— On-again, off-again stomach pain had bothered home
remodeler Jerome Holiday for more than a year, but in January,
it worsened to the point of slowing him down.
I was up on a ladder, I would have to come down," the
59-year-old Pittsburgh resident said. "If I was doing
something strenuous, I would have to stop."
had a potentially fatal abdominal aortic aneurysm, which
doctors at Allegheny General Hospital repaired with an
experimental procedure that could prove more effective and
patient-friendly than the one that’s standard now.
General is one of about 30 sites in the United States, Canada
and Europe taking part in a clinical trial of the new
technology, developed by California-based Endologix Inc.
Holiday, who had the procedure March 4, was the first to
undergo the procedure in Pittsburgh.
Satish Muluk, chief of vascular surgery at AGH and lead
investigator of the Pittsburgh study, said the procedure could
abdominal aortic aneurysm — a leading cause of death among
older patients, the doctor said — is a ballooning of the
body’s main artery near the kidneys. Because of the
expansion, the artery wall becomes so thin that it ruptures,
causing internal bleeding. At that point, the patient faces
estimate the mortality is around 80 percent," Muluk said,
noting many patients have no symptoms before an aneurysm
genetics, high cholesterol and blood pressure, obesity and
smoking are among the factors believed to contribute to
aneurysms, according to the National Library of Medicine. Men
are more prone than women.
the problem can be detected ahead of time with an ultrasound,
which is part of the covered package of care for new Medicare
enrollees. The Medicare years are when the aneurysms are most
likely to develop, Muluk said.
said Allegheny General repairs about 150 of the aneurysms
annually. The standard treatment, developed in the late 1990s,
is minimally invasive endovascular surgery in which a stent,
shaped like an inverted Y, is inserted to bypass the damaged
section of aorta.
percent to 20 percent of patients later require another
procedure because their stent moves or blood leaks into the
procedure involves the insertion of two stents — one to
circulate blood in each leg — inside the aneurysm and the
inflation of two polymer-filled bags to fill up the rest of
the swollen area. The technique is designed to hold the stents
in place and prevent blood leakage.
short, whereas the standard procedure bypasses the aneurysm,
the new procedure "obliterates" it, said Dr. Jeffrey
Carpenter, global principal investigator for the trial and
professor and chairman of surgery at Cooper Medical School of
Rowan University in Camden, N.J.
24 trial participants have undergone the procedure. Each case
has been technically successful, without complications,
a very simple procedure, much simpler than one we currently
do," and it’s likely to help a larger, more diverse
group of patients than is medically eligible for the standard
repair, he said.
trial procedure takes about 90 minutes, compared to the 2˝
hours or so needed for the standard treatment, and has the
potential to be done on an outpatient basis, Muluk said.
Participants in the trial, however, are spending one or two
days in the hospital.
repair also has the potential to be done under a local
anesthetic instead of the general anesthetic used in the
standard procedure. Dr. Carpenter said he recently used a
local while performing the repair on a 90-year-old man.
who also has a heart condition, said he isn’t sure when he
might be able to return to work.
said patients undergoing the standard or new treatment for
repairing the aneurysms generally are able to resume regular