Surgeons Repair Complex Aneurysm Without Major Incision
"Fenestrated Graft" Procedure is the first ever done in Nebraska
Jamie Reynolds is a living, breathing reminder of why it's important to stay on top of your own health. The 78-year-old grandmother from Omaha says she always goes for an annual checkup. Her most recent one showed something she neither felt, nor expected – an aneurysm in her aorta.
"I got a CAT scan and an MRI and that's where they picked it up," Reynolds says. "They told me I had an enlarged aorta. I said, 'What's that?' They showed me where it was positioned."
Reynolds' primary care physician referred her to vascular surgeons Matt Longo, MD and Jason MacTaggart, MD at The Nebraska Medical Center. They explained to her that the aneurysm, or bulge in the aorta, the body's main artery might best be repaired with a new type of minimally invasive surgery – placing a fenestrated graft inside the aorta.
Dr. Jason MacTaggart (left) and Dr. Matt Longo (right) begin the fenestrated graft surgery to repair Jamie Reynolds’ aorta.
Reynolds didn't have to think long about whether or not to go through with it.
"I said, 'Let's get busy!'"
"A graft is a fabric tube we use to replace a blood vessel wall," explained Dr. MacTaggart.
For several years, medical center surgeons have been repairing aortic aneurysms endovascularly by guiding a fabric and metal mesh graft, compressed to the width of a pencil, through an artery in the leg. Surgeons position it inside the bulging aorta without doing surgery. Reynolds' aneurysm was located in the spot where the arteries supplying blood to the kidneys branch off from the aorta. That meant surgeons could not place a conventional graft inside the aorta without cutting off circulation to the kidneys. The fenestrated graft provides "branches" from the main graft that allow blood to continue flowing to the kidneys. Doing such a repair with only two small incisions in the leg is a major advancement.
"Historically, when we've seen aneurysms in that area, we've been forced to do open aneurysm repair," Dr. Longo says. "Which involves a big incision on the belly and sometimes the leg. Open surgeries have higher complication rates, longer hospital stays, and usually mean a much, much longer recovery for the patient."
That point was not lost on Reynolds, who is proud to be the first patient in Nebraska to have this type of procedure done.
"I told my doctor, 'Oh, I made history?' And we laugh about it," she said. "The technology is better now. They went through my groin which was much better than going through my tummy."
Dr. Matt Longo looks at an X-ray image of the fenestrated graft inside Reynolds’ aorta.
Drs. MagTaggart and Longo describe the operation as an exercise in teamwork.
"While Jason is working on one side to bring the graft up, I can work simultaneously on the arteries that supply the gut," Dr. Longo explains. "That's the trickiest part; making sure we have everything aligned."
There are several pieces to the fenestrated graft: the main graft that goes inside the bulging aorta, and the side branches that will line the kidney arteries and connect to the main graft. Each graft is custom-made for the patient's specific anatomy.
"Essentially, we put them together on the inside," Dr. MacTaggart says. "It's similar to an erector set we played with as kids."
Using X-rays, the surgeons carefully guide the grafts into place. When all parts of the grafts are connected, they use dye in the blood stream to make sure the blood is flowing properly and that the aneurysm is sealed off.
The Nebraska Medical Center is the only hospital in the state providing this surgery.
"There are only a handful of places where you can have this done," Dr. Longo says.
"The advantage here is that you have five surgeons who are very involved with aortic and vascular surgery," says Dr. MacTaggart. "Ten eyes are better than two."
Both surgeons say Reynolds' surgery went very well. She recovered quickly and was back home a few days after her operation. A recent checkup showed her newly reinforced blood vessels are doing very well. And she has important advice for anyone.
"Don't put off getting a physical. I go every year. And this one saved my life."