May 21, 2004

First-time case at the MGH saves patient

When an 18-year-old male patient suffering from acute aortic trauma was wheeled into the operating room recently, doctors approached his injuries with a procedure that had never been tried at the MGH for this type of injury. The patient had significant bruising in his lungs and a torn aorta as a result of a high-speed car accident. His injuries were life-threatening, and open-repair surgery on his aortic tear had been ruled out. With the resolve and true spirit of MGH caregivers, the group of doctors, nurses and technicians worked together to perform the first thoracic aortic stent graft for a trauma patient at the MGH.

Under the direction of Richard Cambria, MD, chief of Vascular and Endovascular Surgery and co-director of the Thoracic Aortic Center, the medical team began the 90-minute procedure — brief compared to the standard five hours for open-repair surgery — to repair the tear in the patient's aorta. To do this, Cambria inserted a stent graft replacement— consisting of a new piece of artificial aorta — through a catheter in the femoral artery in the patient's groin. Guided by a fluoroscope, which provides a visual roadmap for the surgeon, Cambria then positioned and placed the graft.

The patient recovered well from the surgery, although other injuries from his accident resulted in a longer hospital stay. "Traditional methods for treating thoracic aortic injuries involve major open operations, which means considerable post-operative pain and prolonged recovery," says Cambria. "In aortic trauma, coexistent injuries either preclude or complicate open surgical repair. There is little doubt that stent graft repair will be the standard treatment in the near future."

Right, clinicians perform stent graft repair at the MGH.

The Thoracic Aortic Center at the MGH is one of only a few groups in the Northeast to perform this type of procedure usually done to repair aortic aneurysms, and the center's surgeons have the largest regional experience to date. In addition, the Thoracic Aortic Center is participating in three clinical trials evaluating thoracic aortic stent graft repair.

A recent thoracic aortic stent graft procedure can be viewed on the MGH
website at http://www.or-live.com/massgeneral/1183/.