Fenestrated Endovascular Aortic Aneurysm Repair | Q&A

[MUSIC]. My name is Dr. James Black, and I’m a vascular surgeon and endovascular surgeon
here at Johns Hopkins Hospital, and I regularly perform aortic
operations on patients of all ages and all distributions along
the aortic tree. [MUSIC]. So an abdominal aortic aneurysm is a
weakness of the abdominal aorta. It tends to produce a dilation of the
blood vessel, whereas normally it’s about the size of a
garden hose, it can grow to reach up to five, six or seven
centimeters, close to the size of a, a liter bottle of
soda. It’s also the fifteenth lea, fifteenth
leading cause of death in the United States for among
adults. [MUSIC]. There are three ways that physicians treat
abdominal aortic aneurysms. The first is surveillance, which of course
is the easiest of all ways we treat
aneurysms. Not every aortic aneurysm needs to be
treated. A lot can be safely monitored, as long as the patient is under surveillance which
can be sometimes performed with something as
simple as an ultrasound, over a cat scan or an MRI. The second way we treat aneurysms is with
open surgery, which has traditionally been done for the last
50 or 60 years. Very good outcomes with expectedly a
longer recovery, because of the nature of the incisions, and the, the body cavity,
and working around the whole aorta. More recently, in the last 10 or 15 years,
we’ve been treating abdominal aortic aneurysms with
stents which has the advantage of a more minimally invasive approach and
avoidance of the major incisions that plagued the recovery of patients who
underwent the open surgery. [MUSIC]. A fenestrated stent graft is a new device
that builds upon a very time tested and excellent platform that we’ve been
using in the United States for over 15 years. The prior version of a stent graft was predominantly used just below the kidney
arteries themselves and in fact, covered probably 50 to 60% of all abdominal aortic aneurysms that we
treat. A fenestrated stent graft implies that the
stent graft itself has small windows cut into it, so that now
we can bring the stent graft up across the
kidney blood vessels themselves, thereby capturing
another 20 or 30% of patients. And now making them a candidate for an
endovascular aneurysm repair, where as previously, they would’ve had to undergo
an open surgery with a much longer recovery. [MUSIC]. The benefits of a fenestrated stent graft really build upon the success that we’ve
had over the 10 or, last 10 or 15 years with a
traditional endovascular aneurysm repair. That is, we have smaller incisions, faster recovery, and generally a much shorter
hospital stay. Most patients will be in the hospital only
two or three days. The specific advantage of the fenestrated
stent graft over what we’ve been doing, is that it allows now us to treat aneurysms that go close to the kidney arteries
themselves. And by doing this type of procedure we can
keep the circulation going to those kidneys as
we’re actually placing the stent. Whereas with a traditional open surgery,
we would have had to interrupt the circulation to the
kidneys for anywhere from 15 to 30 minutes, which,
with a much higher risk for kidney failure after
the operation. [MUSIC]. Patients who are eligible for a
fenestrated aortic stent graft are those whose aneurysms are close to the
kidney artery, kidney arteries themselves. And also have the time to wait for the
device to be engineered. All of these devices are actually built
for the patient individually. That is, once a device is made, it can’t really be used for anyone else in the
entire world. So by doing a CAT Scan before the
procedure, we measure up the stent graft specific to the
patient, the patient’s anatomy, and then order it from a company which
takes around four to six weeks for the device to finally be,
finally be delivered. [MUSIC]. The main risks of a fenestrated ader, aortic endovascular repair is that of an
endoleak. And that is, after we place the device,
that we still see leakage around the aortic endovascular
device into the aneurysm sac itself. This is where the premium is really put upon understanding the anatomy of the
patient individually. So if we’re able to get a very good result
in terms of the fit of the stents against the patient
those risks are much less. Other risks that can occur with a
fenestrated aortic endovascular pair are mostly referred to
those of the kidney. Sometimes some of the stents that we’ve put in the kidney arteries themselves can
have trouble lining up correctly, and produce
kinks and narrow the blood flow into the kidneys
themselves. At the time of the procedure we take multiple views of those stents into the
kidney arteries to make sure that the circulation
to each kidney Is not adversely affected
during the procedure. [MUSIC]. The recovery from a fenestrated aortic
endovascular repair verses a traditional aortic endovascular repair
is not much different. That is, the patient would come in on the
day of surgery and probably go home two, or maybe
three days later. In fact, some of our aortic endovascular
procedures we can do percutaneously and even have the patient
go home the next day. In comparison to an open procedure, it’s
much like apples and oranges. An open procedure is a much longer
recovery in the hospital, usually one or two nights in the ICU, and feeling not like one’s, like oneself for about a month after the
surgery. Final recovery from an open operation
could take up to four to six weeks. [MUSIC]. After a patient undergoes a fenestrated
aortic endovascular aneurysm repair, they can expect to come
back to the hospital or to the outpatient clinic
for a follow-up appointment approximately four
to six weeks after surgery. That first appointment is very important. At that appointment we would do a CAT scan, to make sure that the aortic
endovascular repair is functioning well, and there’s no
sign of any leakage, or effe, effects upon the
kidneys. The next appointment would probably not be
for a year. And at that point we would probably still
do another CAT scan. Or for those patients whose kidney
function goes into the procedure, is somewhat marginal, we might
switch to an ultrasound, to make sure that the aortic endovascular
repair is functioning well, and that there’s no evidence of leakage
into the aneurysm sac. And that also the aneurysm sac begins to
shrink down, which we usually take as a best sign of durability
of the repair overall. [MUSIC].>>Johns Hopkins has been at the head
of aortic surgery for close to 100 years. Many of the aortic operations that occur
around the country, even around the world, have
their birth in the hands of surgeons who trained
at Hopkins at some point along the way. In terms of fenestrated aortic
endovascular repair, Johns Hopkins is one of 30 centers around the country that has access to the
technology to deliver such a device. The team we have at Hopkins is very good
at what they do. Many people here have great interest in
the patients, and put the patient at the forefront of the
decision making. Many aneurysms will not need to be
treated. But when they do need to be treated, the
team we have here is gonna be one of the best. [MUSIC]. [MUSIC]. [BLANK_AUDIO]

Bernard Jenkins


  1. Dr. Black… This is a tremendously, helpful video. My 78 year old mother is being evaluated for this procedure and you have given me hope now.
    Thank you… You are brilliant.

  2. What long term drugs required by perscriptions after grafting needed to maintain..? Can effect the insurance options..

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