By: Jean Johnson for Veins1Fifty-three-year-old actor John Ritter died of a ruptured aortic aneurysm in 2003. The massive bleeding associated with the rupture resulted in death so suddenly there was no time to get to a hospital.
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Detecting Thoracic Aneurysms
A thoracic aneurysm is most commonly caused by atherosclerosis; a hardening of the arteries due to is fat build-up along the arterial wall.
Other risk factors for aneurysms include connective tissue disorders, prolonged hypertension, and trauma (usually falls or car accidents).
Most patients have no symptoms until the aneurysm begins to leak or expand.
Most non-leaking thoracic aortic aneurysms are detected by tests -- usually a chest X-ray or a chest CT scan -- run for other reasons.
Chest or back pain may indicate an acute expansion or leakage of an aneurysm.
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The aorta is the large, major artery that carries blood from the heart to the body’s vital organs. An aneurysm that bulges out like a balloon can develop at weak spots in the walls of the aorta. When pressure reaches a critical point, rupture can occur without warning. While traditional surgery can repair thoracic aortic aneurysms (if they are detected in time) interventional radiology is once again paving the way toward new minimally invasive techniques.
Professor and chairman of the department of radiology at the University of Virginia Health System, Michael Dake, M.D., has been at the forefront of this innovation and has worked to develop high-tech stents and grafts for more than 10 years. In the process, he has directed many of the clinical trials required for the U.S. Federal Drug Administration to finally give its stamp of approval to the device and technique.
Most recently, 72-year-old Malcolm Langston of Etowah, North Carolina received the first FDA-approved graft to treat a thoracic aortic aneurysm. The device, called the TAG Thoracic Endoprosthesis, was manufactured by W.L. Gore and Associates of Flagstaff, Arizona. The “tiny tubular graft made of a Teflon-like material enclosed in a wire mesh corset” was implanted in Langston’s aorta using imaging techniques that interventional radiologists rely on. Via a small puncture in the patient’s groin near the large femoral artery, Dake and his team inserted the Gore TAG device on the end of a small catheter the diameter of a spaghetti noodle. During a two hour procedure, the vascular experts threaded the catheter to the thoracic aortic aneurysm where they then unfurled the Gore TAG graft at the site.
“A large number of interested U.S. physicians and patients have eagerly awaited the approval and release of the TAG device,” said Dake. “Today marks the beginning of a new era of less-invasive repair of thoracic aortic aneurysm, which will provide a safer alternative to regular surgery in some patients. Ultimately the use of the technology may be expanded to manage a variety of challenging aortic diseases with less risk, offering new hope for improved results over current treatment of these aneurysms.”
In earlier trials, patients with TAG devices had one-third less mortality and one-fourth fewer strokes after one month than control groups. Additionally, after two years, there were no ruptures of the aneurysms with the TAG grafts in place. W.L. Gore and Associates also noted that blood loss incurred in placing one of its grafts is 80 percent less than patients experience with traditional surgery. Hospital stays were also cut significantly with intensive care unit time dropping from three days to one day. Time spent recuperating on regular wards decreased from seven to three days.
