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More patients helped with new abdominal aneurysm surgery

Procedure to be available in Port Charlotte by mid-May

A new procedure may not only help more people with abdominal aortic aneurysms, but it will also get them back on their feet in less than half the time of the traditional procedure.

The new surgery, endovascular repair of abdominal aortic aneurysms, is making its way to Charlotte County , and promises to reduce risks of complications and could help patients who were not candidates for the traditional treatment.

"The standard procedure is a very invasive surgery with risk of complications of about 17 percent or so," said Dr. Mammon Jarrah of the Vascular & Thoracic Surgery Center in Port Charlotte . "In the last five years or so, we've started to have a new way to fix this aneurysm, which was experimental and done only in a few centers.

"The good news now is that the Food and Drug Administration approved two new endovascular delivery systems and grafts, and we're trained in one of them."

A trained team along with Jarrah will make this new procedure available in a few weeks.

An aneurysm is a bulge in the aorta that supplies blood from the heart to the organs in the body. Aneurysms can occur anywhere, but are most likely found in the abdomen.

As they grow, aneurysms do not usually show any symptoms, but if they balloon large enough to rupture, they can kill the patient. Once found, a large aneurysm is operated on to reduce the chance of rupturing.

The traditional procedure requires a large incision from the bottom of the breastbone to the top of the pubic bone. The surgeon cuts the aneurysm open and sews a graft in place.

As has been the trend in major surgeries in recent years, the surgeon cuts only two small holes while using instruments like cameras, X-rays and catheters to see what he or she is doing inside the body, without having to cut the patient widely open.

In this surgery, two groin incisions are made and a catheter is inserted into the aorta. At the top of the catheter is a deflated balloon and a tightly wrapped polyester graft and stint.

When properly positioned, the graft is secured in place by inflating the balloon and opening the graft to the diameter needed to prevent blood flow to the aneurysm. The balloon is then deflated and removed with the catheter. The graft and stint is secured to the walls of the aorta with hooks.

Because it will no longer be receiving blood, the aneurysm will shrink over time.

The significance of this type of minimally invasive surgery has been seen in other major surgeries -- even in heart surgery: the patients have fewer risks and less blood loss, and go home more quickly.

Jarrah said the risks of complications has been reduced from 17 percent to 5 percent, and the number of deaths from complications will be reduced by 50 percent.

Plus, the new procedure will let patients get back to their lives in the same amount of time it took patients who had the old procedure just to get out of the hospital. Now they only have a two- or three-day hospital stay and recover within two weeks. Before, patients had to stay in the hospital about 10 days and faced six weeks of recovery.

"There's a significant amount of people in our community that have this aneurysm," Jarrah said. "Sometimes we don't do it because they are too high-risk -- they have very bad lungs, bad hearts. They can't handle the standard procedure.

"This new procedure will allow us to do more of these types of people. Unfortunately, at the present time only 30 percent to 50 percent of patients with abdominal aneurysms will be candidates for this new procedure."

Your physician can determine if you're a candidate for this surgery.

Abdominal Aortic Aneurysms information

* Aneurysm ruptures affect about 15,000 people per year, making it the 13th leading cause of death in the United States .

* More than 95 percent of abdominal aortic aneurysms are due to hardening of the arteries, occurring when cholesterol, minerals or blood cells build up in the walls of the artery.

* Other causes include cigarette smoking, high blood pressure and inflammation or infection.

* Abdominal aortic aneurysms usually occur in patients in their 60s and 70s.

* Once an aneurysm reaches 5 centimeters, surgery is usually required, if the patient is a surgical candidate. A normal aorta measures about 2.3 centimeters.

* There are usually no symptoms involved with an abdominal aortic aneurysm.

* Rapid growth or rupture of an abdominal aortic aneurysm may cause intense back or abdominal pain, signs of shock such as shaking, dizziness, fainting, sweating, rapid heartbeat and sudden weakness.

* Early detection and treatment is the best defense against aneurysms.

By SHELLIE BENSON

When all else fails: Wound Care Center to the rescue

Camielle Hollingsworth waited several months before walking through the doors of the Southwest Florida Wound Care Center in Port Charlotte .

