Like a tree, aortas come in all shapes and sizes – and – aortas also come with branches. But, here the similarity between aortas and trees ends. Because the aorta is hollow, like an inner tube. And like an inner tube, it can develop bulges. These are called aneurysms. And they can be dangerous. If an aneurysm bursts, it can be fatal.
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There are good treatments for aneurysms. The one that people like the best is called an endograft because it can be placed minimally invasively. An endograft is a tube made of polyester wrapped around a collapsible wire scaffold. It is slid up through the blood vessels to a point inside the aneurysm. There, it is expanded and anchored to healthy tissue above and below the aneurysm. The bulging tissue relaxes, as the blood now flows through the wire and polyester tunnel inside it.
But the use of endografts is still restricted in some cases. Like when the aneurysm occurs in one of the branches of the abdominal aorta (the part of the aorta that goes from the bottom of the chest to the middle of the pelvis).
“Treatment of abdominal aortic aneurysms with endografts has reduced mortality and morbidity significantly for patients,” says Daniel Clair, MD, chair of Vascular Surgery at Cleveland Clinic. “Unfortunately, about 25-40% of patients with abdominal aortic aneurysms can’t be treated with endografts because the aneurysm involves the renal or iliac arteries, or because the iliac arteries are narrowed from atherosclerosis or “hardening of the arteries. In cases where the iliac artery is too small to fit a conventional endograft, because of atherosclerotic plaque, these smaller blood vessels are too narrow to admit the device that delivers the endograft to the site of the aneurysm.
Up until now, the only hope for a small number of these people who cannot be treated with conventional endografts has been to use a modified procedure that inserts the device directly into the iliac artery. But that may soon change. The FDA has just approved a new, narrow-gauge endograft and delivery device that is made especially to treat aneurysms in narrow iliac arteries. It’s called the Ovation system. According to the manufacturer, the Ovation system “differs from traditional endografts in that a portion of the metal stent is replaced with ring-shaped channels. After the device is in place in the aorta, the channels are injected with a polymer, expanding the endograft against the aorta to create a seal.”
The Ovation system is the smallest endograft available for delivery through the iliac arteries. “It will be useful for patients with small aortas and those who are ineligible for the modified approach directly into the iliac artery,” says Dr. Clair. “In total, this is a remarkably small number of patients, but for these patients it opens up the possibility of having a safer, less morbid procedure to treat their aneurysm.”
Dr. Clair notes that larger sizes of this device are still undergoing investigation in human subjects, and that its long-term success remains to be proven.
“Slowly but surely,” he observes, “devices, and clinicians are advancing this therapy to more and more patients with complex abdominal aortic aneurysms, and this is but one step in that process.”