aortic aneurysm

New Treatments for High Risk Complex Abdominal Aortic Aneurysms Patients

Aortic Aneurysm TreatmentIn recent years, endovascular techniques have greatly improved the safety of surgical treatment for patients with abdominal aortic aneurysms (AAAs) who had concomitant health conditions that affect cardio-pulmonary and renal function. Because many patients with AAAs do not qualify for endo-vascular repair, newer procedures called “fenestrated and branched endografts” were designed as an alternative for these patients. Until recently, fenestrated endografts were not commercially available and surgeons had to modify grafts themselves to repair the AAAs. In November of 2012, Emory vascular surgeons Yazan Duwayri, MD, and Ravi Veeraswamy, MD, performed Georgia’s first implantation of an U.S. Food and Drug Administration (FDA) approved fenestrated graft. The new device can be used to repair aneurysms in patients who are not candidates for other traditional repair options.

Treatment Options for Abdominal Aortic Aneurysms

Emory offers the full range of treatment options for abdominal aortic aneurysms, including open and endovascular repair techniques. For patients who are not candidates for the newer FDA-approved devices, Emory surgeons still offer open surgical and endovascular repair using the chimney and snorkel techniques. We tailor AAA treatment, selecting the treatment option that is most appropriate for each patient. Learn more about our

There are many benefits to fenestrated endovascular repair including:

  • Shorter days in ICU
  • Less blood loss
  • Fewer mortalities
  • Fewer complications post surgery
  • Shorter average number of days to resume normal diet
  • Fewer days spent in the hospital

Fenestrated Graft Procedure Video



Learn more about fenestrated and branched endografts >>


Dr. Ravi VeeraswamyAbout Ravi Veeraswamy, MD

Dr. Veeraswamy specializes in vascular surgery, and has been practicing with Emory since 2006. Some of his areas of clinical interest include aortic aneurysm repair, carotid endarterectomy and stenting, peripheral arterial and vascular disease, and vascular surgery. Recently, Dr. Veeraswamy has published articles in the Washington University Manual of Surgery, Vascular and Endovascular Challenges, and the Annals of Vascular Surgery.

 

Yazan Duwayri, M.D.About Yazan Duwayri, MD

Dr. Duwayri specializes in endoluminal and endovascular surgery. His areas of clinical interest include treatment of carotid stenosis, abdominal and thoracic aortic aneurysms, aortoiliac occlusive disease, renal arterial stenosis, thoracic outlet syndrome, dialysis access, peripheral arterial disease, and venous disease. He has published articles in several journals including the Journal of Vascular Surgery and Annals of Vascular Surgery, in addition to several textbook chapters.

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Heart Disease is the Number One Killer of Women – Take Action Now to Avoid Being a Statistic!

Many people consider heart disease to be a predominantly male-oriented condition. However, heart disease is the number one killer in women and affects one out of every three in the United States, according to the American Heart Association. Heart disease occurs when fatty build-up in your coronary arteries, called plaque, prevents blood flow that’s needed to provide oxygen to your heart.  When the blood flow that brings oxygen to the heart muscle is severely reduced, or completely cut off, a heart attack occurs.

“The scary thing is that heart attacks in females are more likely to be fatal than in men,” explains Farheen Shirazi, Cardiologist at the Emory Heart & Vascular Center at Johns Creek. “Far too often, women ignore the warning signs of a heart attack and do not seek immediate medical attention. As time elapses, the muscles of the heart weaken, causing severe or life-threatening damage.”

Thankfully the awareness about heart disease continues to be on the rise. “The most important weapon against heart disease is awareness. Women need to research their family history and take time to educate themselves on not only the risk factors and symptoms of heart disease, but preventive medicine as well.”

How can you educate yourself? Join Dr. Shirazi on Tuesday, April 9 for an online web chat on women and heart disease. She will be available to answer your questions such as: what women can do to prevent heart disease, the importance of getting treatment right away and the research underway to combat heart disease in women.


