Date: 1/11/2006

Community Hospital first to use new technology for treatment of AAA

Community Hospital in Munster is the first hospital in Indiana to offer a new technology that will make it easier for patients to undergo lifelong follow-up care for repairs of abdominal aortic aneurysms, a life-threatening bulge in a large blood vessel leading from the heart.

Cardiovascular Surgeon J. Michael Tuchek, D.O., one of the country’s leading experts in endovascular repair of Abdominal Aortic Aneurysms (AAA), performed the procedure on Jan. 4 at Community Hospital. It is also expected to be a site of future testing for the new technology.

The technology, EndoSure™ Sensor, is used in the endovascular repair of AAA, a less invasive approach to the traditional open surgery. It is the first wireless, un-powered, permanently implantable pressure sensor for human use to be commercially available in the United States. The system, which based on the latest innovations in both microelectromechanical systems (MEMS) and wireless technologies, is also being studied for other medical uses.

Tuchek is working with the manufacture of this technology — Cardiomems — to research how the EndoSure Sensor may also benefit patients whose aneurysms must be repaired through the traditional surgical procedure, replacing the disease portion of the aorta with a synthetic vascular graft. Those first cases in the U.S. are expected to be performed at Community Hospital later this month.

Aneurysms are weak areas of a blood vessel that most commonly develop in the aorta, a large artery that begins at the heart and runs through the abdomen. An abdominal aortic aneurysm is also known as a AAA while an aneurysm located higher in the chest is a thoracic aortic aneurysm (TAA). Aneurysm can take the form of a balloon shaped sac expanding to several times its normal arterial diameter. If left untreated, the aneurysm will continue to expand and may eventually rupture or tear. The presence of any aneurysm could be life-threatening, but a ruptured one creates a critical condition that requires immediate medical attention.

The EndoSure Sensor is used with a new option for treating AAA disease — endovascular aneurysm repair. This procedure involves a device called a stent graft inserted through a small incision in the groin and placed inside the aneurysm sac. This stent graft is a tube-like device that allows the blood to flow through it, protecting the disease aorta wall from pressure and aneurysm expansion. Blood flows through the stent graft instead of into the aneurysm sac and reduces the pressure in the aneurysm to keep it from bursting.
The sensor is implanted into the AAA sac as the Stent graft is placed during endovascular procedure. Once in place, the Sensor remains in the sac. Along with pictures taken during the stent graft procedure, the EndoSure Sensor helps physicians to know if the stent graft has been inserted properly. An antenna is held over the Sensor and radio frequency (RF) energy is used to determine the pressure inside the aneurysm sac. Even when fully awake and alert, the patient cannot feel the use of the pressure sensor. Unlike CT and MRI scans, no radiation or dyes are needed to take the pressure measurement, minimizing risks to patients.

“This latest advancement will help us to immediately identify any potential complications such as leaking and it will make it easier for patients to undergo lifelong monitoring done to confirm the graft is working,” said Tuchek, who is the primary investigator in numerous national endovascular clinical research trials for the repair of abdominal and thoracic aneurysms.

The 13th leading cause of death in the United States, AAA is also the 10th leading cause of death in men over the age of 55. The risk factors for aneurysm disease, which increase with age, include: atherosclerosis (plaque in the artery); high blood pressure; smoking; being male; and having an immediate relative who has had an aneurysm.

The treatment for aneurysms depends on their size and rate of growth. Doctors take a watch-and-wait approach for those 4 to 5 centimeters in diameter. AAAs 5 centimeters or larger have an increase risk of rupturing and generally call for treatment.

Traditional aneurysm repair surgery involves an incision from the breastbone stem to the pubic bone, some 12 to 15 inches. The aneurysm is then either shut off from the functioning portion of the vessel or replaced with a synthetic graft that is sewn into place. The open approach takes three to four hours in surgery, seven to 10 days recovery in the hospital and two to three months recovery at home.

With the endovascular approach, the procedure takes only two hours, patients can return home the next day and within two weeks can resume their normal activities. Only small incisions are made on either side of the groin, reducing the risk of bleeding and infection compared with traditional surgery.

Under Dr. Tuchek’s leadership, Community Hospital has become one of the largest endovascular stent graft programs in the Chicagoland area, rated by HealthGrades ® as the top vascular program in the state of Indiana and placed in the top 5 percent of hospitals nationwide. Tuchek travels around the world teaching other surgeons how to perform the procedure and is one of only 40 physicians nationwide who can offer this less invasive approach for aneurysms of the thoracic aorta.