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Published on February 20, 2014

New treatment for a ‘silent killer’

Palos is the only hospital in the southwest suburbs to offer Fenestrated Endovascular Abdominal Aortic Aneurysm Repair


Wanda Neuhaus didn’t realize it at the time, but a persistent pain in her hip following a fall would become her life-saver.

During her hip X-ray, a swelling in the main artery of her abdomen was discovered. After some additional testing, she learned she had a large abdominal aortic aneurysm which, if not treated with surgery, could burst and kill her. Wanda has an extensive medical history, which made traditional open surgery too risky. However, after seeing a vascular surgeon at Palos Community Hospital who specializes in the treatment of aneurysms, she was given the option to have a new and unique minimally invasive procedure to treat her aneurysm.

In October, Wanda became one of the first patients to undergo a fenestrated endovascular abdominal aortic aneurysm repair, or FEVAR. The procedure is not only new to Palos but new to the Chicagoland area, and it saved her life. 

‘Silent killer’

Abdominal aortic aneurysms (AAA) are the 15th leading cause of death in the United States, according to the American College of Cardiology. Approximately 15,000 Americans die each year from ruptured aortic aneurysms, and in the majority of cases, the condition appears without symptoms.

The concern with an aneurysm is that it’s a “silent killer,” and you usually don’t have any symptoms, which was the case with Wanda, says Sanjeev Pradhan, M.D., a vascular surgeon at Palos Community Hospital who performed the surgery.    

“The aneurysm grows and, at some point, bursts or ruptures,” Dr. Pradhan says. “Because of the massive amount of blood that goes through this artery, most patients will pass out and pass away in minutes. It’s a fatal problem.”

Since aneurysms form because of a problem with the actual wall of the blood vessel, medicines are not effective in treating them. An aneurysm is monitored, usually with ultrasound, until it becomes big enough to pose a threat – 4.5 to 5 centimeters for women and 5 to 5.5 centimeters for men. At that point, surgery is recommended.

Wanda’s aneurysm was at 5.5 centimeters and posed a high risk for rupturing.

Once she met Dr. Pradhan, she was ready for surgery, even though she had never had a major operation before.

“Dr. Pradhan was so great to me,” Wanda says. “I would have gone in for surgery that day if he told me to. I was that comfortable with him.”

Treating an aneurysm

Palos offers the entire range of treatment options for aneurysm repair – from traditional open surgery to endovascular stenting. 

The traditional method to repair an aneurysm involves a three- to four-hour operation that replaces the diseased segment of the aorta with fabric tubing. The procedure is performed through a large incision in the abdomen, usually requires a blood transfusion, and patients typically remain in the hospital for seven to 10 days. Returning to normal activity takes three to six months. This repair option can be dangerous for those with other serious medical conditions.

Wanda’s multiple medical problems – lung disease, chronic obstructive pulmonary disease (COPD), high blood pressure and high cholesterol – could have made things detrimental with a traditional open operation.

“The operation can be risky, especially for older patients,” says Dr. Pradhan. “However, the operation is very durable and has a good success rate. There’s not a lot of follow up once the patient is recovered.”

In the 1990s, a minimally invasive option called the Endovascular Abdominal Aortic Aneurysm Repair, or EVAR, was introduced. This method allowed the treatment of abdominal aneurysms of patients with serious medical conditions, such as heart, lung and kidney disease, who would have formerly been considered poor surgical candidates. Through two small incisions in the groin, a stent (a metal scaffold lined with fabric) is placed within the aneurysm to reline the aorta. This results in all of the blood flow and blood pressure being contained within the graft, eliminating the risk of rupture.

With EVAR, patients rarely need a blood transfusion and are fully recovered within a month. However, a patient’s anatomy has to meet certain specifications to have treatment with a stent. Otherwise, the stent would end up covering vital branches of the aorta that supply the intestines and kidneys.

“We need a healthy aorta to get a good seal on the graft. Some patients don’t have that space under the kidney arteries (10 to 15 millimeters) before the aneurysm starts,” says Jennifer Bromeland, an advanced practice nurse for vascular surgery at Palos. 

Until now, if the needed room wasn’t available, the patient had no choice but to undergo the more extensive open surgery. Or, in the case of an elderly person, the choice may have been to leave it alone.

“With the population growing and people living longer and healthier, this is becoming more of an issue. It’s hard to just tell a person let it be. It worries them,” Dr. Pradhan says.

As it turned out, Wanda’s anatomy would not have allowed her to have an EVAR. She didn’t have enough of a sealing zone under her kidney arteries.

