Prior to the March 2016 FDA approval of a game-changing piece of vascular stent technology, a patient with a large iliac artery aneurysm would have been cut open from their sternum to the pelvis, stayed in the hospital for up to two weeks and endured a three-month recovery period.
But on July 22, Sina Iranmanesh, M.D., performed Middle Tennessee’s first endovascular repair of bilateral iliac artery aneurysms at Williamson Medical Center with two small needle pricks in the patient’s groin area. The surgery took about three hours, the patient went home the next day and was up and about 24 hours later with no complications.
“Honestly, we have gone from a major surgery with frequent complications to being able to do the same procedure without even making a real incision,” Iranmanesh says.
How iliac artery aneurysms form
An iliac artery aneurysm refers to an area of weakness and bulging in a pelvic artery that, if untreated, can lead to life-threatening bleeding if it bursts. Aneurysms of the aorta and iliac arteries can be found in up to 5 percent of male smokers.
The iliac arteries carry oxygenated blood to the pelvis and legs. When sections of that artery weaken and can’t support the force of blood flow, an aneurysm, or stretched section of the artery, occurs. The danger is that the aneurysm can grow to several times its normal size and rupture, which is often fatal and a leading cause of death.
So improving upon the way these aneurysms are repaired is monumental and until this iliac branch device gained FDA approval, the previous surgical methods were marginal at best.
Repairing two arteries simultaneously
Although other vascular surgeons in Middle Tennessee have used the iliac branch device, Iranmanesh was the first to do it bilaterally, which means both major arteries were repaired at the same time during the same procedure using this device.
“With aneurysms of the iliac artery, which is located in the pelvic area, there just wasn’t a good minimally invasive option that didn’t involve sacrificing blood flow to the pelvic arteries,” Iranmanesh says.
But this new device, which has been used in Europe for several years, just received FDA approval in the United States and allows the first stent-within-a-stent system so that a surgeon can repair the aneurysm while preserving critical blood flow.
Paul Fleser, M.D., another vascular surgeon who performs surgeries exclusively at Williamson Medical Center, says that prior to the branch system, vascular surgeons were modifying their grafts beforehand by cutting holes in them to ensure adequate blood flow through the device.
“It worked this way, but it took longer to do the procedure, and you had to explain to the patient that you were modifying the device,” Fleser says. “Vascular surgeons really helped develop this branch system device by working with companies who make equipment like this to create something that would alleviate multiple surgeries and a laundry list of complications that were often common with bilateral aneurysm repair.”
The patient who received the bilateral artery repair was the perfect candidate for this procedure with the new branch system stent.
“After looking at his CAT scan, we realized he had aneurysms in both of his iliac arteries,” Iranmanesh says. “Six months ago, we would have talked to the patient about sacrificing one of those arteries, which can come with serious complications. But that was the best option we had in order to save a patient from the artery rupturing, which can be fatal.”
But thanks to this new technology, the patient has open arteries and zero complications.
“He had a total of five aneurysms fixed in one surgery, thanks to this new graft,” Iranmanesh says. “We have been waiting years for this.”
Fleser says this is just another example of how Williamson Medical Center continues to be on the forefront of vascular care.
“We performed the second fenestrated graft in the state and now the first bilateral iliac aneurysm repair,” says Fleser. “This medical center is up to date with the latest techniques in the dedicated vascular operating suite. We continue to move forward and be competitive with all the big universities. We have students here now rotating with us. We have post-operative nursing teams and support staff who are dedicated to these types of procedures.”
Vascular program at Williamson Medical Center
Iranmanesh says he feels the vascular program at Williamson Medical Center is as good if not better than anywhere else in the state.
“The patients love being here,” he says. “They don’t want to have to go downtown. We are creating a situation where there is nothing better downtown. And here, we can get you on the schedule at 7 a.m., whereas at other facilities you may have to wait three days and not be seen until 5 p.m.”Share this Article