Baylor Scott & White The Heart Hospital – Plano is one of a few centers in the region currently offering fenestrated stent grafts for endovascular abdominal aortic aneurysm (AAA) repair. When there is not enough room between the renal arteries and the AAA for a standard endovascular graft to function properly, a fenestrated stent graft may provide another option.
Nationally, about 60-70 percent of patients with AAA are treated using endovascular grafts. With fenestrated stent grafts and other graft options, Baylor Scott & White Heart – Plano is treating approximately 90 percent of patients using an endovascular approach.
Fenestrated endovascular aneurysm repair starts with advanced imaging. Baylor Scott & White Heart – Plano has a protocol in place to streamline patient evaluation and imaging, which is offered through the Center for Advanced Cardiovascular Care, allowing patients to complete these easily and quickly – often in the same day.
Because of the precision needed to place these grafts, patients undergo a 3-D CT scan with very thin slices – around 1.5 millimeters – and advanced programming is used to reconstruct 2-D and 3-D images.
“From these images, we can get precise measurements of the anatomy to plan and design the graft,” said William Shutze, MD, a vascular surgeon on the medical staff at Baylor Scott & White Heart – Plano. “These grafts are customized just for that person based on his or her anatomy.”
Fenestrated endovascular aneurysm repair is performed under general anesthesia using percutaneous access through the femoral artery. The procedure typically takes 3 ½ to 5 ½ hours and usually involves implantation of six graft components.
“We have to rebuild the arteries inside out,” Dr. Shutze said. “With the standard endovascular AAA, we typically use three components. In the platform we’re using, we’re adding three more components to complete the repair, which involves putting the fenestrated component across the renal arteries and special stents into each renal artery.”
For patients, this type of procedure offers several potential benefits. The usual length of stay is only one to three days, and a patient can usually return to normal activity in two weeks, compared to a six-week to 12-week recovery period with open procedures. Quality of life surveys have shown that in the first six months after endovascular aneurysm treatment, these patients have a self-reported quality of life that’s higher than open surgery. There is also a slight benefit in operative mortality.
Fenestrated stent grafts have also filled in a gap for a population of AAA patients who were too sick to survive an open procedure but not candidates for other endovascular grafts.
For 93-year-old Bill Pasewark, a retired professor who is still active as a professional speaker, endovascular surgery using fenestrated stent graft technology gave him an option for repair when his AAA was too close to his kidney.
Pasewark, who was 92 at the time of his procedure, traveled from Lubbock and spent one week as a guest at Baylor Scott & White Heart – Plano, followed by two weeks of inpatient rehabilitation and two weeks of in-home rehabilitation. He said it was remarkable that he did not experience any pain after his procedure.
“At 92 years of age and after only five weeks of painless recovery, it gives me comfort to know that I can continue my professional activities. I was a professor for many years, and I give Baylor Scott & White Heart – Plano a grade of A+.”
Bill Pasewark, retired professor
The availability of fenestrated endovascular aneurysm repair at Baylor Scott & White Heart – Plano complements numerous other vascular care options provided at the hospital for aneurysms. Within the hospital’s thoracic aortic program, surgeons are implanting fenestrated grafts in the aortic arch and performing advanced endovascular repair for aortic dissection.
“It rounds out the menu at Baylor Scott & White Heart – Plano for care of complex aortic diseases, both open and endovascular,” Dr. Shutze said. “Baylor Scott & White Heart – Plano is committed to provide advanced care, and that’s allowed the hospital to build a reputation that results in referrals from all over the Southwest.”
To further advance the care of these complex cases, surgeons on the medical staff at Baylor Scott & White Heart – Plano are committed to staying involved in research studies and clinical trials. Through Baylor Scott & White Research Institute, surgeons are working to bring an investigational type of fenestrated stent graft to the hospital in the coming months.