More Aortic Aneurysms Being Treated With Stents

An estimated 60,000 Americans are walking around with time bombs in their chests called thoracic aortic aneurysms.

At any time, their main chest artery could suddenly burst open, causing massive internal bleeding that is almost always fatal.

It's possible to repair the defect before the artery bursts, but traditional surgery is highly invasive. The operation typically requires an 18-inch incision, a week or two in the hospital and three to six months to recover. There are several major risks, including stroke and paralysis.

At Loyola University Hospital, an increasing number of patients are being treated with a device called a stent graft, which is inserted without opening the chest. Stent graft patients typically go home in a day or two, and recover fully in about two weeks.

At Loyola's Thoracic Aortic Disease Clinic, about 70 percent of patients who undergo surgery for aneurysms in the chest artery are receiving stent grafts rather than open chest surgery. "And as the technology evolves, we will be doing more and more stenting," said Dr. Jeffrey Schwartz, associate professor in the Department of Thoracic and Cardiovascular Surgery at Loyola University Chicago Stritch School of Medicine.

The stent graft used in chest arteries is a polyester tube covered by metal webbing. It is delivered with a catheter (thin tube). The surgeon inserts the catheter in a groin artery, and guides it to the thoracic aorta (chest artery). Once the stent graft is deployed from the catheter, the device expands outward to the walls of the artery. Depending on the patient, the stent graft is roughly 1 inch to 2 inches wide and 4 to 8 inches long, said Dr. Michael Tuchek, who has conducted several clinical trials of aortic stent grafts. Tuchek is a clinical assistant professor in the Department of Thoracic and Cardiovascular Surgery at Stritch.

James Feehan of Bolingbrook, Ill. recently received a stent graft to repair a life-threatening aneurysm in his chest aorta. The aorta is the main artery from the heart. An aneurysm occurs when the walls of the aorta thin and balloon outward. As the bulge grows, there's an increasing risk the aorta could suddenly burst. Feehan had undergone four earlier open-chest surgeries to repair other defects in his aorta. By comparison, the stent graft procedure was "a walk in the park," he said.

Feehan, 78, probably could not have survived another open chest surgery, said Tuchek, who placed the stent graft. Now, thanks to the stent graft, "he can go home and see his grandkids," Tuchek said.

The first-generation thoracic aortic stent grafts were approved in 2005. Feehan recently became one of the first patients in the country to receive the latest-generation stent graft, called Talent. The new device will make it possible for significantly more patients to have stent graft repairs rather than open surgery, Tuchek said.