St. Luke’s second in nation to perform EVAR with Endurant AAA Stent Graft System

Dec 23 2010

An 80-year-old patient at St. Luke's Episcopal Hospital (St. Luke's) in Houston became the second in the nation to be treated with a newly approved FDA device for an abdominal aortic aneurysm (AAA). The condition, often called, "the silent killer," is a dangerous bulge or ballooning in the main artery of the body that typically causes no symptoms until it ruptures.

“Mr. Holiday was a good candidate for the device because of the size of his aneurysm, his age and his complex anatomy”

Interventional cardiologist Zvonimir Krajcer, MD, performed an endovascular abdominal aortic aneurysm repair (EVAR) on James Holiday of Lufkin, Texas, using the Endurant AAA Stent Graft System from Medtronic Inc. The FDA approved the device on December 20 for the minimally invasive treatment of the largely unknown, and often fatal, condition. An estimated 1.2 million people in the United States have an AAA, which is the third leading cause of sudden death in men over the age of 60. The Endurant AAA Stent Graft System is already the most widely used stent graft in Europe; and, the FDA approval expands the number of U.S. patients for whom EVAR may be a viable treatment option.

Holiday's aneurysm recently was discovered during medical imaging for another condition. "Mr. Holiday was a good candidate for the device because of the size of his aneurysm, his age and his complex anatomy," said Dr. Krajcer. "The procedure would have been difficult to perform with stent grafts that are currently available."

Dr. Krajcer added, "This is the smallest device in diameter that is commercially available and is well-suited for people who have very small and very narrow arteries. Mr. Holiday's only other option would have been major surgery, but due to his other serious medical conditions, he had been turned down by other physicians because the risk of surgery is higher as we get older."

The Endurant device consists of a flexible wire frame—the stent—sewn onto a specially woven fabric tube—the graft—that physicians use to create a new path for blood flow to a patient's aorta, thus reducing pressure on the aneurysm and the risk of rupture.

Dr. Krajcer performed the EVAR on Holiday using a minimally invasive "preclose" technique that he pioneered at St. Luke's. In the procedure, he accessed the femoral artery through a small puncture in the patient's groin. Prior to inserting the stent graft, he threaded sutures attached to needles through the artery wall. The sutures were laid to the side, available for closing the artery at the end of the procedure. The stent graft was then inserted through the artery and, using X-ray guidance, positioned in the aorta, where it was deployed. The procedure was performed with the use of local anesthesia, comparable to that used for dental procedures, as opposed to general anesthesia, which poses a higher risk and is commonly used with surgical procedures.

After undergoing EVAR, Holiday is expected to leave the hospital today and return to normal activities, as opposed to a weeklong hospital stay and two months of recovery if he had surgery.