�An estimated 60,000 Americans are walking around with meter bombs in their chests called thoracic aortic aneurysms.
At any time, their primary chest arteria could on the spur of the moment burst receptive, causing massive internal hemorrhage that is almost always fatal.
It's possible to compensate the defect before the artery bursts, but traditional surgery is highly incursive. The operation typically requires an 18-inch incision, a week or two in the infirmary and three to six months to recover. There are several major risks, including stroke and paralysis.
At Loyola University Hospital, an increasing number of patients are organism treated with a device called a stent graft, which is inserted without opening the chest. Stent graft patients typically go home in a day or deuce, and regain fully in about deuce weeks.
At Loyola's Thoracic Aortic Disease Clinic, about 70 percent of patients world Health Organization undergo surgery for aneurysms in the chest arteria are receiving stent grafts rather than open pectus surgery. "And as the technology evolves, we will be doing more and more stenting," said Dr. Jeffrey Schwartz, associate professor in the Department of Thoracic and Cardiovascular Surgery at Loyola University Chicago Stritch School of Medicine.
The stent grafting used in chest arteries is a polyester thermionic valve covered by metal webbing. It is delivered with a catheter (thin tube). The operating surgeon inserts the catheter in a seawall artery, and guides it to the thoracic aorta (chest artery). Once the stent graft is deployed from the catheter, the device expands outward to the walls of the artery. Depending on the patient, the stent grafting is roughly 1 in to 2 inches across-the-board and 4 to 8 inches long, said Dr. Michael Tuchek, who has conducted several clinical trials of aortic stent grafts. Tuchek is a clinical assistant professor in the Department of Thoracic and Cardiovascular Surgery at Stritch.
James Feehan of Bolingbrook, Ill. recently received a stent graft to repair a life-threatening aneurysm in his chest aorta. The aorta is the main artery from the heart. An aneurysm occurs when the walls of the aorta thin and balloon outward-bound. As the bulge grows, there's an increasing peril the aorta could of a sudden burst. Feehan had undergone four sooner open-chest surgeries to recreate other defects in his aorta. By comparison, the stent bribery procedure was "a walk in the park," he said.
Feehan, 78, probably could not hold survived some other open bureau surgery, said Tuchek, wHO placed the stent graft. Now, thanks to the stent graft, "he canful go household and see his grandkids," Tuchek said.
The first-generation pectoral aortic stent grafts were approved in 2005. Feehan recently became one of the low gear patients in the land to have the latest-generation stent graft, called Talent. The modern device will make it possible for significantly more than patients to have stent graft repairs rather than open surgery, Tuchek said.
The difference between the old stent grafts and the new one "is kind of like the remainder between a Model T and a Ferrari," Tuchek said.
In a study promulgated recently in the Journal of Vascular Surgery, researchers compared 195 patients wHO received the new stent graft with 189 patients who underwent traditional open chest surgery. About 84 percent of the exposed chest surgery patients experient major complications, compared with only 41 percent in the stent graft grouping. After 12 months, 11.6 percent of the open chest surgery patients had died of aneurysm-related causes, compared with 3.1 percent in the stent bribery group. Tuchek is a co-author of the field, which was funded by the manufacturing business of the stent graft.
Loyola's thoracic aortic disease clinic follows more than 1,000 patients. About 80 percent of the patients have aortal aneurysms. Other conditions treated at the clinic include aortic dissection (the privileged layer of the aorta's artery paries splits open) and cankerous plaques (irregular buildup of cholesterol and other deposits in the aortic walls).
Risk factors for aneurysms and other aortal defects include smoking, solidifying of the arteries, diabetes, family history, high rake pressure and congenital disorders such as Marfan syndrome. Many people do not realize they have aneurysms until the bulges ar detected on CT scans or MRIs.
Because aortic disease is relatively uncommon, many surgeons and cardiologists refer patients to specialty centers such as Loyola. Loyola's aortic clinic treats patients from Illinois, Indiana, Wisconsin, Michigan and Iowa. Patients have come from as far away as Florida and Arizona.
The clinic is a collaborative effort. Schwartz, for model, specializes in open pectus surgery, patch Tuchek has helped pioneer the use of thoracic aortic stent grafts.
"My vision is that patients with aortic disease receive comprehensive, multi-specialty charge for this unique stipulation," Schwartz said.
Tuchek is a leading enroller in a second multi-center clinical trial run of the new stent graft, which is made by Medtronic, and he is a consultant to the company.
Based in the western suburbs of Chicago, Loyola University Health System is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and 22 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center of attention campus is conveniently placed in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus, Loyola University Hospital, is a 570-licensed bed adroitness. It houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald� Children?s Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as comfortably as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Health & Fitness. Loyola's Gottlieb campus in Melrose Park includes the 250-bed community hospital, the Gottlieb Health & Fitness Center and the Marjorie G. Weinberg Cancer Care Center.
Source: Jim Ritter
Loyola University Health System
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Tuesday 2 September 2008
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