UC Performs Tristate's First Endovascular Aneurysm Repair
Published February 2008
The Saturday before Thanksgiving, Frank Crabtree was sure he was dying.
As he lifted a forkful of dinner to his lips, he was suddenly overwhelmed by jolting, stabbing back pain.
“It was like someone had stuck a knife in me,” he recalls. “I couldn’t control my body—I was suddenly shaking all over and covered in sweat.”
Unbeknownst to Crabtree, he had an abdominal aortic aneurysm (AAA). The knife-like pain he felt was his aorta slowly rupturing, leaking blood into his abdomen.
Angie, Crabtree’s wife of 52 years, struggled to hold him up while calling 911 to have him rushed from their home in Cold Spring, Ky., to University Hospital.
“I had just gotten home from a bridal shower, and the next thing I knew he was flopped over in excruciating pain and couldn’t sit up,” she recalls. “He’d suffered a massive heart attack in 1981, so I thought he was having another one, or a stroke.”
Crabtree arrived in the emergency room at midnight. Less than an hour later, the 74-year-old man was in the operating room, where UC vascular surgeon
George Meier, MD, completed Cincinnati’s first endovascular (minimally invasive) repair of a ruptured AAA.
“Mr. Crabtree is a very lucky man because 80 percent of people with ruptured abdominal aortic aneurysms never make it to the hospital, and only about half of those who do live to talk about it,” explains Meier, professor and chief of vascular surgery at UC.
The human vascular system is a complex arrangement of vessels comprised of arteries, which carry oxygen-rich blood away from the heart and distribute it throughout the body, and veins, which return blood to the heart.
Vascular problems occur when fat and cholesterol (plaque) build up on artery walls. As plaque increases, the arteries harden and become narrow. In the aorta, this can cause the vessel to stretch and weaken, forming a bulge in the vessel wall. If that bulge, called an aneurysm, ruptures, it can rapidly result in death.
For the past 50 years, surgeons have relied on open surgery to repair a ruptured AAA, which requires a major chest incision and carries a serious risk of additional medical complications.
The endovascular AAA repair is a minimally invasive technique done through two small incisions in the groin. The patient is given local anesthesia, remaining awake to avoid further compromising his heart rate and blood pressure.
During Crabtree’s surgery, Meier first inserted a balloon through vessels in the groin to inflate the aorta and close-off the ruptured section of the vessel to gain control of the blood leak. He then inserted a catheter to deploy a Teflon-coated metal graft that would replace the ruptured section of the aorta. Blood flow was permanently redirected through the graft to eliminate pressure on the aneurysm.
Eventually, the aneurysm will shrink and disappear because it no longer has a blood supply.
“Techniques and technology have evolved to a point where we can provide this minimally invasive surgery in an emergent setting, but timing is absolutely critical because a patient can literally bleed to death in a few minutes without stabilization,” explains Joseph Giglia, MD, an associate professor of surgery and fellow vascular surgeon.
“I believe patients have a better chance of surviving a ruptured aneurysm at University Hospital because there is a system in place to respond to these cases,” Giglia says.
That system includes a free-standing combination angiography suite and operating room, air care and an AAA response team designed to get patients into the operating room fast.
Crabtree went home four days after surgery, a much shorter stay than patients who undergo traditional (open) repair—they typically spend up to a month or more in the hospital.
He will need frequent imaging scans to monitor for potential leaks or new aneurysms, but he says he doesn’t mind.
“I feel like I could do just about anything now, but I know I need to make some changes in my life to stay healthy, like exercising more,” Crabtree said during a recent follow-up visit to UC. “I’m thankful to be alive, and I don’t believe any other medical team could have done what Dr. Meier and his team did for me.”
According to the American Vascular Society, about 200,000 people are diagnosed with AAA annually, and many others live with the life-threatening condition without realizing they are at risk for rupture and death. Men over age 60 who smoke and have high blood pressure are at the most risk.
To schedule an AAA screening exam, call (513) 558-3700.
AAA Screenings Available for New Medicare Patients
New Medicare Part B health insurance enrollees are eligible for a preventive abdominal aortic aneurysm screening.
Upon completion of a physical examination, which is mandatory for new Medicare patients, male patients who have smoked at least 100 cigarettes during their lifetime and anyone with a family history of vascular disease can request the abdominal aortic aneurysm screening exam.
The test is done using ultrasound, a technology that uses sound waves to create a picture of organs and other structures inside the abdomen. If vascular problems are found, the patient may be referred for additional screening exams to determine the best course of treatment.
Appointments must be made in advance by calling (513) 558-3700, and patients will be required to show a current Medicare insurance card.