A routine screening may have saved Sam Welker’s life in 2001. His wife, Delia, had signed up for a mobile screening of the leg, abdomen, and carotid arteries. Her husband Sam, 77, saw no need to have the screening himself, but Delia talked him into it.
Although he had no symptoms, Sam’s screening detected an abdominal aortic aneurysm. An aneurysm is a bulge that forms in the wall of a blood vessel, usually as the result of the accumulation of fatty deposits on the vessel wall. If the aneurysm forms in the aorta (the body’s main blood vessel) that extends through the abdomen, it is called an abdominal aortic aneurysm (AAA).
Two Treatment Options: Traditional Open Surgery or Minimally Invasive Surgery
Sam’s Kelsey-Seybold primary care physician and a Kelsey-Seybold cardiologist confirmed the diagnosis and referred him to Ali Mortazavi, M.D., Chief of Cardiology at Kelsey-Seybold Clinic. Dr. Mortazavi discussed two treatment options with Sam — traditional “open” surgery, which requires a large incision in the abdomen, and a newer alternative that is minimally invasive.
“If there is a risk that the aneurysm will burst, the conventional treatment is open surgery requiring a large incision in the abdomen,” Dr. Mortazavi explained. It is performed under general anesthesia and takes about three to four hours. Patients typically spend one to two nights in intensive care and remain in the hospital for up to 10 days.
But conventional surgery isn’t an option for many patients. “Some patients have co-existing illnesses that rule out traditional surgery, such as coronary artery disease, congestive heart failure, or diabetes. Others have had previous abdominal surgery that has left them with a ‘hostile’ abdomen not conducive to traditional surgery. And others simply want a less invasive procedure,” Dr. Mortazavi explained.
Less Invasive Procedure Speeds Recovery
Sam opted for the newer, less invasive treatment, which has a quicker recovery time than traditional open surgery with a large incision. In this procedure, a stent graft (a woven polyester tube that is partially or entirely covered with a metal web) acts as a barrier between the blood and arterial wall. Without a barrier, the pressure of blood passing through the weakened artery causes a bulge. The stent graft serves to reinforce the weakened artery and decreases the risk of rupture.
How a Stent Graft Works
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The X-ray image at the top left shows a distinctive bulge (an aneurysm) in the aorta - the large vessel that carries blood from the heart to other parts of the body. The pressure of blood passing through a weak blood vessel causes the bulge in the X-ray. It's similar to what happens when a balloon is filled with water. If the bulging stretches too far, the vessel may burst.
The image at the bottom left shows what happens after the stent graft (the covered wire mesh tube) is inserted and inflated. The stent acts as a barrier, eliminating the pressure of the blood against the weakened artery.
The stent graft is placed inside the aneurysm using a catheter (a long, tube-like device) that is inserted through a small incision in the groin. The stent graft is deployed inside the aorta.
“It’s still a relatively new procedure,” said Dr. Mortazavi, “but based on our clinical trials and current experience, the long-term results seem very promising.”
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There are only a few institutions in the Texas Medical Center offering this innovative treatment alternative, and Dr. Mortazavi is among a small group of cardiologists trained, skilled, and experienced in endovascular grafts. In a collaborative effort with the Texas Heart Institute at St. Luke’s Episcopal Hospital, Dr. Mortazavi and his colleagues have implanted more than 250 stent grafts with a 99.2 percent success rate after 22 months.
Size of Aneurysm a Factor
Most abdominal aortic aneurysms are found during routine medical examination of the abdomen. The doctor can feel a pulsating or expanding mass and may hear a distinctive sound. An ultrasound can be used to visualize the aneurysm, and a CT scan can then be utilized for more accurate measurements. Depending upon the size and shape of the aneurysm, the physician may decide to do periodic checking instead of a repair.
Sam’s initial screening was in October 2000, and the endovascular procedure was performed the following spring. Dr. Mortazavi had recommended waiting a few months before treatment to monitor the size of the aneurysm.
“He Was Open and Frank”
Sam felt very comfortable and confident with Dr. Mortazavi. “He was open and frank with me, explaining all the options and risks. I never felt rushed. He answered all our questions. He takes you every step along the way. I had every confidence in him,” Sam said.
The stent procedure went smoothly. Sam was in the hospital two nights, then discharged. A pacemaker was installed several months later to regulate an irregular heartbeat, which was a pre-existing condition and not a result of the procedure.
Sam, who was SVP of International Operations for a large oilfield supply and manufacturing company, has lived all over the world, including Saudi Arabia, Bahrain, Singapore, Australia, New Zealand, Venezuela, and Switzerland. Six and a half years ago, Sam and Delia, who was born in England, moved from London to Houston. Now Sam is looking forward to showing Delia more of the United States.
“I’m looking forward to a long life,” he said.
“I strive to stay at the cutting edge of technology to fight the consequences of this disease, but I sincerely believe the prime focus should be on prevention.”
~Dr. Mortazavi
