Hank Madaloni knows what it is like to have his chest and abdomen opened up by surgeons.
The 77-year-old La Verne resident has had not one, but two heart bypasses–not to mention operations for colon and bladder cancer–during his lifetime.
So when doctors found an aneurysm in Madaloni’s belly, the operating-room veteran figured for another big reunion with the surgeon’s scalpel. That was until he met USC vascular surgeons Fred Weaver and Douglas Hood.
After thorough testing and discussion, the doctors and patient concluded the best treatment for Madaloni was an endovascular procedure, which requires only two small incisions in the groin area and the installation of a small, flexible tube in his artery, instead of traditional open surgery.
“It was like nothing!” said Madaloni. “I was awake during the operation and I went home two days later.”
Quick recovery time and minimal pain for patients are pluses for a new, minimally invasive procedure using advanced devices to treat abdominal aortic aneurysms. Weaver, professor of surgery and chief of vascular surgery, and Hood, assistant professor of surgery, are beginning to offer the highly specialized procedures at USC University Hospital to patients needing treatment for the aneurysms. The surgeons were specially trained to conduct the procedures, which are currently being done mainly at academic medical centers such as USC, Hood said.
An aneurysm is a ballooning of an artery that forms when pressure from blood flow pushes against a weakened section of artery wall–much like a bulge in a faulty water hose. In the case of an abdominal aortic aneurysm, the ballooned, weakened area is in a part of the aorta just above the iliac arteries (near the top of the pelvis).
Patients usually only find out they have one of these aneurysms quite by accident. A doctor often finds it by sensing a suspicious, pulsating mass in the abdomen of a patient during a physical exam, or the aneurysm shows up on an MRI or other scan.
“Those are the lucky ones,” Hood said. The aneurysms wreak no symptoms until they burst, and at that point, patients bleed internally and survival is difficult.
“Traditionally, what we-ve done to treat these aneurysms is an open operation, with a large incision,” Hood said, motioning from his breastbone down to his abdomen. “That requires a seven-day hospital stay, as well as a two-to-three-month recovery period after the surgery. And it has a five percent mortality rate.”
In addition, during that operation, surgeons must put a clamp on the aorta while they remove the part of the artery with the aneurysm and carefully suture the artery back together. “The clamping can be stressful on the heart,” Hood says. “Some patients may have a heart attack.”
But under the endovascular procedure, a surgical team makes two, two-to-three-inch incisions in the groin on the left and right. They insert thin catheters into the iliac arteries and guide a small plastic or nylon tube, or stent, up through the artery to the aneurysm. Depending on the type of stent, surgeons pop it into place in the area of the aneurysm and lodge it there, so that ordinary blood flow passes through the stent instead of filling up the aneurysm and posing a risk for rupture.
The Food and Drug Administration has approved two stents for the procedure Guidant’s Ancure Endograft and Medtronic’s AneuRxand each has its advantages. Surgeons choose the device based on characteristics of the aneurysm and the patient.
There are some drawbacks, though, Hood observed. Some blood may leak out of the stent within the artery, for example. Some patients may get stenosis, a narrowing of the artery. And depending on the type of stent used, the stent may kink when the artery contracts over time.
But doctors watch patients carefully for such signs, Hood said. And researchers continue to make advances in the procedures. At USC, for one, Hood and Michael Katz, an interventional radiologist, will soon begin a trial for a percutaneous procedure for aneurysm patients, one that is even less invasive because it requires only punctures, instead of incisions.
Madaloni said the procedure, which treated his 5.7 centimeter-wide aneurysm, has worked out well for him.
“I know with the other operation, they have to move your innards around,” he said with a chuckle. “And I found out that I knew a bunch of people with friends who had aneurysms, and they all said they took a long time to get better.”
Instead, Madaloni was able to eat a meal the night after the endovascular procedure, and only felt some post-operative pain at the site of his incisions. He could drive within a week.
One month after the surgery, a CT scan showed the stent working well, so Madaloni took off in a fully-equipped travel van for a cross-country road trip. “Dr. Hood gave me the OK,” Madaloni said. “Since they put in the stent, I’ve got feeling in my leg back, I can walk well and Im feeling good.
“The doctors, nurses and everyone were great. I’d recommend it.”