 About Dr. Farheen Shirazi

Farheen Shirazi, MD is an Assistant Professor of Medicine at Emory University School of Medicine and a cardiologist at the Emory Heart & Vascular Center.  She specializes in preventive cardiology and heart disease in women.  Dr. Shirazi completed medical school at Morehouse School of Medicine, her Internship at New York University School of Medicine, her residency at Stanford Hospital and her Fellowship at Emory University School of Medicine.  Dr. Shirazi has been practicing at Emory since 2012 and primarily sees patients at Emory Heart & Vascular Center at Emory Johns Creek Hospital and Emory Heart & Vascular Center at Cumming She is passionate about educating women about how to prevent heart disease.

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Emory is the Only Site in Georgia with New Branched Aortic Stent Graft Trial

Aortic Aneurysm Clinical TrialEmory Heart & Vascluar Center is the only site in Georgia participating in a new multi-center, FDA-approved clinical trial that will study a new stent graft designed as a minimally invasive option for patients with juxtarenal (JAA) and pararenal (PAA) aortic aneurysms.

Emory Heart & Vascular Center vascular surgeon and Emory University School of Medicine associate professor of surgery Ravi Veeraswamy, MD, is the local principal investigator of the study. The trial, sponsored by Endologix, Inc., will evaluate the safety and efficacy of the Ventana™ Fenestrated System for these patients.

It is estimated that 20% of diagnosed abdominal aortic aneurysms are not treatable with currently approved endovascular devices because they have extremely short aortic necks and/or involve the renal arteries. So it is exciting to know that early clinical experience with the new graft outside of the United States with the device has been promising. Until now, there has not been an “off the shelf” graft that could treat complex aneurysms that involve the renal arteries. Previously, surgeons had to burn holes in existing grafts or have customized devices made for each patient, involving time, labor and expense. Also the open repair is an invasive procedure that can result in significant blood loss, complication rates and long hospital stays.

Dr. Veeraswamy and his team are hopeful this new device will permit a less invasive treatment to be extended to a much larger group of patients. The distinguishing characteristics of the Ventana system include a main column intended to protect the aorta and exclude the aneurysm from blood flow, and two branched renal stent grafts that are inserted through the main device and into the renal arteries to maintain blood flow to the kidneys.

To learn more about the study, call Emory HealthConnection at 404-778-7777.

Dr. Ravi VeeraswamyAbout Dr. Veeraswamy
Dr. Veeraswamy is an Associate Professor of Medicine at Emory University School of Medicine, Division of Vascular Surgery, Department of Sugery. He specializes in surgery and vascular surgery, and has been practicing with Emory since 2006. Some of his areas of clinical interest include aortic aneurysm, carotid endarterectomy, peripheral arterial and vascular disease, and vascular surgery. Recently, Dr. Veeraswamy has published articles in the Washington University Manual of Surgery, Vascular and Endovascular Challenges, and the Annals of Vascular Surgery.

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Emory Vascular Surgeons Implant 1st FDA-approved Fenestrated Stent Graft in Georgia

Emory Heart & VascularContinuing its prominent regional and national role as a top-tier center for the treatment of arterial and venous disease, the division of vascular surgery and endovascular therapy of the Emory University School of Medicine now provides implantation of the FDA-approved Zenith® Fenestrated Endovascular Graft. Emory vascular surgeons Yazan Duwayri, MD, and Ravi Veeraswamy, MD, recently performed Georgia’s first implantation of the stent graft, which has been approved as a minimally invasive treatment option for patients with abdominal aortic aneurysms (AAA) that possess an aneurysm anatomy that is incompatible with currently available devices.

“In recent years, endovascular techniques have greatly improved the safety of surgical treatment of AAA, but there are high risk patients whose aneurysms are too close to the arteries that feed the kidneys to qualify for these methods,” says Dr. Veeraswamy. “If placed, the endovascular graft itself would block blood flow. And unfortunately, traditional, open techniques of repair have significantly high morbidity and mortality rates.”

Designed as an endovascular alternative for such patients, the fenestrated system is associated with faster recovery and decreased risk of complications. The most unique factor of the graft—essentially a tube of fabric and metal that functions as a sleeve inside the aorta that excludes the aneurysm from blood flow—is that it can be customized to accommodate the anatomical specifications of each individual patient. “We use specialized software to design the fenestrations or scallops of the Zenith device so that they line up with the patient’s renal and mesenteric arteries,” says Dr. Duwayri. “Through these holes, we can place additional stents into the branch arteries to repair the aneurysm.”

