New Emergency Treatment for Burst Aortic Aneurysm

Jack Kory of Mokena, Il. was eating his breakfast oatmeal when he suddenly felt the worst pain in his life.

The searing pain came on suddenly in his stomach and spread to his knees. It was caused by an abdominal aortic aneurysm (AAA) that had suddenly burst, causing massive internal bleeding.

Traditionally, few patients have survived such ruptures. But Loyola University Medical Center vascular surgeon Dr. Richard Hershberger was able to repair Kory's aneurysm with a minimally invasive emergency procedure.

"I'm very happy with how it worked out," Kory said.

An AAA is a bulge in the large blood vessel that supplies blood to the abdomen. The bulge typically develops slowly over many years. The larger the aneurysm, the more likely it is to rupture and cause massive bleeding. About 80 percent of people who suffer AAA ruptures die before they get to the hospital. Among patients who make it to the hospital in time, only about 50 percent survive traditional open surgery.

But more patients are surviving minimally invasive procedures that Hershberger and other vascular surgeons at Loyola are performing on patients with ruptured AAAs. The newer procedure is called endovascular surgery. About 70 percent of ruptured AAAs now can be repaired with the endovascular technique. In the last four years, Hershberger and other vascular surgeons at Loyola have performed endovascular surgery on 12 patients who suffered ruptured AAAs, and they all survived.

An aortic aneurysm is a bulge that develops in the aorta, the largest artery in the body. While an aortic aneurysm may burst, causing serious health problems, it is also possible for an aneurysm to be in the aorta without rupturing. Many people mistakenly believe that an aneurysm refers to the actual event of a rupture.

Smaller aneurysms are generally monitored by a physician. They can be diagnosed and monitored using a variety of diagnostic tools, such as an x-ray, EKG, MRI or CT scan. If the physician notices the aneurysm getting larger, he may recommend treatment. The larger an aneurysm becomes, the greater the likelihood is that it may burst.

Aortic aneurysms are most commonly located in the area below the kidneys. In this location, an aneurysm is called an abdominal aneurysm. If the aneurysm is located higher up, in the chest cavity, it is called a thoracic aneurysm.

Kory was first taken to a community hospital and then taken by helicopter to Loyola. Fortunately, the blood clotted enough to temporarily stem the bleeding. But his only chance to survive was an emergency repair of the aorta.

In traditional surgery, a surgeon makes a large incision in the abdomen and replaces the damaged portion of the aorta with a Dacron tube.

Hershberger instead used the endovascular technique. He inserted a catheter in a groin artery and guided it through blood vessels to the site of the burst aneurysm.