Health Info & Resources for Seniors
A ground-breaking advancement in surgery occurred in 1990 when a pair of Argentinian surgeons successfully repaired a large aneurysm in the artery of a 70-year-old man’s abdomen. What made this surgery so significant is they reached the aneurysm by making a small incision in the patient’s groin, threading a wire to the aneurysm and opening a graft inside the vessel diverting the blood flow away from the aneurysm. This restored the patient’s blood flow to the legs and prevented the risk that the artery would burst, causing him to bleed to death.
“The procedure, called an endovascular aneurysm repair (EVAR), is widely available today, including at local hospitals. At the time, however, it was trailblazing, ushering in a new era in vascular surgery”, said Dr. Jay Fisher, Medical Director of St. Luke’s University Health Network’s Vascular Center, and SLUHN network Vascular Laboratories.
Endovascular, which means “inside the blood vessel,” is a type of surgery that uses very small incisions and long, thin tubes called catheters that are placed inside the vessel to repair it, Dr. Fisher explained. It is an alternative to traditional or open surgery, where the surgeon cuts through the skin and muscle to reach the blockage. Years ago, open surgery was the only option to repair an abdominal aortic aneurysm (AAA). Because of advancements in endovascular surgery, today open surgery is used in only about 25 percent of AAA repairs. Patients having open AAA repair stay in the hospital seven to 10 days.
“You never would have convinced me 20 years ago that you could ever repair a AAA using two tiny incisions and send the patient home the next day with two Band-Aids,” said Dr. Fisher, a vascular surgeon. He envisions that within five years, patients will likely go home the same day.
AAA repair is just one way that endovascular procedures have transformed cardiovascular surgery. Many people are familiar with some of the common heart procedures, such as cardiac catherization. It uses a tube inserted into a chamber or vessel of the heart for diagnostic and treatment purposes.
Another more commonly known procedure is angioplasty, which uses a balloon-like device to widen a narrow or obstructed veins or arteries. Specially trained cardiologists called interventional cardiologists perform these procedures in the heart while vascular surgeons and interventional radiologists perform similar procedures in other areas of the body.
To prevent stroke, endovascular surgery is used to open the carotid arteries, the two large arteries on each side of the face that supply oxygen rich blood to the neck, face, scalp and brain. Endovascular surgery is also used to repair blocked vessels in the limbs, often averting amputation, especially in the lower legs and feet. “Every day there are new advances in endovascular surgery”, Dr. Fisher said. He and his colleagues stay current by reading journals, attending lectures and working with colleagues who have recently completed fellowships at leading teaching institutions. They show the longer practicing physicians the newest procedures. In turn, the recent graduates become proficient in performing open surgery by working with physicians experienced in these techniques.
In addition, endovascular physicians have access to the hybrid operating room, which combines the worlds of both advanced imaging and surgery into one operating room. In fact, when the Discovery IGS 730 Hybrid OR was installed at St. Luke’s University Hospital in Bethlehem in 2012, it was the first in the country. Now, a second state-of-the-art hybrid OR from GE will be installed at St. Luke’s Allentown Campus in November, creating a Vascular Center of Excellence at the Allentown Campus. “At St. Luke’s we all work together,” he said. “It is the best of both worlds. Everyone does what’s best for the patient.”
Medicare Provides Abdominal Aortic Aneurysm (AAA) Screening
If you have a family history of abdominal aortic aneurysms, or you’re a man age 65-75 and have smoked at least 100 cigarettes in your lifetime, Medicare Part B covers a AAA screening. You pay nothing. However, Medicare requires a physician referral and you must go to a qualified physician who has agreed to accept Medicare payment rates.
If you are not yet eligible for Medicare, or have risk factors, such as high blood pressure, diabetes, a family history of stroke or heart attacks, have been a smoker, and are 50 or older, St. Luke’s offers an affordable vascular screening. The cost is $49 with no need for a physician order. The program screens for:
• Abdominal Aortic Aneurysm
• Peripheral Arterial Disease
• Carotid Artery Disease/Stroke