She had many ulcers in both of her legs resulting in unsightly wounds that could have led to amputation.

"The kids kept getting after me," she said. "I was just being stubborn."

Finally, Hollingsworth saw an ad for the center on television and traveled to the office from her Englewood home. She was put in the hospital the next day.

After debridement surgery, where all the effected areas of the wound were cut out, surgeons grafted skin from her upper leg to help heal the wound. The Wound Center uses a growth factor called Procuren, a patented procedure in which the patient's own blood is processed and used as a dressing on the wound.

Staff from First American Home Care came to Hollingsworth's home and changed the bandages twice a day. Hollingsworth also attended physical therapy sessions for three weeks and said she nearly had to learn to walk again.

Nearly a year later, Hollingsworth is healed and walking much easier.

"The nurses (at the Wound Care Center ) make you feel at home," Hollingsworth said. "You go there and you never meet a stranger."

Hollingsworth said she thinks her wounds were a result of circulatory problems. That's a common problem the Wound Center sees as well as wounds caused by diabetes, poor oxygen and pressure, especially in the feet.

"Most problems are in the foot," said Mamoon Jarrah, MD, a vascular surgeon. "If you have foot problems, poor circulation, diabetes ... bunions and pressure from shoes, it's usually a more complex problem."

That's why the Wound Center , which has been in operation for three years, has six different types of physicians on staff. Two vascular surgeons, two podiatrists, two general surgeons, an infectious disease specialist, a plastic surgeon and an endocrinologist meet monthly to discuss and solve challenging problems. The Wound Center boasted a 86 percent success rate in May versus the 79.6 national average.

"For the cases that don't improve, healing-wise, we bring it at the end of the month to the meeting ... and everybody suggests something different," Jarrah said. He said most hospitals don't do this intense sort of interdisciplinary research.

"(Patients) go to a doctor and the doctor tries, but there's no team. They get fed up so they got somewhere else," Jarrah said. "Because there is no team approach, a lot of these wounds are complex and no one person can do it. It has to take a plastic surgeon and a vascular surgeon just to get things going. It takes this kind of teamwork."

The Wound Center also works with the patient's primary physician, according to the center's director, Charlotte Briscoe.

We need to work closely with the primary care physician because that physician has to take care of the underlying cause such as the diabetes," she said. "That primary physician needs to be kept in the loop."

Faye Rogers of Arcadia was not able to find a cure for her leg wound after visiting two doctors.

"The (first) doctor operated and it didn't get well," Rogers said. "He kept telling me 'two more weeks, two more weeks.' "

Six months went by after a surgery that never healed and she finally got a referral to the Wound Center . She had another surgery and follow up similar to Hollingsworth and in about five weeks, her leg started to heal.

For close to 10 weeks, a home health agency visited Rogers ' home and changed the dressing on her wound twice a day.

"They were just wonderful," Rogers said. "The just bent over backward."

Rogers is now getting around, taking care of her house and taking care of her wound.

"If it starts to swell they want me to lay down," she said. "Then I just start over again."

Jarrah said many of the patients he sees over 50 years old and are diabetic with poor immune systems. As a result, their wounds do not heal quickly.

"If you have a wound, like if you cut yourself, it should be healed in seven or eight days," Jarrah said. "I would say, if you go four to six weeks without healing, there's a problem."

Wound assessments are done by measurements, actually probing down into the wound to see how deep it goes. Although a wound might look small on the surface of the skin, it may actually tunnel deeply.

After measuring the wound, diagnostic tests and cultures are done as well as vascular studies to check blood vessels.

Debridement is a painful procedure where all of the infection is cut away. The wound may end up bigger, but it's a clean wound, Briscoe said. Wound Center staff will debride weekly to keep it clean, and antibiotics are used to keep infections to a minimum.

"One of the biggest things we do is educate the patient on what they have to do to take care of this wound," Briscoe said. "Do they have to change their lifestyle? Do they have to change the way they sit? Do they have to change the shoes they wear ... or their diet?

"We have a real simple system -- it works," she said. "Our outcomes are great."

By SHELLIE TERRY