A Minneapolis vascular surgeon is one of the few doctors across the country to treat aortic aneurysms in the area between the navel and kidneys without surgery, providing a less invasive way to fix what can often be a silent killer.
"What this has done is open the door to people who were denied surgery in the past, so they can have much better results," said Dr. Jesse Manunga of Abbott Northwestern Hospital. "The idea was: 'What if we can take a graft and make it fit the patient?' "
An aortic aneurysm is a potentially deadly blood-filled bulge in the aorta, the main artery that carries blood from the heart to the rest of the body. If it bursts, it can kill a patient within seconds. Most patients don't know they have one until it is too late, although an ultrasound can spot it.
Repairing an aortic aneurysm used to mean risky surgery until about 20 years ago, when doctors began using stent grafts — tiny mesh tubes that are inserted with a catheter and allow blood to flow past the aneurysm. However, stent grafts have not been used on aneurysms in the area of the aorta near the kidneys, bowel, spleen or liver because the stent could block blood flow to those organs. For the 20 to 40 percent of patients with an aneurysm there, surgery was the only option.
And, for patients considered too ill for surgery, Manunga said, there was really no option at all. Doctors simply won't do the surgery and patients sometimes died.
But using a fenestrated stent graft that he designs, Manunga is helping patients who previously couldn't have stents or surgery. Armed with an array of detailed scans and meticulous measurements taken from each patient, Manunga and an Australian medical device company — Cook Medical — tailor stent grafts for each patient's unique anatomy. The company cuts precise holes in the stent to match Manunga's measurements.
It usually takes four to six weeks for Manunga to get the tailored stent graft back from Cook, but in more urgent cases, Manunga can make the alterations himself. Manunga, who learned his craft at the Mayo Clinic in Rochester, is the only one who does the procedure in the Twin Cities.
Millions of Americans are at risk for abdominal aortic aneurysms. The exact causes are not clear, but men over age 60 who smoke and have a family history of the problem are at the highest risk.