A custom graft for abdominal aortic aneurysms

custom graft

Living with an abdominal aortic aneurysm is like teetering on the edge of a cliff, sometimes for years, waiting as the body’s largest artery weakens, stretches, and finally bulges to the point of bursting.

For patients who also have other serious medical conditions, standard abdominal surgery is often too risky, leaving few, if any, treatment options.

Emory vascular surgeon Joseph Ricotta is one of a handful of surgeons across the United States who repair this critical condition using a custom-made fenestrated and branched aortic endograft (FEN) inserted into the aorta through arteries in the groin. Ricotta fashions each graft himself based on the patient’s CT and PET scans. The endograft is a tube of fabric and metal that functions as a sleeve inside the aorta that excludes the aneurysm from blood flow.

The FEN is inserted through needle punctures in the groin arteries. The FEN’s holes line up with blood vessels, including kidney and intestinal arteries, and through these holes, additional stents are placed into branch arteries to repair the aneurysm and preserve blood flow to the abdominal organs. “The people who benefit from this procedure the most have no other options for aneurysm repair and could not survive open aortic surgery,” says Ricotta. FEN candidates possess large aneurysms likely to rupture and are often too sick from heart, lung, or kidney disease for conventional abdominal surgery.

The FEN procedure offers patients a quicker recovery and a lower risk of complications or death. Approximately 20% to 30% of patients who undergo traditional open thoracoabdominal surgery die within one year, and 10% to 15% will die during or shortly after open surgery. Ricotta reports that only 1% to 2% of his patients who underwent the FEN procedure died. Emory’s FEN program, which has done more than 30 procedures since Ricotta arrived from the Mayo Clinic in September 2010, is one of only a few nationwide and the only one in the Southeast.

Approximately 15,000 people die each year of a ruptured abdominal aneurysm, and 200,000 new cases are diagnosed each year. Congress recently revised the SAAAVE ACT (Screen Abdominal Aortic Aneurysms Very Effectively) to include ultrasound screening for at-risk Medicare recipients aged 65 to 75 years.

“Screening is crucial, because abdominal aortic aneurysms are asymptomatic, silent killers,” Ricotta says. “That’s why early detection with ultrasound is key.”—Valerie Gregg

To watch a video on this procedure, access tinyurl.com/endografts.

Table of Contents

Emory Medicine Fall 2011