If you ask vascular surgeon Dr. John You what he does for a living, he might chuckle and tell you he’s a plumber. “Vascular surgeons fix leaks and clogs,” explains You, the head of vascular surgery at The Scarborough Hospital. “We are plumbers with big egos.” The leaks and clogs he is referring to are aneurysms – ruptured or blocked blood vessels – and if left untreated, can cause death.
Vascular surgeons deal with the vessels – or pipes – that carry blood throughout the body. An abdominal aortic aneurysm occurs when the aorta weakens and balloons. Traditional aneurysm repair is invasive, requiring a large incision along the abdomen, general anesthesia and a five to seven day stay in the hospital. But a less invasive grafting procedure called endovascular aneurysm repair (EVAR) is proving to have long-term success.
The Scarborough Hospital – recently designated as a vascular centre of excellence by the Central East Local Health Integration Network – was the first community hospital to perform EVAR. For Scarborough area residents, this means they don’t have to go downtown to an unfamiliar hospital. The latest in vascular surgery is available in their community hospital. “It was nice to be able to get this done close to home,” says James Chalmers, who lives about 20 kilometres east of the hospital.
Like many with abdominal aortic aneurysms, Chalmers suffered no symptoms and only discovered he needed surgery after seeing a doctor about an unrelated health issue. “When the doctor told me, I didn’t like the idea of being cut right open,” says Chalmers. So when he was referred to Dr. You and told he was a good candidate for the less invasive procedure, Chalmers was relieved. “Just having two small cuts, that seemed less major. I was only in the hospital a few days. I had no pain after the surgery,” says Chalmers. “This was a much safer procedure for me. If you have the option, this is the way to go. It was not as hard on the body and I healed faster.”
The majority of patients requiring repair for an abdominal aortic aneurysm are over 65 and although it is not an option for every patient, EVAR is safer for some. “EVAR is a safer alternative for patients with coronary or pulmonary disease,” says You. “In the past we had to make a large incision along the abdomen. Some patients are too sick to do that surgery.”
Returning to You’s plumbing analogy, he compares aneurysm repair surgery to that of a leaky pipe behind a wall. “Imagine you have a special x-ray machine that allows you to see the exact location of the leak. You could cut a hole in the wall and fix it,” he says, explaining this is how the traditional surgery is performed – by making a large incision along the abdomen. “But what if there’s a Picasso mural painted on that wall? It would be better to make a hole in a discrete place and thread the equipment up to the site for repair,” says You.
That’s how EVAR works. A vascular surgeon makes two small incisions in the groin and threads a custom-fit stent graft through the femoral arteries to the site of the aneurysm. The graft takes the pressure off the bulging area thus preventing the aneurysm from expanding and rupturing.
The procedure is performed with spinal anesthesia and allows patients to bypass the intensive care unit because EVAR places less stress on the cardiac and respiratory systems. Typically a patient only requires a two to three day hospital stay. At The Scarborough Hospital, about 30 per cent of all abdominal aortic aneurysms are repaired using EVAR.