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Drs. Shang A. Loh and Apostolos K. Tassiopoulos
Custom-made stent device offers new treatment options for abdominal aortic aneurysms

Two vascular surgeons at Stony Brook University Hospital (SBUH) are the first on Long Island to successfully implant custom-made fenestrated endografts in patients with complex abdominal aortic aneurysms (AAAs). The new procedure is the latest advance in AAA treatment, enabling experienced vascular surgeons to treat patients with very complex aortic anatomy in a minimally invasive way.

Apostolos K. Tassiopoulos, MD, and Shang A. Loh, MD, performed the first fenestrated endovascular aortic aneurysm repair (FEVAR) procedures at Stony Brook in February. The tube-like stent device used for the procedure was recently approved by the Food and Drug Administration and is the most state-of-the-art device available for AAA treatment.

Fenestrated endograft placed within abdominal aortic aneurysm, showing arteries that feed kidneys through custom-tailored openings (fenestrations) in top of graft
Fenestrated aortic endografts are custom made for each individual patient's anatomy, based on reconstructions of the patient's vascular anatomy derived from CT scans, Dr. Tassiopoulos said. The FEVAR technique involves insertion of a self-expanding, fabric-covered stent inside the aneurysm, using two small groin incisions for access to arteries, to effectively exclude the aortic aneurysm from circulation. The tube-shaped stent devices contain precisely placed openings - full-circular holes and/or semi-circular scallops, called fenestrations -that allow extension of the "seal zone" above the kidney arteries, thus permitting normal blood flow to the kidneys and bowel.

FEVAR addresses a common limitation of standard endografts, allowing minimally invasive endovascular repair of AAAs located very close to the arteries supplying the kidneys. The procedure can be performed on patients with a "short neck" - indicating little or no distance between the top of the aneurysm and the arteries feeding the kidneys. An estimated 10 percent of all patients with AAA have the short neck condition and thus are not candidates for standard EVAR repair. Prior to FEVAR, their treatment options were limited, and most underwent traditional open AAA repair.

Minimally invasive endovascular aortic aneurysm repair (EVAR) has revolutionized treatment of AAAs in recent years. The EVAR technique has become the preferred treatment method for most patients, including a significant number of patients who would have been turned down for a traditional open repair because of other health issues. It has significantly reduced the mortality and complication rate associated with traditional open repair of AAAs.

Dubbed the "silent killer," AAA is fatal in most cases if the aneurysm ruptures before being repaired. Therefore, early detection and repair are crucial. The condition occurs when a weak spot on the wall of the abdominal aorta balloons out-like a bulge on an overinflated tire.

An estimated one million Americans live with an undiagnosed AAA - including 20,000 in Suffolk County alone. According to the Centers for Disease Control and Prevention, AAA is more common in men and in individuals aged 65 years and older.

About Stony Brook University Hospital:
Stony Brook University Hospital (SBUH) is Long Island's premier academic medical center. With 597 beds, SBUH serves as the region's only tertiary care center and Level 1 Trauma Center, and is home to the Stony Brook Heart Institute, Stony Brook Cancer Center, Stony Brook Long Island Children's Hospital, Stony Brook Neurosciences Institute, and Stony Brook Digestive Disorders Institute. SBUH also encompasses Suffolk County's only Level 4 Regional Perinatal Center, state-designated AIDS Center, state-designated Comprehensive Psychiatric Emergency Program, state-designated Burn Center, the Christopher Pendergast ALS Center of Excellence, and Kidney Transplant Center. It is home of the nation's first Pediatric Multiple Sclerosis Center. To learn more, visit www.stonybrookmedicine.edu.
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