VA Boston Healthcare System

VA Boston surgical staff conduct a fenestrated endovascular aortic aneurysm repair.

BOSTON (May 14, 2019) – Abdominal aortic aneurysm (AAA) is a serious condition involving weakening and abnormal growth of the aorta, the main artery which provides blood flow to the rest of the body. Without proper monitoring and treatment, AAA can lead to death from rupture of the aneurysm.

Previously, Veterans within the New England area were presented with two options for repairing AAA. They could have an open repair, where a large incision was made, and the diseased segment of the aorta was replaced with a synthetic graft. Or they could be referred out into the community to receive the less invasive procedure which was previously only offered at a few medical centers in the area.

The third option now presented to the Veterans of New England is to have the minimally invasive procedure, known as fenestrated endovascular aortic aneurysm repair, performed right at VA Boston Healthcare System.

According to Dr. Sarah Carlson, a vascular surgeon at VA Boston Healthcare System, we are able to offer this technique because of the advanced endovascular training of our vascular surgery team, and because of the technology available in our hybrid endovascular operating suite.

“We’re excited about the possibilities to continue to offer great care to our Veterans with some of the techniques that are really new and cutting edge in the vascular and endovascular world,” said Carlson.

The newer technique allows for the endovascular approach to treat AAA with aneurysm very near the kidney and intestine arteries. This is done by placement of a main stent graft inside the aorta, and small side-branch stents which are placed in the kidney and/or intestine arteries, in order to maintain blood flow to the kidneys and intestines while fixing the aneurysm.

For Veteran William Madera, the less invasive option made the most sense for him.

“Without a doubt I would recommend this procedure to any Veteran for the simple reason, you don’t have to worry about going swimming or something else with a big scare coming up the front of you,” said Madera. “This way here, you got two little pinholes, one on each side and the bathing suit covers it.”

VA Boston surgical staff monitor a fenestrated endovascular aortic aneurysm repair.

Patients who meet criteria for fenestrated endovascular repair with the Zenith Fenestrated device are able to undergo aneurysm repair without a major abdominal operation. This means less postoperative pain, fewer days in the hospital, and potentially fewer complications from the surgery.

“I’ve just been pleased with the whole procedure, I have no problems whatsoever,” said Madera.

Until recently, patients with AAA in certain anatomical locations, too close to the kidney and intestine arteries, were not eligible for endovascular repair. These patients have traditionally required open repair, which can be very risky and have many complications, especially in older or sicker patients.

This technique is offered in select vascular surgery centers nationwide and requires a custom-built stent graft which is hand made for the patient’s particular anatomy. The name of the device is the Cook Zenith Fenestrated® aortic device. 

“I’m very proud of the vascular team, and actually all of surgical service at VA Boston Healthcare System,” said Kamal Itani, Chief of Surgical Service. “The vascular team has been at the forefront of innovation and adopting new technologies within surgery. We would like to continue this trend of innovation and offer these technologies to our Veteran population.”