Elam H. "Bud" Phillips, Sr., 79, has had a productive life in Springfield. He started working as a paper boy in the mid-1930s and went on to work as a tailor, a boiler maker, a clothing salesman and eventually to run a popular neighborhood general store with his wife, Roberta.

Now retired, Phillips still is active but recently was found to have an abdominal aortic aneurysm (AAA), a weakening in the main blood vessel to the lower body which can be life threatening. His heart disease made the usual surgical repair of this condition risky.

Instead, Phillips was referred for a minimally invasive version of the surgery being tested at Southern Illinois University School of Medicine as part of a 11-site trial being conducted by the U.S. Food and Drug Administration (FDA). Dr. Kim J. Hodgson, associate professor of vascular surgery, performed Phillips' surgery in mid-June at Memorial Medical Center (MMC). A degenerative result of aging, abdominal aneurysms affect five percent of the population over 60 and are the 13th leading cause of death in the U.S. because of their risk for rupture, which results in overwhelming internal bleeding.

"Although the long-term results of this approach are not yet know, the initial results from 120 procedures, including the first six here at SIU, are good," explained Hodgson. "This is much better for the patient as it has a lower risk for cardiac and pulmonary problems during and following the surgery since the aortic artery does not have to be clamped. Most patients have a two-day recovery in the hospital and return to normal activity within a week."

The minimally invasive surgery to treat an abdominal aortic aneurysm takes two to two-and-one-half hours, compared to three to four hours for traditional surgery. A two-inch incision is made in each groin to expose both femoral arteries in the legs. A flexible catheter seven millimeters in diameter is inserted into the vessel and used to move the graft to the mid-abdominal site where is it placed. Once released, the graft expands and seals, forming an internal bypass of the weakened aorta, eliminating the chance of rupture. The first four patients received general anesthetic while the last two were performed with only sedation and local anesthesia to numb the groin regions.

The graft is made of a thin tube of polyester fabric surrounded by self-expanding stents made of nickel titanium alloy called Nitinol. The graft is of modular construction and has several extensions that allow it to be custom-fitted to each individual patient's anatomy.

Traditional surgery to repair an abdominal aortic aneurysm uses an incision from the bottom of the breast bone to the top of the pubic bone. Since patients often have coexisting cardiac and/or pulmonary disease, complications from the surgery can be as high as 25 to 30 percent. Surgeons have been working since the early 1990s to develop less invasive methods for repair of abdominal aortic aneurysms. Initial clinical trials for various devices have been performed in the U.S., Europe, South America and Australia.

Hodgson said there usually are no reliable warning symptoms of an abdominal aortic aneurysm prior to its rupture. The rupture is associated with severe back pain. Most patients with ruptured abdominal aortic aneurysms never even knew they had this life-threatening condition. In thin patients, an abdominal aortic aneurysm can often be felt on routine physical examination, while this is usually not possible with larger patients. Ultrasound is used to confirm the presence of an aneurysm, and to accurately determine its size, which correlates with its risk for rupture. Since aneurysms run in families, people with parents, brothers or sisters who have had aneurysms are at increased risk and should be checked for the presence of an aneurysm periodically after age 60.

Hodgson estimates 150 abdominal aortic aneurysm surgeries are performed in Springfield each year and others are performed throughout central Illinois. Most of these would be candidates for the new procedure. By summer's end, Hodgson had performed nine minimally invasive surgeries for AAA and procedures for additional patients were being scheduled.

Charges for the minimally invasive and conventional surgeries initially are comparable. "Although the cost of the new graft, $8,000 to $10,000, is higher than the cost of the graft used for traditional surgery, the reduced length of hospitalization and lack of need for Intensive Care Unit care is expected to compensate for this," explained Hodgson. "While it is impossible to place a value on the reduced risks and discomfort for the patient, or the earlier return to normal activity, quality of life survey information is being collected from each patient as part of the study to evaluate these factors."

Medicare reimburses both the hospital and surgeon the standard amount for abdominal aortic aneurysm repair no matter which approach is used. Any hospital costs for Medicare patients that exceed the standard reimbursement are presently being absorbed by MMC.

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