Aug 21, 2001 – About 1.5 million Americans, typically men 60 and over, have an abdominal aortic aneurysm, but only 200,000 of them are diagnosed each year. Indeed, this abnormal dilation often does not cause any symptoms: the aneurysm is “silent” until its rupture, which generally causes a fatal internal hemorrhage which kills 15,000 Americans each year.
The surgery to overcome this condition is heavy and long (eight hours) and therefore very risky for some elderly patients. That’s why, in 1999, the United States Food and Drug Administration (FDA) approved two implants that prevent a major operation. Through an incision in an artery in the groin (angioplasty), the surgeon delivers an implant (or endoprosthesis) to the abdominal aorta, which becomes a new circulation route for the blood. This technique greatly reduces postoperative complications and the number of days in hospital.
Unfortunately, despite several thousand successful interventions, cases of injury (625) and death (41) have accumulated. The FDA is working with the two manufacturers to improve their stents. One of them, Guildant Corp., even voluntarily stopped selling its own (Ancure) last spring pending the results of a study on a second generation product. It is true that at $ 10,000 per implant, we are entitled to demand certain improvements …
The problems are diverse and affect around 10% of patients: certain accessories allowing the positioning of the implant sometimes remained stuck; some surgeons have used these stents to treat an overly large aneurysm, and when the aneurysm changed shape, they would leak.
So how do you choose between major surgery and less invasive surgery? According to Dr. Hugh Beebe, director of the Jobst Vascular Center in Toledo, Ohio and chairman of the FDA committee that looked into the issue, patients should consider the following three points:
- Angioplasty is suitable for patients who would not survive a major operation, but it requires lifelong follow-up every six months to diagnose any problems. For others, surgery solves the problem once and for all in 97% of cases.
- Obtain a diagnosis based on a ” scan »In three dimensions: this technology makes it possible to better detect excessively large aneurysms and sinuous arteries where the implant could become stuck.
- Do not hesitate to ask the surgeon about his experience in stent implantation.
The FDA recently wrote to thousands of surgeons urging them to strictly follow implantation instructions and not to use this technique on patients who are at risk of neglecting semi-annual follow-ups.
Françoise Ruby – PasseportSanté.net
According to The Associated Press – August 14, 2001
