Surgical Repair of Abdominal Aortic Aneurysms Remains an Important Treatment Option

An abdominal aortic aneurysm is a bulging, weakened area in the wall of the aorta, the largest artery in the human body. The aorta carries oxygenated blood from the heart to the rest of the body. When an aneurysm is large or continues to grow, it can burst or tear, causing internal bleeding and death.

Although many aneurysms today are treated through minimally invasive procedures that use special stents to relieve pressure on the blood vessel’s weakened wall, that is not always the best solution, says W. Anthony Lee, M.D., chief of vascular surgery at Boca Raton Regional Hospital, part of Baptist Health. In this case, Dr. Lee determined the best treatment for Ms. Ross was an open surgical repair.

(Watch video: Hear from patient Diane Ross and W. Anthony Lee, M.D., chief of vascular surgery at Boca Raton Regional Hospital. Video by Dylan Kyle.)

“Some AAA anatomies are ill-suited to be treated with a stent,” Dr. Lee says. “I think Diane is a great example of someone who has done very well with open surgery, who has recovered completely and is now enjoying a return to the lifestyle that she enjoyed before the surgery.”

Seeking the Best Solution

W. Anthony Lee, M.D., chief of vascular surgery at Boca Raton Regional Hospital.

According to Dr. Lee, it’s not uncommon for patients to come to him hoping for minimally invasive repairs that avoid large incisions. In some cases, other physicians have suggested to patients that this endovascular (stent) approach might be an option because it requires a shorter hospital stay and less recovery time. In other cases, the patients researched their condition themselves, often on the Internet, and come in seeking a particular treatment.

“While an endovascular repair and stent can be a good option for some patients, it is definitely not for everyone,” Dr. Lee explains, adding that at Boca Raton Regional Hospital, each patient’s condition is very carefully evaluated. “The treatment must be uniquely tailored to that individual, and in many cases the best option may be open surgery.”

For some patients, the aneurysm’s location and complexity can be deciding factors. But there also are other things to consider. “In our practice, the decision to offer stenting versus open surgery really hinges upon the person’s age, their expected longevity and health status,” Dr. Lee says.

Dr. Lee says he understands that being advised to get open surgery can be disappointing for some patients, who were hoping for the shorter hospital stay and easier recovery associated with endovascular procedures. But the patients may not be aware of some of the long-term issues that can come with endovascular repair, such as the need for frequent CT scans and the potential for mechanical failure of the stents that can result in the need for another major procedure a few years later.

“Many patients are very anxious regarding undergoing open surgery, especially in terms of the pain of the incision, post-operative recovery and return to their previous lifestyle,” Dr. Lee says. He strives to educate them in “a sincere and candid” manner. “If you talk about the positives and negatives of stenting versus open surgery and spend the time to explain why their anatomy might not be best-suited for a stent, most people will say, ‘Dr. Lee, that makes sense. Do what you think is best.’”

A Good Result

That’s exactly what Diane Ross told Dr. Lee, who has about 25 years of experience in repairing abdominal aortic aneurysms and is considered a leader in the field because of his surgical skill and relentless pursuit of innovative solutions.

“Whatever he decided to do, I was fine with it,” Ms. Ross says. “I trusted in him.”

The surgery took about three hours. Dr. Lee completely removed the weakened portion of her aorta and replaced it with a graft. Because her problem involved the blood supply to one of her kidneys, he also had to create a bypass to preserve the function of that vital organ.

Ms. Ross was in the hospital for about four days and fully recovered in about 10 weeks.

“I can do everything I used to do, so I am fine,” says Ms. Ross, who lives in Davie. “I’m really great. I thank him for basically saving my life.”

In the case of Ms. Ross, 77, a full recovery was important because she cares for her husband, who has Parkinson’s. She also has five children and 10 grandchildren, and loves to host Sunday brunch. “My family means the world to me,” she says.

Dr. Lee says he completely empathizes with patients who are anxious about having open surgery when they were hoping for a less invasive procedure. But it’s important to find an experienced surgeon who can perform both types of repairs, open and endovascular, so the solution they recommend will be the best treatment for that patient.

It’s important for patients to seek help at a medical center like Boca Raton Regional Hospital, which has a wide range of highly trained experts and handles a high volume of such cases.

“I cannot emphasize strongly enough the importance of a multi-disciplinary approach to the success of these open aortic surgeries, starting with good anesthesia,” Dr. Lee says. “At Boca Regional, working in close collaboration with Dr. Leslie Renfro, an expert in regional anesthetic techniques, we place a very tiny catheter in the patient’s back right before surgery, and this has rendered the incision from the surgery almost painless.” 

The anticipated recovery time generally takes in less than 12 weeks, as it did with Ms. Ross.

“When it comes to fixing an aortic aneurysm, the choice of treatment needs to be the correct one, and most importantly, result in a permanent fix,” says Dr. Lee. “If done properly by a skilled vascular surgeon, one can enjoy an excellent quality of life for many years without worrying about a stent breaking down, the need for frequent doctor visits or the possibility of needing another procedure in five to seven years.”