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Angiogram of an abdominal aortic aneurysm in 90-year-old patient Repair of abdominal aortic aneurysm with endovascular stent graft in the same patient surgery, because they can not safely withstand such a lengthy operation. About 20 years ago, endovascular abdominal aorta aneurysm repair (EVAR) oŸered an alternative. " Wit h E VA R , we ca n operate on patients who have more complicated medical problems and are at high risk for open surgery," she says. "The procedure is minimally invasive and much shorter in duration. Most patients are in the hospital only a day or two, and they're back to their regular activities in a few weeks." "Aneurysms in the chest can also be repaired with endovascular grafts," says Dr. Zink. "We've been doing this for about eight years. Akron General was actually the first hospital in northeast Ohio to repair a traumatic aortic injury with a thoracic endograft." Two years ago at Akron General, percu- taneous EVAR (PEVAR) was introduced and has become a common procedure. PEVAR involves a needle puncture in the groin and placement of sutures inside the artery from outside the body. An overnight stay in the hospital is usually all that's needed. Full recovery is generally three to four weeks. According to Dr. Zink, patients must have certain-sized vessels in their legs to place the graft. "They also must have what we call a 'landing zone' – a certain distance below the arteries that go to their kidneys to allow us to safely have enough of a seal zone to do this repair endovascularly," she says. For patients who do not meet these criteria, fenestrated EVAR may be an option. Dr. Zink and Dr. Masterson plan to perform together the first A A A repair with a fenestrated graft in the next few months at Akron General. "With fenestrated grafts, we can treat minimally invasively aneurysms that are much more complicated," Dr. Masterson explains. "The stents are custom-made for each patient. They are more complex than traditional endovascular stents, but they can still be delivered percutaneously. Sometimes an additional incision must be made in the arm to place the diŸerent parts of the graft, but that's still much, much less invasive than the old open surgery. And the hospital stay and recovery period are much less — one to two days in the hospital and a few weeks for recovery." For a l l of t he s e pr o c e du r e s , t he most adva nced technolog y is needed. A kron Genera l's hybrid OR , which is dedicated to aneur ysm repair, supplies it . High-resolution, rea l-time ima g- ing a llows even the most complex a nd complicated a neur ysm repa irs to be per formed more precisely. A nd t hat tra nslates to improved outcomes. M o s t i m p o r t a n t , h o w e v e r , i s ea rly detection. " W hen pr i m a r y c a re phy sici a n s a r e s c r e e n i n g p a t i e n t s f o r h e a r t d i s e a s e , t he y m ay w a nt t o s c r e en f o r v a s c u l a r d i s e a s e , a s w e l l , " Dr. Masterson suggests. "Medica re a nd the U.S. Preventive S e r v i c e s Ta s k For c e r e c om m e n d screening for A A A at the age of 65 for men," adds Dr. Zink. "But if a patient has a lot of risk factors or a family history, his primary care physician may want to consider screening after age 50." For more information about aneu- rysm repair at Cleveland Clinic Akron G e n e ral , v is it akronge n e ral .org. To r e fe r a p a t i e n t t o A k r o n G e n e r a l Cardiac Thoracic & Vascular Surgery, call 330 -34 4-1400. ■ IMAGES COURTESY OF CLEVELAND CLINIC AKRON GENERAL M D N E W S . C O M /// M D N E W S C L E V E L A N D /A K R O N / C A N T O N ■ M A R /A P R 2 016 1 5