Interventional Radiology and Vascular Surgery

Stalking AAA and Starving Fibroids

Abdominal Aortic Aneurysm (AAA for short) is an abnormal enlargement of the largest blood vessel in the body and is known as a “silent killer”.

cheema_hallisey_windels (1)More than 200,000 patients are diagnosed annually with an AAA, yet most have no symptoms. Screening for AAA in select populations at risk has been shown to reduce the morbidity and mortality due to this disease.

Conventional treatment of AAAs requires a 12-inch incision in the patient’s abdomen or flank, a two-day stay in the intensive care unit, a week stay in the hospital and a six-week recovery at home. A team of interventional radiologists and vascular surgeons at Hartford Hospital have been pioneers in the development and implementation of a newer approach to abdominal aortic aneurysms 10 years ago.

Using only 2-inch incisions in the groin, a small flexible tube (called a catheter) is introduced into the artery to deliver a metal stent (covered with graft material) into the AAA and eliminate blood flow within the aneurysm. This reduces the blood pressure and flow on the weakened wall of the aneurysm and reduces the risks of the surgery with a shorter hospital stay (on average, 48 hours) and recovery period.

Michael Hallisey, MD, of Jefferson Radiology has been one of the leaders in this new branch of medicine called endovascular therapy and is one of the national leaders in repair of AAAs. An early participant in the landmark clinical trials of this stent-graft repair along with other colleagues at Hartford Hospital, Dr. Hallisey has established the first dedicated and active AAA clinic at Hartford Hospital which is used to follow and counsel patients at risk for AAA.

Interventional radiologists and vascular surgeons bring a wealth of experience to vascular disease. As a board-certified, fellowship-trained vascular and endovascular surgeon and a member of the Vascular Institute, Mohiuddin Cheema, MD, treats vascular disease using either open surgery or minimally invasive procedures.

When a patient’s condition allows a minimally invasive approach, Dr. Cheema repairs aneurysms in both the abdominal and thoracic aortas. He notes that more and more cases are being done minimally invasively and that the benefits are dramatic.

“Using stent grafts to repair aneurysms has reduced mortality from about 15 percent to less than 5 percent,” Dr. Cheema says. He adds that another significant risk of open thoracic and abdominal repair was paraplegia resulting from disturbances to the spinal cord caused by clamping and unclamping the aorta. “The risk of paraplegia is 10 to 15 percent with conventional surgery,” he says. “With minimally invasive stent graft repair, it is less than 5 percent.”

Dr. Cheema also treats peripheral vascular disease—blockages in the arteries of the leg—with minimally invasive techniques that include balloon and drug-eluding stents, lasers and special “cutting” balloons, all of which remove the blockage and eliminate the need for bypass surgery. Instead of an incision from the groin to the calf, patients have just a puncture in the groin, and risks of infection, bleeding, heart attack and stroke are all significantly reduced.

Dr. Cheema and his colleague, Mary Windels, MD, also use minimally invasive, endovascular techniques to open blocked arteries to the intestines and kidneys and to the legs.

Eliminating the Debilitating Symptoms of Fibroids

Interventional radiology has made uterine fibroid tumors—a common but troublesome condition—much easier and safer to treat.

“About one-third of women with fibroids require treatment for them,” says interventional radiologist Domenic Zambuto, MD, past Director of Interventional Radiology at Hartford Hospital and a member of Jefferson Radiology. “In the past, the options were to remove the fibroid surgically, remove the uterus or use hormone replacement therapy.”

Surgery typically involved considerable pain and four to six weeks of recovery, though, and hormone therapy frequently simulated menopause. Fortunately, Dr. Zambuto and his colleague, Dr.Hallisey, are experienced in treating fibroids using a minimally invasive interventional technique called embolization. It eliminates the debilitating symptoms of fibroids by cutting off its blood supply.

“In the angiographic suite, we first map out the blood supply to the uterus,” says Dr. Zambuto. “We then place a microcatheter the size of a piece of spaghetti into the artery supplying the fibroids and inject small particles into the fibroids, blocking the blood supply.”

This starves the fibroids of their blood supply causing them to shrink as well as reduce the symptoms of pain, bleeding and bloating. Most women go home the same day and are advised to rest for about a week.

“In Connecticut, we have the most experience with this procedure,” says Dr. Zambuto. He notes that many women in the country still undergo surgery for the problem simply because their health care providers are unaware of this minimally invasive option. 

Photo Above: Dr. Cheema, Dr. Hallsey, Dr. Windels.

Minimally Invasive Surgery