Loyola surgeon performs minimally invasive emergency procedure to repair AAA

Jack Kory of Mokena, Il. was eating his breakfast oatmeal when he suddenly felt the worst pain in his life.

The searing pain came on suddenly in his stomach and spread to his knees. It was caused by an abdominal aortic aneurysm (AAA) that had suddenly burst, causing massive internal bleeding.

Traditionally, few patients have survived such ruptures. But Loyola University Medical Center vascular surgeon Dr. Richard Hershberger was able to repair Kory's aneurysm with a minimally invasive emergency procedure.

"I'm very happy with how it worked out," Kory said.

An AAA is a bulge in the large blood vessel that supplies blood to the abdomen. The bulge typically develops slowly over many years. The larger the aneurysm, the more likely it is to rupture and cause massive bleeding. About 80 percent of people who suffer AAA ruptures die before they get to the hospital. Among patients who make it to the hospital in time, only about 50 percent survive traditional open surgery.

But more patients are surviving minimally invasive procedures that Hershberger and other vascular surgeons at Loyola are performing on patients with ruptured AAAs. The newer procedure is called endovascular surgery. About 70 percent of ruptured AAAs now can be repaired with the endovascular technique. In the last four years, Hershberger and other vascular surgeons at Loyola have performed endovascular surgery on 12 patients who suffered ruptured AAAs, and they all survived.

Kory was first taken to a community hospital and then taken by helicopter to Loyola. Fortunately, the blood clotted enough to temporarily stem the bleeding. But his only chance to survive was an emergency repair of the aorta.

In traditional surgery, a surgeon makes a large incision in the abdomen and replaces the damaged portion of the aorta with a Dacron tube.

Hershberger instead used the endovascular technique. He inserted a catheter in a groin artery and guided it through blood vessels to the site of the burst aneurysm.

Hershberger then deployed a device called a stent graft -- a GoreTex® tube supported by metal webbing. The stent graft is about 4 inches long and 1 inch wide. After it was deployed from the catheter, the device expanded outward to the walls of the artery. This allowed blood to flow safely through the stent, rather than gushing into the abdominal cavity.

About 15,000 people in the United States die each year from ruptured AAAs. Albert Einstein, Lucille Ball and George C. Scott are among those who have died from ruptured aortic aneurysms.

Risk factors for AAAs include smoking, high blood pressure, high cholesterol, male gender, emphysema, genetic factors and obesity. Hershberger said men 65 and older who have smoked more than 100 cigarettes in their lifetime should be screened for AAAs.

It is much easier and safer to repair an aneurysm before it bursts. Surgery generally is recommended once the aneurysm bulge expands to 5 cm or larger.