Heart & Vascular Institute Physician eNewsletter - Summer 2012
Patients facing open surgery to repair aneurysms and dissections of the ascending aorta and aortic arch could have another alternative at Cleveland Clinic, one of the only medical institutions in the country where complex endovascular stent grafting can be performed. With the introduction of new stent graft devices that can bend to accommodate the aortic arch, it’s now possible to treat more extensive disease, says Matthew Eagleton, MD, a vascular surgeon at Cleveland Clinic.
"Branched devices aren’t available everywhere," Dr. Eagleton says. "Because of the research conducted here, we are not limited to only treating patients with conventional aneurysms. We can treat much more complex disease."
Is open surgery for repairing the ascending and aortic arch on the way out? Not likely. But new devices are giving Cleveland Clinic physicians an opportunity to treat more extensive disease. Closer to the heart, the anatomy and pathology become more complex. In the past, endografting was limited to areas where there were no significant branches coming off of the aorta.
Customized Stent Graft
Today, it’s a different story. Cleveland Clinic’s Dr. Roy Greenberg developed endovascular stent grafts in a variety of sizes that can bend to accommodate the aortic arch. The grafts have branches to the supra-aortic vessels and seal down in the ascending aorta. Such new devices extend the treatment area and give patients who might have previously been ushered down the road of open surgery a different, less invasive path.
As with all new promising treatment options, we’re not yet sure how these devices will perform 10 to 20 years down the road—or whether their outcomes will be equivalent to open surgery, Dr. Eagleton says. Until patient outcomes with the new technology prove otherwise, open surgery remains the gold standard for repairing complex aortic aneurysms. Open surgical techniques can involve grafting with branches, or hybrid "elephant trunk" procedures combining endografting.
Endovascular stenting is a veteran solution for treating abdominal and thoracic aneurysms. And as technology advances, and with continued use of new, flexible devices, Dr. Eagleton says more patients dealing with complex aneurysms in the aorta could choose interventional procedures using endografting if they are candidates.
Currently, ideal candidates for endografting to repair aneurysms fit the indications for commercially available devices, Dr. Eagleton says. "They must have a good route to get the device into the aorta, and they must have a healthy aorta above and below where the devices are implanted." He estimates that no more than 60 percent of patients fit this description.
"Physicians who have patients with aneurysm should have those individuals evaluated to see if they are a candidate for one of these procedures," Dr. Eagleton says.