Advances in endovascular treatment for abdominal aortic aneurysms and peripheral vascular occlusive disease in the legs may benefit patients because they are less invasive and can result in shorter hospital stays and recovery time. The vascular specialists at Saint Louis University hope that, through the development of more advanced technology, the next few years will result in an even higher percentage of patients who are eligible for endovascular treatment.

For those who may be suffering from vascular disease, common symptoms are:

• Pain in the thigh, calf or buttocks when you are active (pain goes away when you rest)
• Numbness or continuing pain in the feet
• Foot injuries or ulcers that do not heal
• Severe abdominal pain
• Failure to have an erection in males.

Aneurysms (Aortic and Abdominal)
An aneurysm is an abnormal widening or enlargement of a blood vessel. This happens when the wall of the blood vessel weakens. Over time, an aneurysm can get big enough and the tension in the artery wall strong enough to cause the aneurysm to rupture. When this happens in the chest or abdomen, the outcome may be fatal. Aneurysms can develop on any blood vessel in your body, but there are certain areas that are more susceptible than others.

• A thoracic aortic aneurysm is an aneurysm that develops in the aorta, the artery that takes blood away from the heart. These aneurysms develop in the chest near the heart or down the back near the left lung.
• An abdominal aortic aneurysm is an aneurysm that develops in the aorta in the abdomen in the space below your breathing muscle (diaphragm) between your kidneys. This is a continuation of the thoracic (chest) aorta and it divides to go to each leg.

Peripheral Vascular Disease (in the arteries and veins)
Peripheral vascular disease refers to diseases in the blood vessels outside of the heart and brain. It’s often a narrowing of the blood vessels that carry blood to leg and arm muscles. There are two types of these circulation disorders:

• Functional peripheral vascular diseases don’t have an organic cause and don’t involve defects in blood vessels’ structure. They’re usually short-term effects and can come and go. Raynaud’s disease (or Raynaud’s phenomenon) is an example. People with Raynaud’s have spasms in the arteries of the hands and/or feet, which causes severe pain and tingling. It can be triggered by cold temperatures, emotional stress, working with vibrating machinery or smoking.
• Organic peripheral vascular diseases are caused by structural changes in the blood vessels (such as inflammation and tissue damage). Peripheral artery disease (PAD) is an example. PAD, caused by atherosclerosis, is a general term for thickening or hardening of the arteries.

Vascular Surgery and Endovascular Treatment
The AneuRx Stent Graft
SLUCare vascular specialists at Saint Louis University Hospital were among the first in St. Louis to implant the AneuRx Stent Graft System following FDA approval for treatment of abdominal aortic aneurysms. Since then, more than 30 procedures have been completed.

The AneuRx Stent Graft System offers some abdominal aortic aneurysm patients a minimally invasive alternative to major open abdominal surgery. Although this graft system recently approved by the FDA is suitable for many such patients, it may not be appropriate for everyone. Abdominal aortic aneurysms (AAAs) are seen commonly among patients who have risk factors for heart disease, stroke or peripheral vascular disease. White men over the age of 55 are at the greatest risk. AAAs occur less frequently in white women, and they are relatively uncommon in African Americans of both sexes.

Recent studies indicate that the new stent graft system is as effective as open abdominal surgery, allows patients to become ambulatory sooner after surgery, has reduced complications related to the surgery and has shortened the number of days spent in the hospital.

The procedure is performed using either general or regional anesthesia through small incisions in each groin. The stent graft is then inserted by a catheter into the femoral artery and guided through the aorta to the aneurysm site. Once placed, the stent graft expands to fit within the diameter of the aorta, providing the new path for blood flow and reducing pressure in the aneurysm.

The AneuRx Stent Graft System’s self-expanding, diamond shaped nickel-titanium stent rings are designed for self-anchoring to the vessel wall without the need to puncture the vessel with hooks or barbs. The stent graft system’s modular design makes it adjustable to individual patient anatomies. Extender cuffs may be used to modify the length and/or diameter of the implanted graft, providing surgeons with a means to address wide ranges of aneurysm size and shape. Additionally, the stent graft’s full supported exterior is designed to prevent kinks or twisting and device migration over time.

Carotid Endarterectomy
A carotid endarterectomy is a surgical procedure that removes plaque that has built up in the carotid artery (one of the arteries that supplies blood to the brain). Through a small incision, the surgeon opens the carotid artery in the neck and removes the plaque that keeps blood from flowing freely to the brain.

Lower Extremity Revascularization
The arteries that carry blood to the legs can become narrowed or clogged, slowing or stopping the flow of blood. Revascularization re-opens and unblocks the arteries to improve blood flow. Techniques to revascularize blocked arteries in the legs include: inserting a balloon through the skin into the blocked artery in the legs; inserting a small tube in the artery – called a stent – through a small incision to hold the blood vessel open; or by injecting clot-dissolving drugs through a catheter to restore blood flow.

Varicose Vein Stripping
Varicose veins are swollen, twisted, cord-like or knotted blood vessels in the legs. To remove varicose veins, a thin wire-like instrument is inserted into the vein, which then removes the diseased vein.