A stent graft to repair an abdominal aortic aneurysm (AAA) in a trauma victim was used for the first time ever by University of Washington (UW) physicians.
The procedure was performed at Harborview Medical Center on a 21-year-old male who suffered massive abdominal and bowel injuries from a seat belt in a high-speed car crash. "This injury is incredibly rare-it's seen about once every 10 years," says Dr. Arthur Fontaine, UW associate professor and section chief of angiography and inteventional radiology. He performed the procedure with Dr. Steve Nicholls, a UW associate professor of vascular surgery based at Harborview, and Dr. Ted Kohler, UW professor of surgery based at the VA Medical Center.
"When the abdominal aorta is torn this way, it balloons out causing an aneurysm," says Fontaine. "Due to the aneurysm leaking blood into the abdomen, together with contamination due to his bowel injury, open surgery was not a possibility. This new form of therapy simplified treatment in this complex situation, such that the patient was repaired in one day."
The procedure involves a stent graft-a Dacron tube inside a collapsed metal-mesh cylinder-that is threaded into the femoral artery to the site of the aneurysm. It expands to fit within the diameter of the aorta and serves as a substitute channel to carry blood, bypassing the aneurysm to prevent a rupture.
Stent grafts to treat AAAs received marketing approval from the US Food and Drug Administration in September, offering many patients a less invasive alternative to open abdominal surgery. Although AAAs are the 13th leading cause of death in the United States, they are almost always caused by cellular changes due to arteriosclerosis-the build-up of plaque on the inside of the artery.