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Heart Catheterization 
 Tests & Procedures
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Abdominal aortic aneurysms (AAA) rank as the 13th leading cause of death in the United States. Caused when a weakened area of the aortic wall becomes enlarged, and resulting in rupture and often death from internal bleeding, this condition can be successfully treated with a minimally invasive surgery performed by vascular surgeons at Oklahoma Heart Hospital Physicians. Over 425 of these innovative surgeries, which use catheter-based technologies and endovascular grafting, have been completed. The first in the state to use the procedure, OCA’s vascular surgeons have an outstanding combination of expertise and access to FDA-approved grafts, as well as research grafts, to keep them on the forefront of the life-saving treatment. This procedure, which is a much less invasive surgery, carries less risk than traditional “open” surgical methods, meaning more patients are able to undergo the treatment. Jim Melton, D.O., and Lenny Stubbs, M.D., OCA vascular surgeons, who perform these surgeries, say that approximately 80 percent of all aneurysm patients who come to OCA can be treated with this new endovascular technique. “We can use this to take care of people who might not survive the traditional open surgery because of the condition of their heart or lungs,” Dr. Melton said. Detecting Abdominal Aortic Aneurysms Called a “silent killer” because it often occurs without any warning symptoms, AAA results in more than 15,000 U.S. deaths annually. Over 200,000 new cases are diagnosed each year, and the occurrence of AAA has tripled in the past three decades. They affect as much as 8 percent of people over age 65, and about one out of every 250 people over age 50 will die of a ruptured AAA. Seventy-five percent of aneurysms in the aorta occur in the abdomen, usually in the part below where the renal (kidney) artery originates. AAA also can extend into the blood vessels in the hips and pelvis. In abdominal aneurysms, a progressively weakened area of the aortic wall becomes enlarged. The pressure of the blood flowing through the aorta beats against the weakened wall, causing it to bulge. The diameter of the aorta is usually an inch or less, but when an aneurysm is present it can dilate to more than five inches. The risk is directly related to the size. Left undiagnosed and untreated, the aneurysm will rupture, causing fatal internal bleeding. This occurs in 80 to 90 percent of the patients whose AAA ruptures. Detecting and preventing aortic rupture through treatment is vital to saving lives. Knowing the risk factors and being screened regularly, as well as, heeding possible symptoms, are key ways for senior citizens and others to help their doctor diagnose an aneurysm early. Major risk factors included being over age 55, high blood pressure, atherosclerosis, inflammation or infection, and a history of smoking. In fact, aneurysms grow faster in smokers, and smokers die from ruptures four times more frequently than non-smokers. Men are four times more likely than women to have AAA. A family history is also a major factor, so physicians should screen all patients whose direct relatives have had AAA. Most patients have no symptoms. However, symptoms that can indicate an AAA include abdominal pain (either constant or intermittent); pain in the lower back that radiates to the buttocks, groin or legs; and a pulsating feeling or mass in the abdomen at the level of the naval. A ruptured AAA can cause sudden, severe abdominal or back pain, paleness, dry mouth and skin, excessive thirst, nausea and vomiting. In addition, signs of shock including dizziness, shaking, sweating, sudden weakness, fainting and rapid heartbeat can occur and require immediate emergency treatment. To screen patients, physicians perform a thorough clinical exam of the abdomen, determine risk factors – especially family history – and have imaging tests done. Abdominal ultrasounds are an easy and accurate tool for detecting the presence and size of an aneurysm. Other diagnostic imaging techniques include CAT scans, MRIs and arteriograms. OCA can provide ultrasounds to patients in rural areas through its mobile units. Treatment is recommended for aneurysms that reach four to five centimeters in diameter. About 60 to 70 percent of patients with AAA below the kidneys are also candidates for endovascular repair. Treating AAA with Endovascular Grafting The endovascular grafting treatment used by OCA offers less risk, fewer complications and faster recovery than the traditional major surgery that opens the abdomen, lay aside folds of intestines and works around internal organs to reach the AAA. Because it is minimally invasive, the new procedure causes less tissue damage and postoperative pain. It is considered the treatment of choice, especially in patients with multiple medical problems. The exceptions are patients with unusually small arteries or vessels or those with aneurysms situated near a kidney. When performing the procedure, OCA surgeons use a general or local anesthetic on the patient, depending on the individual’s risk factors. To reach the area to be repaired, two small incisions of approximately 2.5 centimeters each are made in the groin, and a delivery catheter is then inserted through the femoral artery. Using radiographic imaging as a guide, the surgeon sends a tightly wrapped graft through the catheter to the damaged area, where it is then expanded and affixed to the weakened vessel wall to seal off blood flow into the bulging aneurysm. The entire procedure takes about two hours, and patients usually require only an overnight hospital stay. Close follow-up is provided to ensure that leaks and limb problems, such as leg pain, do not occur. Only a few years ago, this treatment was new. Now it is a routine, safe and effective treatment for a highly dangerous medical condition, performed by Oklahoma’s leaders in the procedure. The field of vascular surgery is benefiting from great strides in technology, and OCA is proud to be part of the emerging advancements in treating vascular disease. |
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