Novel UCLA Procedure Provides Treatment For Aortic Aneurysms
In 1998, UCLA began using a novel method, CESA, to provide treatment for "ticking bomb" aortic aneurysms. CESA is a combined endovascular and surgical approach. The first patient to benefit from UCLA’s novel procedure was Patrick Lane who was 74 years old in 1998. Today he is alive and doing well.
Since 1998, Dr William Quinones-Baldrich and colleagues have done 2o high-risk patients with “ticking bomb” aortic aneurysm with excellent results. Their results have been published in a recent issue of the Journal of Vascular Surgery.
Traditional surgery is not an option for high-risk patients with aortic aneurysms. The risk of surgery is too great, even with the risk of the “ticking bomb” aneurysm.
The aorta is the largest artery in the body and is the blood vessel that carries oxygen-rich blood away from the heart to all parts of the body. When an area of the wall of the aorta weakens, the wall abnormally expands or bulges as blood is pumped through it, causing an aortic aneurysm. More than 10,000 Americans die each year from ruptured aortic aneurysms
The 20 patients Quinones-Baldrich and his team treated between 1998 and 2008 were not candidates for traditional surgery and ranged in age from 51 to 89.
The surgical portion of the CESA procedure involves the surgeons first making an incision in the abdomen to access vital arteries stemming from the aorta. The surgeon then performs bypasses on these arteries using prosthetic grafts in order to reroute blood flow. This allows for the eventual exclusion of the segment of the aorta affected by the aneurysm through the placement of a tiny endovascular device during the second part of the procedure (the endovascular portion).
The minimally invasive endovascular stage of the CESA procedure is often completed at a later date, allowing the body time to recover and adjust to the new blood-flow pattern. This stage involved the use of a small incision in the groin through which the surgeons thread the tiny, tube-like endograft through the femoral artery and guide it towards the aortic aneurysm. Once in place and released, the endograft acts like a stent, relining the aortic artery wall, and becomes the new conduit for blood flow, closing off the aneurysm.
During UCLA's 10-year experience there has been no perioperative mortalities. CESA technique appears to be safe and durable. Quinones-Baldrich does note that there were major complications in six patients, including respiratory failure, deterioration of kidney function and minor heart attack, as well as paralysis in one patient. The complication of paralysis has been reported in 8 to 20 percent of cases with traditional surgery; the one CESA patient represents 5 percent of total CESA patients at UCLA.
The standard of care is still traditional surgery which is recommended for those who are candidates. The CESA approach does have a few advantages compared to traditional surgery including not having to open the chest and utilize extracorporeal circulation.
More study and longer follow-up needs to be completed for the CESA technique, but the authors are hopeful that this method will prove a viable approach for most patients, particularly those who don't have the option of conventional surgery.
Other authors included Dr. Juan Carlos Jimenez, Dr. Brian DeRubertis and Dr. Wesley Moore, all of the division of vascular surgery at the David Geffen School of Medicine at UCLA.