Endovascular Program at The Queen's Medical Center Offers Advanced Medical Technologies for Aortic Stent Graft Repair

Vascular surgeon Harvey Takaki, MD, (right) works across from interventional radiologist Clayton Yamada, MD, during a recent aortic stent graft repair.

Lifelong follow up—yearly CT scans, that is—seems a small price to pay for getting rid of what is essentially a time bomb in your body, in this case, an abdominal aortic aneurysm. The disease, which kills about 15,000 people a year, is the 13th leading cause of death in the U.S. Since late last year, The Queen's Medical Center's interventional radiologists have been making repairs to abdominal aortas using two advanced medical technologies—aortic stent grafts and minimally invasive surgery.

Abdominal aortic aneurysm (AAA) is the stretching or ballooning of the aorta (the body's main artery from which all others derive) in the area below the diaphragm. Risk factors include atherosclerosis and high blood pressure, but there can be other causes.

An aortic stent graft repair is generally recommended for a person with symptoms, because the risk of a fatal rupture can be high. Aneurysms can be repaired using an open surgical procedure, but recently FDA approved stent grafts—which can be placed using minimally invasive surgery—are giving some patients an alternative. "Patients with risk factors that would prevent conventional surgery—such as heart, lung or kidney disease, a history of previous abdominal surgery and the elderly—are considered [for minimally invasive surgery]," says interventional radiologist Clayton Yamada, MD.

Clayton Yamada, MD, with samples of synthetic stents used in the procedure.

Recently, Dr. Yamada was performing a minimally invasive aortic stent graft repair in a newly blessed Endovascular Suite dedicated to these procedures. He collaborated with Harvey Takaki, MD, a vascular surgeon. Two areas of expertise are needed for aortic stent graft repair—the highly specialized catheter techniques of an interventional radiologist and those of a vascular surgeon. The goal of the procedure is to prevent the aneurysm from rupturing by isolating the area from pressurized blood flow.

The synthetic stent is delivered by the catheter in a sheath. Once deployed inside the aorta, the stent automatically expands by body heat. Although the three-hour procedure is not appropriate for all AAA patients and is not without risk, aortic stent graft repair has an overall technical success rate of 98 percent.