Studies Aim To Expand Aortic Aneurysm Treatment
The aorta does the crucial job of carrying blood from the heart through the chest and abdomen to the rest of the body. When an aneurysm, or bulge, develops in this major vessel, the outcome can be fatal. In fact, about 13,000 Americans die each year when an aortic aneurysm ruptures or tears.*
For decades, Washington University vascular surgeons at Barnes-Jewish Hospital have played a leading role in advancing treatment for abdominal aortic aneurysms by testing surgical placement of stent grafts — devices that reinforce the vessel walls. Today, these surgeon-scientists are evaluating similar technologies that provide treatment options for aneurysms that develop in more complex regions of the aorta.
“Over the past several years, we participated in trials of fenestrated stents for aortic aneurysms close to the renal arteries,” says Luis Sanchez, MD, chief of vascular surgery and the Gregorio A. Sicard Distinguished Professor of Vascular Surgery. “These devices have small openings — fenestrations — that can be strategically placed to allow blood to pass into the renal arteries. Soon, we will be testing devices with branches that can be placed into other arteries connected to the aorta and the aortic arch.”
Sanchez will lead early clinical trials to test the safety and technical feasibility of two stent grafts. One device is designed for placement in the aortic arch, with branches into the innominate and left carotid arteries. Collectively, these vessels supply the head, right shoulder, right arm, and brain. The other device is for the abdominal aorta with branches to the celiac, superior mesenteric and renal arteries, which supply abdominal organs. Another trial, led by Sanchez, could result in FDA approval of a stent graft for the aortic arch with a single branch that can be placed into the subclavian or innominate arteries.
“These devices could complete our ability to treat aneurysms from the aortic arch all the way to the groin,” says Sanchez. “This group of patients is the sickest and least likely to be candidates for open surgical repair; it gives us an option we can offer them.”
Cardiac Surgery Chief Marc Moon, MD, director of the Center for Diseases of the Thoracic Aorta, and the section’s other vascular surgeons also will participate.
*National Heart, Lung, and Blood Institute
Nanette Reed, MD, patient safety lead for the section, was one of 10 faculty who participated in a Teaching for Quality (Te4Q) Workshop of the Association of American Medical Colleges to better prepare faculty to lead, design and evaluate effective learning in the area of quality improvement and patient safety. Reed also used the workshop to advance the development of a treatment protocol to improve the speed and quality of care for patients with aortic aneurysm rupture and aortic dissection. The protocol will cover procedures from the emergency room to the operating room and intensive care units.
The Vascular Surgery Residency received full accreditation by the Accreditation Council for Graduate Medical Education and will have its first graduate in 2017. The five-year program began four years ago for medical school graduates who choose to focus exclusively on vascular and endovascular surgery and the management of patients with vascular disease. A vascular surgery fellowship is still offered for those who wish to pursue training after their general surgery residency.
New faculty expand the section’s focus:
- Sean English, MD, who completed a vascular surgery clinical and research fellowship at Massachusetts General Hospital, has a basic science research interest in matrix metalloproteinases in aortic aneurysms.
- Gerald Fortuna Jr., MD, a colonel in the U.S. Air Force, will maintain a vascular and trauma surgery practice while serving as the director of the Air Force’s C-STARS military preparedness program. (See article in Section of Acute and Critical Care.)