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Published in CenterView on November 07, 2011
Baldwin, left, and Smith show off the state-of-the-art stent graft.
Baldwin, left, and Smith show off the state-of-the-art stent graft.

UMMC surgeons employ revolutionary procedure for minimally invasive repairs

By Patrice Sawyer Guilfoyle

Patients suffering from complex aortic aneurysms have a new treatment option available only at the University of Mississippi Medical Center that offers a chance at life without fear of the ticking time bomb in their chests exploding.

"In the past, patients who weren't a candidate for open operation had no real options for repairing aneurysms that involve branches which feed major organs, such as the brain, liver, or intestines," said Dr. Zachary Baldwin, assistant professor of surgery. "They oftentimes were sent home to wait for it to burst."

Baldwin and Dr. Sumona Smith, assistant professor of surgery, performed the first endovascular fenestrated repair of a thoracoabdominal aneurysm in the state on Sept. 30. Using this fenestrated technology, they were able to treat the patient's aneurysm while maintaining blood flow to all vital organs.

The stent graft is inserted percutaneously using a needle, wire and a sheath (or tube) about the size of a pencil.

The procedure used a stent graft which is customized by the surgeons and designed specifically for the patient's anatomy. The term fenestrated refers to holes cut into a large stent graft to allow for blood flow to the vessels that supply major organs. Through these holes, smaller secondary stents are placed to bridge the main graft to those vessels serving vital organs such as the kidneys, liver or bowel.

"It is akin to bypassing the aneurysm by building a new freeway for blood flow while also installing the necessary off-ramps needed to keep vital organs alive," Baldwin said.

He said in aortic aneurysms the aorta will balloon and dilate to a point where there's risk of rupture. Previous treatment options carried a high risk of death and a major operation that involved a large incision from the chest down to the groin area.

"This technology allows treatment of these aneurysms in a very minimally invasive, incision-less fashion. We can do these procedures without having to enter the abdominal or thoracic cavity, which would have been necessary just five years ago," Baldwin said.

Smith said this treatment option is so new that only a few select centers have been doing it for three or four years.

"It gives us an option as an academic medical center to treat these complex aneurysms," she said.

Smith, a vascular surgeon, joined the Department of Surgery in July, allowing the department to offer aneurysm surgery. She is a 2002 graduate of the School of Medicine and completed her surgery residency at the Emory University School of Medicine in 2009. As a research fellow in Emory's Division of Vascular Surgery and Endovascular Therapy, she authored and co-authored two papers on aortic aneurysms that were published in vascular surgery journals.

Smith said many of the people who have this condition are either sick or elderly and don't qualify for the more invasive treatment options. They are also not eligible for traditional endovascular stent graft because of where the aneurysm is located.

Baldwin, who joined UMMC in 2008, earned the M.D. at the University of Chicago Pritzker School of Medicine. He completed his general surgery residency training at the University of California, San Francisco-East Bay. During residency, he returned to the University of Chicago, where he undertook a research fellowship. He went on to obtain specialty training at UC-San Francisco, where he completed a fellowship in vascular and endovascular surgery.

The graft used in the surgery is metal and cloth, but it is expensive. A large graft costs $12,000-$15,000, and a small graft is $2,000-$3,000. The graft, which is manufactured, is altered by the surgeons to create the branch grafts because they must be tailored for the patient's particular condition.

The importance of this life-saving technology is immeasurable, said Baldwin.

"With the ability to do these, we can treat any aneurysm anywhere in the body," he said.