Surgical Innovations
Fenestrated Endograft for Aortic Abdominal Aneurysms
A fenestrated endograft was used to repair this patient's abdominal aortic aneurysm.
Endovascular procedures are widely performed to repair abdominal aortic aneurysms, which are weakened areas in the aorta that can enlarge and rupture.
In such procedures, a small covered metal scaffold, or stent graft, is placed in a catheter which is passed through a small incision in the groin, into the patient's arteries and into the abdominal aorta.
It is placed securely in the abdominal aorta so that it will exclude the aneurysm from the pressure of the arterial flow, and allow blood to flow safely to the legs.
This type of repair has been an option for patients whose aneurysms are located far enough from the kidney arteries that the stent can be securely attached to the aorta.
For patients without enough space below the kidney arteries for stent graft implantation, the only options have been major abdominal surgery or no repair.
Now, a new device is making it possible for more patients with aortic abdominal aneurysms to undergo minimally invasive endovascular stent graft repair instead of major open surgery.
The fenestrated endograft is specially designed so that it can be placed in the aorta and attached very close to the kidney arteries, according to James F. McKinsey, MD, Columbia Site Chief, Division of Vascular Surgery.
Each device is custom made for each patient, and it takes very precise CT imaging to create the stent graft with fenestrations, or holes that correspond to the position of the arteries within the aorta, going to the kidneys, small bowel, and liver.
The graft is then implanted into the aorta and secured to the more normal section of the aorta above the kidney arteries.
The fenestration holes are positioned over the openings for the kidney arteries as well as the bowel arteries, so that the blood flow continues to these vital vessels while the graft is secured in place.
"This method allows us to treat patients with endovascular therapy and local anesthesia, rather than undergoing the stress of a major operation."
At this time, NewYork-Presbyterian Hospital is one of only three U.S. centers approved to use the investigational device.
Compared to open surgery, the fenestrated endograft affords patients tremendous benefits including shorter hospital stay and fewer complications.
Patients have just two small groin incisions, and can return home one to two days after the procedure.
"Aneurysms often occur in elderly patients, who may have extra risks during open surgery.
This provides a safer, less stressful way of treating patients, some of whom may not be eligible for open surgery," says Dr. McKinsey.
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