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By Ken Ige, Star-Bulletin
William Oliver recovers from a new type of surgery
for aneurysm with less-invasive scars on his abdomen,
as opposed to the usual cut down the middle. Drs.
Michael Caps, center, and Samuel Wu are satisfied
with Oliver's recovery and are about to release
him from the hospital.

Patients hail advanced
aneurysm treatment

By Helen Altonn
Star-Bulletin

John Marks, 87, and William Oliver, 86, shared more than a room recently at Kaiser Permanente's Moanalua Medical Center.

The two Honolulu men were the first Kaiser patients to undergo an advanced procedure used by vascular surgeons Peter Snyder and Michael Caps to correct aneurysms, on March 13.

The first aortic stent-graft procedure in Hawaii had been performed two days earlier, on March 11, by vascular surgeons Dean Sato and Bo Eklof at Straub Clinic & Hospital, Caps said.

"It's incredible; I'm feeling wonderful," Marks said while waiting to go home three days after the surgery.

"Instead of going down through the stomach, which is very invasive, they go up through the groin," Oliver explained. "The scarring is minimal."

Snyder said, "It's a real nice thing to avoid all the potential risks and problems that go with a bigger operation."

Open aneurysm surgery, the usual procedure to fix a bulging or abnormal enlargement of the abdominal aorta, generally requires a hospital stay of seven days or longer, he said.

Many patients still will need the standard operation, because not every aneurysm can be treated this way, Snyder said.

But as the procedure improves, he said it probably can be used on more people -- especially those who are older or have many medical problems and can't undergo the risks of major surgery.

The abdominal aorta, the largest blood vessel in the body, comes off the heart. It's how the heart gets blood out to the various organs.

"It turns out that a section of the aorta in the abdomen that goes from the rib cage down is uniquely prone to abnormal widening," Snyder said. "The risk is if it gets big enough it could pop or rupture and people usually die because it is the biggest blood vessel in the body."

To repair that condition, he said, surgeons have operated on the abdomen, which involves a fairly sizable incision. "We go in behind the intestines -- replace that section of blood vessel with a new tube or pipe."

Instead of going through the abdomen, the new technique involves placing a graft or replacement tube of synthetic material through the femoral artery at the top of the leg in the groin.

The surgeon threads the graft into the artery with a very large catheter -- while watching it go to the correct place by X-ray -- then releases it.

"That forms a new lining, so the lining of the aorta no longer is bulging and at risk for popping."

Caps said the main factor deciding whether the new procedure can be done on a patient is the shape of the aneurysm.

"There are very specific requirements with regard to the shape of the aneurysm, and the shape in the size of arteries below and above the aneurysm, that determine if and where the device can be successfully placed."

Snyder said two devices have been released by the Food and Drug Administration for the procedure and he and Caps are trained in use of both. Sam Wu, Kaiser interventional radiologist, works with them on the program.

Caps joined Kaiser's staff in December. He previously was a professor at the University of Washington, where FDA-sponsored studies were done on stent-graft devices.

"This is the cutting edge of vascular surgery right now," he said.

Caps said he observed and Snyder scrubbed in for the procedure, which takes two to three hours -- a bit less time than going through the abdomen.

"It's extremely dramatic: There's less blood loss, less time in the intensive care unit and less overall time in the hospital post-procedure. Patients are back to full function much, much sooner than the usual procedure."

Marks and Oliver -- who didn't know each other before their shared medical adventure -- said they feel lucky that their aneurysms were discovered and they were able to have the less-invasive operation.

Marks, preceding Oliver with the surgery, said his aorta was bulging almost five centimeters. "If it's more than five centimeters, you're in danger, and if it bursts, you're a goner."

When he awoke the afternoon of the surgery, he asked, "'How come I feel so good?' It's amazing."