Retired state highway worker feels great after innovative surgical treatment for aortic aneurysm

In July, Howard Long had surgery to treat his aortic aneurysm--not an unusual occurrence as approximately 5 percent of men over 60 develop an abdominal aortic aneurysm. However, Long was the first person treated for this condition at University of Iowa Hospitals and Clinics using a new, FDA-approved, less invasive surgical procedure.

University of Iowa Health Care surgeons, Jamal J. Hoballah, M.D., and William J. Sharp, M.D., led the surgical team.

The aorta is the main blood vessel from the heart to the body. When aortic walls weaken, a bulge, or aneurysm, forms. The effect is similar to what happens to old inner tubes, which can balloon at weak points. Left untreated, an aneurysm can burst, resulting in massive internal bleeding that is often fatal. Ruptured aortic aneurysms annually cause about 16,000 deaths nationwide.

Long, 75, lives with his wife, Shirley, in Washington, Iowa. In 1988 he retired from the Iowa Department of Transportation and now enjoys woodworking. Like most people with aortic aneurysms, Long was completely unaware anything was wrong. Although aortic aneurysms can cause pain in the lower back, many aneurysms are without symptoms. Luckily, an ultrasound scan performed by Gordon Goldsmith, M.D., a urologist at Mercy Hospital in Iowa City, for an unrelated condition alerted them to the silent danger.

Aortic aneurysms were not new to Long's family. Shirley's sister had been successfully treated for an aortic aneurysm at UI. She had the traditional procedure, which has a high survival rate but involves major surgery. A large incision is made in the patient's abdomen, cutting through muscles and moving internal organs to expose the diseased aorta. The weakened aortic section is replaced with artificial tubing that is sewn into place. Not surprisingly, the patient usually needs prolonged hospitalization and a lengthy recovery period.

"Because many patients requiring this form of surgery are older, traditional open surgery can be a big stress to the body. Full recovery can be slow and painful," Hoballah said.

In contrast, the new procedure is much easier on patients. Rather than opening the abdomen, two small incisions are made near the groin and a catheter delivers an endograft, special tubing, into the aorta. The endograft is then guided through the blood vessel to the aneurysm site. These new self-supporting grafts do not require sutures to stay in place.

"While not everyone is a candidate for the procedure, 40 to 60 percent of patients will have blood vessels with the anatomy required for this technique," Hoballah said.

"They did tests on me and found out that I was a good candidate for this type of surgery," Long said. "Dr. Hoballah recommended the procedure, so I took his advice."

Sharp said, "The main benefit is that this new procedure is much less stressful and allows for quicker recovery. In fact, this procedure is much preferred for older patients with other medical problems for whom conventional surgery is highly risky."

Long agrees that the operation was a success. He was home within days of surgery and his recovery went well.

"I do feel great and I don't have any problems or pain whatsoever. It's just amazing." Long said. "Dr. Hoballah showed me some follow-up scans, and he's got proof that it's working."

Indeed, CT images tell a compelling story. Before the operation Howard's aorta had swollen to about twice its normal diameter at the aneurysm site. After the endograft was in place, the CT clearly showed blood safely flowing through the device rather than putting pressure on the blood vessel walls.

Long is thankful the surgery led to a speedy recovery, now he can get back to his woodworking.

For more information about aortic aneurysm treatment, patients and families may call the UI Health Access number listed below and ask for Dr. Hoballah or Dr. Sharp, or call the Vascular Disease Center directly at 319-356-8272. Physician calls for consultation or referral may be directed to UI Consult.

Howard Long, who received treatment for an aortic aneurysm using a new, less invasive surgical procedure, likes to travel.