Traditionally, we repaired and replaced aortic aneurysms through open surgery. Today, we’re more likely to do a minimally invasive procedure that slips a wire-reinforced liner inside the aorta to relieve the pressure and be the new pipeline for circulation.
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These liners, called endografts, are amazing devices. The first generations of endografts were straight tubes that bifurcated or branched into arteries to the legs. These devices were expanded at the site of the aneurysm and hooked onto the healthy tissue at either end. These straight up and down grafts are approved by the FDA and have been very successful. But aneurysms don’t only occur in the straight up and down part of the aorta. They can also happen at the points where the aorta branches off to the kidneys or intestinal arteries. So we’re in the process of developing a new generation of grafts that have windows in them where we can slip other grafts through to make branches. The final product looks like a tree trunk with limbs coming off in different directions. Right now these grafts need to be customized to each patient’s particular dimensions. But we’re working on “on the shelf” models that will be more convenient and less expensive.
There are other challenges as well. Aneurysms can distort or angulate even simple parts of the aorta, changing the flow patterns and calling for even yet more sophisticated endografts. We’re working on them! Standard endografts have not been useful in some women and Asians, who have smaller aortas in the hip area where the vessel splits off to either leg. But we’ve developed a smaller version of the branched endograft that is perfect for this population.
Cleveland Clinic is implanting these new endografts on an investigational basis. We’re collecting data that we hope will allow them to be approved for general use. Overall, I’m proud to say that our department leads the world in the development and use of endografts for the treatment of aortic aneurysms. We look forward to improving them further for better outcomes and better lives for our patients.