Marking the 20th Anniversary of First Endo AAA Repair

TWENTY YEARS LATER WE REMEMBER DECEMBER 3RD, 1999, AS THE LAUNCH OF THE NEW ERA OF ENDOVASCULAR ANEURYSM REPAIR IN EAST TENNESSEE.

Open surgical repair was the standard method of aneurysm repair for five decades.

Dr. Juan Parodi, Dr. Julio  Palmaz and Dr. Nicholas  Volodos are recognized as pioneers of endovascular aneurysm repair.  Dr. Parodi and Dr. Palmaz performed their first case in September of 1990. Dr. Frank Veith and Dr. Michael Marin and Dr. Parodi performed the first endovascular case in the United States in New York on November 22, 1992.

After years of technological development, endovascular repair of abdominal aortic aneurysms were eventually approved in the United States in September of 1999.  My endovascular team, which was already performing complex vascular cases since the early ’90s, was brought together and was excited about being pioneers. With appropriate treatment planning and strategy, the team was ready.

On December 3rd, 1999, I brought the endovascular team together including myself, Abercrombie interventional radiologist Dr. Lloyd Smith and my lead surgical technologist Kimberly Hardy and successfully carried out the first endovascular aneurysm repair in East Tennessee.  My involvement in early endovascular aortic techniques and deployments including hybrid techniques allowed me to help teach other colleagues, vascular surgical personnel and participate in multiple new trials and registries. This was the beginning of a new and exciting era.

Endograft used in 1999

The early endovascular aortic stent grafts were larger and not as flexible and could not accommodate some of the anatomic challenges.  The evolution of new technology though has allowed lower profile stent grafts to track easily and treat a wide array of aortic pathology. We can now treat more patients with endovascular techniques than ever before.

Two decades have gone by and we continue to develop and embrace new technology that ultimately saves lives and limbs.

ENDOVASCULAR ANEURYSM REPAIR

The aorta is the largest blood vessel in the body. An aortic aneurysm is a bulging or ballooning of the wall of the abdominal aorta.  As the aneurysm enlarges it stretches the aorta. Abdominal aortic aneurysms can often grow slowly without symptoms, making them difficult to detect. Once detected you should be in an aortic surveillance program watching for potential growth.  Small aneurysms can stay stable and small and never grow. Some small aneurysms never rupture. Some aneurysms grow slowly over time and others expand quickly.

If you have a symptomatic or enlarging abdominal aortic aneurysm, you might notice:

  • Deep, constant pain in your abdomen or on the side of your abdomen or back pain

If your aneurysm reaches a critical point the aorta can rupture and can cause life-threatening bleeding. Your vascular surgeon can help you with surveillance and decision making regarding the best treatment option.

Risk factors:  There are multiple risk factors but the most common are listed below

  • Tobacco use. Smoking can weaken the aortic walls, increasing the risk not only of developing an aortic aneurysm but of rupture.
  • These aneurysms occur most often in people age 65 and older but can also occur in younger patients.
  • Men develop abdominal aortic aneurysms much more often than women
  • Family history. If anyone in your family had an abdominal aortic aneurysm it increases your risk of having the condition. Please get an ultrasound of your abdominal aorta.
  • Other aneurysms. Having an aneurysm in another large blood vessel, such as the artery behind the knee or the aorta in the chest, increases your risk of an abdominal aortic aneurysm.

The current procedure usually takes 2-3 hours through two small groin incisions. It can also be performed under local anesthesia percutaneously without skin incisions if appropriate.  This is certainly much different than two decades ago and patients are usually discharged within one to two days.

Image: https://www.researchgate.net/figure/Ancure-Endograft-bifurcated-graft-with-the-markers-enhanced-Markers-are-sewn-at-regular_fig1_3221520

Image: https://surgery.ucsf.edu/media/1672048/aneurysm_endovascular%20repair.jpg

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