Dr. Raed Al Dallow says the procedure itself is not new.
“Basically, with a percutaneous repair, the promise and the intent is to do a procedure that is easier for the patient, that has no incisions and no scars, and that does not require a stay in the intensive care unit.”
Percutaneous repair – as opposed to endovascular repair – allows doctors to fix aneurisms without an incision. Endovascular repair requires a small surgical site in the groin, where doctors would snake a catheter through the blood vessel to the area that needed to be fixed.
With percutaneous repair, the doctor can use just a needle – which can be enlarged to fit the stent or other device into its place. It requires just a stitch to close, and patients usually go home from the hospital the next day.
Aortic aneurysm involves an enlarged blood vessel in the chest or abdomen. If it grows to the point of rupture, it can be fatal. Dr. Al Dallow says screening for these is critical, because patients aren’t usually aware of the problem.
“One fact about aortic aneurysm is often the aneurysm is asymptomatic – which means the person cannot feel the aneurysm. Therefore, unless you actively screen for it, and seek it out, you may not find it. Or you may just have to find it incidentally.”
Medicare changed its screening rules last year, meaning more people are able to get tested. That can involve everything from a conversation with a doctor, to an ultrasound, or an angiogram. But Al Dallow says that change is already netting results.
“We are finding many, many more aneurysms that otherwise you’d either not find or maybe incidentally, maybe later on you’d get a CT scan done for a gall bladder or something else, and then you find the aneurysm.”
The study, getting underway across the nation this month, aims to standardize the percutaneous repair procedure. That’ll mean doctors will eventually be using the same process to fix the aneurysms, and experts hope it will lead to better outcomes and easier recoveries for the patients.
Dr. Al Dallow says percutaneous repair is not just about a no-incision approach – he says it will help more people in the long run.
“It’ll make the aneurysm repair more available. You can extend it to a certain number of patients that, in the past, were not able to have the procedure. Basically, sometimes older women have very small blood vessels. Now we have a new device that we are using in this trial particularly, that have a very low profile so the catheter is much smaller. And in the past, before we had it, certain older ladies with very small blood vessels, we could not fix their aneurysms, and now we can.”
Al Dallow says studies like this one help raise awareness about the need for screening, and can help get important conversations started in doctors’ offices all over the country:
“When you talk to your doctor about screening for aneurysm because you smoke, and you have high blood pressure, and you have diabetes, that opens a good window for the physician to say, ‘Well, good thing there is no aneurysm – but you really should quit smoking because it’s a risk.’ It opens a good, good discussion with the patient about whether those risk factors need to be controlled and whether we all need to do a better job at smoking cessation, educating the public, controlling diabetes better, controlling hypertension better.”
As Al Dallow embarks on the study, he says he hopes more patients will soon be able to benefit from it. The study itself will take a year, and then he and other doctors involved in it will continue checking in with patients and tabulating results.
It also allows him to share his knowledge with other doctors – Carbondale is the only site in the Midwest taking part in this study.
