Endovascular repairs are minimally invasive and do not require the large incisions necessary for open surgery.
“Most of our procedures are performed through small incisions — about one centimeter — in the groins,” said Adam Beck, MD, an assistant professor in UF’s division of vascular surgery and endovascular therapy.
Repairs performed in this manner leave smaller scars, cause much less pain, pose less risk of infection, heal faster and cause less bleeding than traditional open procedures. Most aortic aneurysm and dissection repairs currently involve the use of endovascular stent grafts, which are made of a woven, cloth-like material and supported by metal stents. These devices are delivered through catheters that are placed over wires and directed to the site of treatment using X-ray imaging. The device is then unsheathed and re-lines the diseased portion of the aorta.
Although straightforward endovascular infrarenal aortic repairs (EVAR) are performed at many institutions around the country, the minimally invasive treatment of thoracic and thoracoabdominal aneurysms, as well as abdominal aneurysms extending above the level of the kidney arteries (juxtarenal or suprarenal aneurysms), is performed only at specialized centers. For these procedures, UF surgeons often use customized devices called branched and fenestrated endografts.
These complex repairs require a great deal of skill and experience on the part of the surgeons and the anesthesia and operating room team. Shands at UF is one of the busiest hospitals in the U.S. for these types of procedures, Beck said. Additionally, for patients with pathology in the thoracic portion of the aorta, the vascular and cardiovascular surgeons at UF work as a collaborative team to offer the most advanced care possible.
“One of the real strengths of our aortic surgery program is that the patients benefit from the expertise of an entire surgical team,” said Philip J. Hess, MD, an associate professor and program director of thoracic and cardiovascular surgery. “This includes cutting edge technology, which contributes to better outcomes.”
Beck noted that UF vascular and cardiovascular surgeons also have extensive experience and a great deal of expertise in performing aortic repairs via open surgery, for patients who require or prefer it. Open aortic repairs are often performed on younger, healthier patients and those who have anatomy not suitable for endovascular repair. Certain patients are better treated with endovascular procedures because they are at higher risk for complications after open surgery, including those with kidney problems, advanced age, coronary artery disease, congestive heart failure or emphysema.
In an effort to continue improving care for patients with aortic problems, UF&Shands is “in the process of establishing a formal Aortic Treatment Center that will work to develop processes of care that will streamline the management of our patients,” Beck said. “This will further improve the already excellent overall care that patients receive in our institution.”
Some patients may benefit from enrolling in a clinical trial focused on repair of aortic disease. UF&Shands has a long history of participation in successful clinical trials, and is currently involved in 11 active trials. Some trials offer participants access to devices not widely available because of their experimental nature.
For more information about endovascular repair of aortic aneurysms and dissections or related clinical trials, call 352.265.9928.