Transcript No Slide Title

By James Wey, Christopher Chan,
Elizabeth Quadros, Ziad Sergie,
Jason Sousa, Lillian Hang
• In the past 30 years, the incidence of AAA has tripled in the Western
world and is the 13th leading cause of death in the US.
•There are approximately 200,000 patients diagnosed with AAA in the US
each year, and approximately 500,000 patients diagnosed worldwide.
Estimated AAA Diagnosed each year.
Adapted from Lester et. al
• An estimated 60% of patients diagnosed with AAA are considered suitable for the
new endovascular repair method.
Stent-Graft vs. Conventional Surgery
•The stent-grafts costs $12,000, and the
entire operation is approximately
$27,000.
•The approximate cost for conventional
open-chest surgery is approximately
$31,000.
•There are approximately 85,000 stentgraft procedures performed in 2001
worldwide, which amounts to a cost
of $2.3 billion.
•There are approximately 110,000
conventional surgeries performed in
2001 worldwide, which amounts to an
expenditure of about $3.41 billion.
•Average ICU stay is close to none.
•Average ICU stay is about 55 hours.
Diagnosis and Risk Factors
•Diagnostic techniques:
•Abdominal X-ray
•CT (Computed Tomography)
•MRI (Magnetic Resonance Imaging)
•Arteriogram
•Risk Factors
•Family History
•Increased age (over 60)
•Male gender
•Smoking
•High blood pressure
•High cholesterol
•Atherosclerosis
•Cardiovascular Disease
•Obesity
Source:
http://www.aorticaneurysm.com
April 26, 2002
Treatment
•Do nothing except monitor the status of the
aneurysm with routine ultrasounds. This
option is preferred if the AAA is relatively
small (4-6cm) and the patient is elderly or
very high risk.
•Conventional surgery- Common choice of
treatment for large aneurysms in otherwise
young and healthy patients.
•Endoluminal surgery with stented graft- this
usually represents the best choice for an
elderly or high risk patient with an aneurysm
that must be repaired.
Source:
http://www.aorticaneurysm.com
April 26, 2002
Source:
http://www.aorticaneurysm.com
April 26, 2002
Risks Associated with Treatment
On the Operating Table
•failure to complete the procedure
•device-related or procedure-related complications
•and arterial complications
Usually up to 30 Days Post-Operation
•graft-limb thrombosis or kinking
•peripheral embolization
•local hematoma or bleeding
•failure to advance the device into the correct position
•vascular laceration
•occlusion of the renal arteries
•device migration
•systemic complications related to organ failure
•paraplegia
•infection of insertion site
•endoleak (most common)
Risks Associated with Treatment (continued)
Usually after 30 Days Post-Operation
•peripheral vascular occlusion
•device disruption or dislodgement
•aneurysm rupture
Problems Discovered Upon Recovery of the Stent
•Stents without barbs or hooks detached readily from the native arteries
•Very little or no vascular tissue at all was found adhered to the fabrics
•constant endoleak and graft-migration
Major Causes of Death
•anatomically incompatible device
•migrated stent causing the occlusion of renal arteries
•thrombosis
•post-operative renal failure(7% of stent-graft procedure)
Companies and the Devices
FDA Approved
•Guidant
•Medtronic
- Ancure
- AneuRX
In Clinical Trials
•Boston Scientific
•Cook Group
•Edwards Lifesciences
•Endologix
•W.L. Gore and Assoc.
•Sulzer Vascutek
•TeraMed
•World Medical
Manufacturing/Medtronic
-
Vanguard III
Zenith
Lifepath
PowerLink
Hemobahn; Excluder
Anaconda
Ariba
Talent
Guidant
Ancure
•Uses hooks to secure the graph in place
•8,000 sold in 2001
•Made of Dacron and Elgiloy
•Recalled recently because the hooks damaged
arterial walls
Source:
http://www.medicaldata.com
April 26, 2002
Medtronic
AneuRX
•Uses a pressure fit to secure the graft in
place
•Made of Dacron and Nitinol
•Modular device
•30,000 sold in 2001
•growth of sales is 80% per year
•More popular device than Guidant’s
Ancure
Source:
http://www.medicaldata.com
April 26, 2002
Future of the Endoluminal Stents
Rapamycin coated stents
•Implant Sciences
•Gold-coated Nitinol Stent
•CardioTech
•ChronoFlex
Source:
J Thorac Cardiovasc Surg 2001; 122:47-52
Use for Thoratic Aortic Aneurysms
•Non-Stented Grafts
•Surgical Assisted Therapies
•Use laproscopic techniques to
secure the graft
Source:
http://www.ideasforsurgery.com/SAT_solutions3.html
April 26, 2002