The graft is inserted through small punctures in the groin and femoral arteries and guided into place using x-ray images. Wires, catheters, and stents can be placed inside the artery without the external aorta ever being touched.

By offering this new, FDA-approved technology and other devices in the clinical trial phase, Emory vascular surgeons are advancing the delivery of care to patients with these complex aneurysms.

About Ravi Veeraswamy, MD
Dr. Veeraswamy specializes in surgery and vascular surgery, and has been practicing with Emory since 2006. Some of his areas of clinical interest include aortic aneurysm, carotid endarterectomy, peripheral arterial and vascular disease, and vascular surgery. Recently, Dr. Veeraswamy has published articles in the Washington University Manual of Surgery, Vascular and Endovascular Challenges, and the Annals of Vascular Surgery.

About Yazan Duwayri, MD
Dr. Duwayri specializes in endoluminal and open vascular surgery. His areas of clinical interest include treatment of carotid stenosis, abdominal and thoracic aortic aneurysms, aortoiliac occlusive disease, renal arterial stenosis, thoracic outlet syndrome, dialysis access, peripheral arterial disease, and venous disease.


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Back to Life After an Aortic Aneurysm – Part II

As part of our commitment to providing the best patient-centered care possible, our team of physicians, nurses, specialists, and staff make advancing the medical possibilities a priority each and every day. There are only so many factors we can control, however, and sometimes, it is perfect timing coupled with the efforts of our team that make treatment for our patients that much more successful.

Warren "Allen" Owens

Take Allen Owens, for example. He may be someone you’re familiar with if you frequent our heart & vascular blog. We introduced you to him in a post a few weeks back detailing his remarkable story. Prior to arriving at Emory, Allen experienced 8 heart attacks, 21 congestive heart failures, had 13 stents placed, had 5 bypass surgeries (4 of them failed) and had taken 4 life flights (emergency helicopter rides to the hospital). On each life flight he was not expected to make it to the hospital because of his critical status.

It may sound like Allen faced a run of unfortunate health bad luck. After all, he did what he could to prevent a decline in his health. He’s not a smoker or a drinker, and considered himself to be a relatively healthy adult.

Perhaps surprisingly, it was when his local doctors were out of answers that Allen’s life (and luck) changed for the better. He was referred to Emory and last summer, received another diagnosis to add to his plate – Allen’s abdominal aorta was weakening and he had developed an aortic aneurysm that was ballooning and could burst at any time. You may be wondering, what’s lucky about that? The majority of aortic aneurysms are found after they burst, and fortunately, doctors caught Allen’s prior to this happening.

What’s more, Allen’s health wasn’t strong enough to undergo another heart surgery to repair the problem. Once again, Allen’s luck was changing for the better. At about the same time that Allen was diagnosed with his aortic aneurysm, Dr. Joseph Ricotta, a vascular surgeon, had just transitioned his career at the Mayo Clinic to working at Emory Healthcare. At the Mayo Clinic, Dr. Ricotta had perfected a new procedure to treat aortic aneurysms, an alternative aortic aneurysm treatment he brought with him to Emory– the use of fenestrated and branched aortic endografts, a procedure Dr. Ricotta has performed approximately 120 times thus far.

Six months after performing this revolutionary procedure for Allen, Dr. Ricotta told Fox 5 News the graft is working perfectly, “The aneurysm’s shrinking actually. There’s no evidence of leak and all the branches to his intestines and kidneys are open and look very good.”

The procedure and Dr. Ricotta’s presence in Atlanta have hopefully put an end to this Cherokee County native’s run of bad luck. It’s Allen’s hope now, that with his condition under control, he will be able to qualify for a heart transplant. “This will be eight years in April, that I’m not supposed to have,” Allen told Fox 5 News.

You can learn more about the fenestrated and branched aortic endograft procedure for aortic aneurysms, and learn more about the story of Allen Owens by watching this video from Fox 5 News below:

“Back to Life” After an Aortic Aneurysm

September 2, 2010 was a memorable day for Emory patient Warren (Allen) Owens when he realized years of heart trauma were behind him.

