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Custom graft allows Aortic Program to address patient’s unique needs

George Williamson has a debilitating case of sciatica to thank for putting him into the skilled hands of VCU Health’s vascular surgery team. An MRI to determine the source of his persistent sciatic nerve pain revealed the presence of two abdominal aortic aneurysms the physicians in Pauley’s Aortic Program were uniquely equipped to treat.

Fenestrated endografts

Fenestrated endografts are custom built to fit a patient’s anatomy.

Aortic aneurysms are abnormal bulges in the wall of the body’s main artery that grow slowly and have no symptoms. Left untreated, however, they can rupture and cause death.

Williamson’s were in a spot that made a traditional repair impossible. His neurologist referred him to Pauley Heart Center, where Dr. Mark Levy monitored Williamson’s aneurysms for several years. When the time came for treatment, Dr. Robert Larson performed a six-hour surgery on the 80-year-old.

“Most hospitals are able to do the standard basic aneurysm repair, but Mr. Williamson had less fortunate anatomy,” said Larson. As with 5% of patients, Williamson’s aortic aneurysms were too close to the arteries that branch off to the kidneys for traditional endovascular aneurysm repair to work. Until recently, the only option these patients had were major abdominal surgery or no surgery at all.

Open surgical repair wasn’t a possibility. “That’s a pretty huge operation,” Larson explained. “I’m not entirely sure that Mr. Williamson would have been able to come through that without major issues, given his age and his other medical problems.”

The retired investment banker was an excellent candidate, however, for fenestrated endovascular repair, or fenestrated EVAR. The minimally invasive surgical option uses a fenestrated graft, a custom-built device with holes called fenestrations that precisely fit the patient’s anatomy. The graft can cover the branch arteries of the aorta (in Williamson’s case, the kidney arteries) because the graft has corresponding holes positioned over the branch vessels that allow for blood to flow through the graft.

“Fenestrated endografts offer a number of benefits over open surgery, including shorter hospital stays, fewer complications and risks, and faster recovery times."

The graft is inserted into the femoral artery via an incision in the groin and guided through the blood vessel to the aneurysm. Once the fenestrated endograft is implanted inside the aneurysm, blood can flow through the diseased area without putting pressure on the weakened aortic wall.

“I read up on Dr. Larson,” Williamson said. “There are only a very few people who can do that operation. He saved my life.”

Larson has been performing the specialized surgery since Cook Medical LLC made this generation of the fenestrated graft available in 2012. “It’s revolutionized how we treat these types of aneurysms,” he said. “The technology that’s been developed is really exciting.”

Williamson was in the hospital for four days, an average length of recovery for fenestrated EVAR. “If we had done the open procedure, he would have been here for at least two weeks, if not more, with several months of recovery and rehab,” Larson explained. “The most rewarding thing, from our point of view, is we can provide these types of therapies, and fix the problem and get people who were previously quite frail back to their normal routine as quickly as possible.”

Williamson, now 81, has made a full recovery since his 2019 surgery, which has enabled him to spend winters in Florida and continue his love of travel, volunteer work and philanthropy. “I’m back to normal,” he said. “I think life is incredibly good.”

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