But she was lucky to meet Dr. Pradhan and be introduced to the FEVAR procedure.

The fenestrated endovascular abdominal aortic aneurysm repair now offered at Palos expands the number of people who can be treated through a minimally invasive procedure.

Wanda’s anatomy was perfectly suited for this new technique.

“If my only choice was to have an open surgery, I don’t think I would have had it done,” Wanda says. “I wouldn’t have been able to afford being off work for the recovery time needed.”

She is thankful for Dr. Pradhan and the staff at Palos for such a pleasant experience during her recovery. “Everyone was great to me, especially Jennifer Bromeland. She was like an angel to me.”

How the FEVAR works

The fenestrated stents are different than the previous ones because they have holes and openings within them called fenestrations that allow blood to continue flowing to the intestines and kidneys. The stent can now be placed in a more normal part of the aorta even if the intestinal and kidney arteries are in the way.

“With this new graft, I’m able to use the stent for minimally invasive treatment of the aneurysm even if I don’t have enough sealing space,” Dr. Pradhan says. “Before the fenestrated graft was available, this just wasn’t possible. If you covered the kidney arteries, a patient would lose function of the kidney and be on dialysis, or if you covered the superior mesenteric artery, the patient would die. People can’t live without that artery.” 

The stent can still be inserted through the groin arteries through small incisions. Once in place, patients have a CT scan at one month, six months and a year to monitor the placement and effectiveness of the stent. If the results are good, patients continue with a yearly scan for the rest of their life.

The fenestrated grafts are unique. They are customized and specially engineered in Australia. It takes about four weeks to receive the stent grafts, which means they cannot be used for patients who need surgery urgently or patients with an aneurysm that has already ruptured.

Palos is the only hospital in the southwest suburbs with the ability to offer the fenestrated graft. In the greater Chicago area, only two university hospitals presently offer it.

Dr. Pradhan stresses one of the main benefits of having this procedure instead of open surgery can be seen in the response of the body.

“The recovery time is phenomenal,” he says. “Patients feel they can get back to life right away.”

Wanda was the perfect candidate for the fenestrated stent graft procedure. The open operation not only would have been more risky to her health, but she would not have been able to bounce back as quickly as she did. She loves her job and she’s already back to work full force.

“I feel good,” she says. She was hoping to go ice skating with her granddaughter this winter, but that’s on hold for now. “But next winter, we’re doing it!”


Knowing the risks (breakout 1)

Since aneurysms are difficult to diagnose, knowing your risks is important. You are more likely to develop an abdominal aortic aneurysm if you have the following risk factors:

  • If you are a male age 55 or older
  • If you smoke or have ever smoked
  • If you have high blood pressure
  • If you have a collagen vascular disorder
  • If you have a family history of aneurysms

“Since early detection is critical to safely treating aortic aneurysms, people with risk factors or a high suspicion for aneurysm disease should be screened by ultrasound,” Dr. Pradhan says. “Ultrasound is a safe, effective method to view and measure the aorta. More invasive imaging with CT scans or MRI is sometimes helpful as well.”

The Screening Abdominal Aortic Aneurysms Very Efficiently (SAAVE) Act, signed into law in 2006, provides a one-time AAA screening as part of the Welcome to Medicare physical exam for males, ages 65 to 75, with a history of smoking and men and women, ages 65 to 75, with a family history of AAA.


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Hybrid Room brings new possibilities

Last year, Palos opened its Hybrid Room during the unveiling of the Hospitaller Pavilion. It is the southwest suburb’s only hospital to offer a room of its kind.

With CT scan and ultrasound technologies available in the same space, the Hybrid Room is a state-of-the-art suite with the latest technology in terms of imaging capabilities for patients requiring interventional radiological, vascular, cardiac and orthopaedic procedures, thereby reducing surgical time and lowering any inherent risks. The unique dual-procedure operating suite is equipped to accommodate both open and closed surgical procedures.

“Palos is ahead of the curve,” Dr. Pradhan says. “The Hybrid Room allows me to do procedures I wouldn’t even imagine doing at any other hospital.”

And one of those procedures is the fenestrated endovascular abdominal aortic aneurysm repair.

“I wouldn’t do these cases in any room but a Hybrid Room because of the clarity in imaging and the complexity of the case,” he says. “Combine the advanced technology of the Hybrid Room with the traditional operating room techniques and abilities and it’s really the best of both worlds.”


PULL QUOTE:  “Palos is ahead of the curve. The Hybrid Room allows me to do procedures I wouldn’t even imagine doing at any other hospital.” Sanjeev Pradhan, M.D.