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Reaching a significant milestone in the treatment of aortic aneurysms, University of Florida College of Medicine surgeons performed their 1,000th endovascular stent graft procedure on May 15, 2008 at the Shands at UF academic medical center.

The minimally invasive procedure, also called an endovascular aneurysm repair, is used to treat thoracic and abdominal aortic aneurysms. These aneurysms are bulges in the body's largest artery, which extends from the heart to the lower abdomen. UF surgeons say the high volume of endovascular stent graft procedures they perform enhances the level of care they can provide to patients.

"Surgical outcomes after many vascular surgical procedures are correlated with hospital and surgeon volume," said Dr. W. Anthony Lee, UF vascular surgeon. "Our team has focused on gaining expertise of endovascular repair for aortic aneurysms and placed an emphasis on offering this procedure to our patients. Only a handful of institutions around the country have reached this volume, and I anticipate continued growth of this field in the future."

Research shows hospitals with higher volumes of endovascular procedures have better patient outcomes. The latest findings published last month by researchers at the University of Michigan Medical Center in the Journal of Vascular Surgery show that hospitals with high volumes of patients with abdominal aortic aneurysms repair them more frequently with minimally invasive techniques. These techniques offer patients many benefits, including shorter post-operative recoveries.

During an endovascular aneurysm repair, surgeons place a stent graft, which is a wire mesh tube covered in fabric, in a patient's aorta using a specially designed catheter inserted through a small incision in the groin. The stent graft is then deployed using X-ray guidance, allowing blood to flow through the device instead of pushing against the thinned walls of the aneurysm. If a large aneurysm is left untreated, there is risk of rupture, which is often fatal.

Dr. James M. Seeger, UF chief of vascular surgery, along with Dr. James Caridi, UF radiologist, performed the first stent graft procedure at Shands at UF in 1997. He said back then they used first-generation devices and were limited to a small subset of patients with abdominal aortic aneurysms who had favorable anatomies.

"This has now obviously changed to the point that only a few patients are not candidates for endovascular aneurysm repair," Seeger said. "We have gone from using portable imaging equipment to our state-of-the-art endovascular suite and a full endovascular team available at all times. The change has been dramatic and clearly beneficial for our patients. Endovascular repair of aortic disease has produced a revolution in the management of these complex problems and will only continue to expand as new devices and new techniques become available."

The UF and Shands endovascular team - which includes vascular and cardiothoracic surgeons, and highly trained nurses, technicians and endovascular-equipment specialists - now repairs approximately 60 percent of aortic aneurysms using endovascular techniques.

Dr. Tomas D. Martin, UF cardiothoracic surgeon, said "Endovascular techniques forever have changed aortic and vascular surgery and greatly advanced patient care, particularly with regards to their recovery."

He added, a patient's hospital stay after a stent graft procedure is only two to four days and complete recovery is usually less than one week. Traditional open surgery, which requires a large chest incision, typically requires one to two weeks in the hospital and six to eight weeks for full recovery.

According to the Centers for Disease Control and Prevention, aortic aneurysms are the 18th leading cause of death for all age groups. They are known as a "silent killer," because usually there are no symptoms. If symptoms are present, they may include severe, prolonged and unusual back or abdominal pain.

If a small aneurysm is identified, it will be monitored until the risk of rupture is greater than risks associated with surgery.

"Endovascular treatment of aortic aneurysms is less invasive than the traditional open procedures and this enables us to treat patients who in the past may have been refused surgery because of the risks involved," said Dr. Philip J. Hess, Jr., UF cardiothoracic surgeon, who performed the 1,000th procedure with Lee.

Striving to advance patient care, the UF and Shands endovascular team is working on multiple clinical trials studying new and next generation stent grafts.