Previously, Mr. Owens had experienced 8 heart attacks, had been diagnosed 21 times with congestive heart failure, had 13 stents placed, had 5 bypass surgeries ( (4 of them failed) and had taken 4 life flights (emergency helicopter rides to the hospital). On each life flight he was not expected to make it to the hospital because of his critical status.

Mr. Owens was referred to Emory after physicians at his local hospital were no longer able to help him with his life-threatening condition, an 8-cm aortic aneurysm that was at risk of rupturing. At Emory, patients with complex aortic aneurysms like Mr. Owens now have an option they did not have before – the fenestrated and branched endograft procedure that we discussed in a previous blog post. Now over a year later Mr. Owens is able to perform the daily tasks that he could not do before the surgery. He credits Emory physicians with “bringing him back to life.”

“I can’t put it into words how thankful I am that he was able to do what he did and bring me back to a semblance of my former life.” – Warren Owens

Listen to Mr. Owens touching story by watching the video below.

About Joseph J. Ricotta II, MD:
Dr. Ricotta specializes in vascular and endovascular surgery, and came to Emory from the Mayo Clinic in August 2010. His areas of clinical interest include fenestrated and branched endografts to treat aortic aneurysms, thoracoabdominal aortic aneurysms, peripheral aneurysms, PAD, carotid endarterectomy and carotid stenting, mesenteric and renal artery disease, and venous diseases. He has authored several journal articles and book chapters on the topic of fenestrated and branched endografts, and holds organizational leadership memberships at the American Medical Association, the American College of Surgeons, the Society for Clinical Vascular Surgery and the Society for Vascular Surgery.

The Emerging Role of Fenestrated & Branched Aortic Endografts in the Treatment of Complex Aortic Aneurysms

Dr. RicottaAs Dr. Kasirajan mentioned in the last blog about aortic aneurysms, this condition can cause serious medical issues or even death. For patients with large complex aneurysms, there is a new procedure that we are performing at the Emory Heart & Vascular Center called a fenestrated and branched stent graft. This procedure is a viable option for patients who may have once been considered inoperable. These grafts are now used in select high-risk patients with complex aneurysms that are located throughout the entire length of the aorta.

In addition to being a safe and effective option for high-risk patients, fenestrated and branched endograft implantation provides patients with a number of benefits including:

• No incisions
• Shorter hospital stays (one or two days vs. 10 to 14 days for open surgical repair)
• Quicker recovery

Unfortunately, these devices are not yet commercially available in the United States. In countries where they are available, the grafts must be customized for each patient, a process that can take up to 12 weeks. During this time patients are at risk for a rupture in their aneurysm. As an alternative since 2007, several vascular surgeons in the United States have been custom-making fenestrated and branched stent grafts using available components.

Emory currently is one of only a few institutions in this country and the only one in the Southeast that offers these investigational procedures.

Fenestrated and branched endografts appear destined to play a key role in the management of complex aortic aneurysms. Research results have shown that these devices are both safe and effective in treating carefully selected patients, with low incidence of complications. Although additional research is needed to substantiate these results, Emory is poised to participate as a primary site in proposed clinical trials of these innovative devices.

You can learn more about Emory’s fenestrated and branched aortic stent graft program at www.emoryhealthcare.org/vascular

Do you have questions about fenestrated and branched aortic endografts? If so, feel free to ask away in the comments section.

About  Joseph J. Ricotta, MD:

Dr. Ricotta specializes in vascular and endovascular surgery, and came to Emory from the Mayo Clinic in August 2010.  His areas of clinical interest include fenestrated and branched endografts to treat aortic aneurysms, thoracoabdominal aortic aneurysms, peripheral aneurysms, PAD, carotid endarterectomy and carotid stenting, mesenteric and renal artery disease, and venous diseases.  He has authored several journal articles and book chapters on the topic of fenestrated and branched endografts, and holds organizational leadership memberships at the American Medical Association, the American College of Surgeons, the Society for Clinical Vascular Surgery and the Society for Vascular Surgery.