externally with industry partners to help us meet those needs. It’s important to have clinical trials like these, because they allow us to treat complicated problems in a more effective manner.”
Article By: Carin Moonin; Photo by: Sarah Pack