Drs. Zachary Baldwin (left) and Sumona Smith show off the state-of-the-art stent graft.

UMMC surgeons employ revolutionary procedure for minimally invasive repairs

 Patients suffering from complex aortic aneurysms have a new treatment option available only at the University of Mississippi Medical Center (UMMC) that offers a chance at life without fear of the ticking time bomb in their chests exploding.

“In the past, patients who weren’t a candidate for open operation had no real options for repairing aneurysms that involve branches which feed major organs, such as the brain, liver, or intestines,” said Zachary Baldwin, MD, assistant professor of surgery at UMMC. “They oftentimes were sent home to wait for it to burst.”

Baldwin and Sumona Smith, MD, also an assistant professor of surgery at UMMC, performed Mississippi’s first endovascular fenestrated repair of a thoracoabdominal aneurysm on Sept. 30. Using this fenestrated technology, they were able to treat the patient’s aneurysm while maintaining blood flow to all vital organs.

Here’s how it works: The stent graft is inserted percutaneously using a needle, wire and a sheath (or tube) about the size of a pencil. The procedure uses a stent graft that is customized by the surgeons and designed specifically for the patient’s anatomy. Through these holes, smaller secondary stents are placed to bridge the main graft to those vessels serving vital organs such as the kidneys, liver or bowel. 

“It’s akin to bypassing the aneurysm by building a new freeway for blood flow while also installing the necessary off-ramps needed to keep vital organs alive,” Baldwin said, adding that previous treatment options carried a high risk of death and a major operation that involved a large incision from the chest down to the groin area. “This technology allows treatment of these aneurysms in a very minimally invasive, incision-less fashion. We can do these procedures without having to enter the abdominal or thoracic cavity, which would have been necessary just five years ago.”

This treatment option is so new that only a few select centers have been doing it for three or four years, noted Smith.

“It gives us an option as an academic medical center to treat these complex aneurysms,” she said.

Many patients who have this condition are either sick or elderly and don’t qualify for the more invasive treatment options, Smith pointed out, adding they are also not eligible for traditional endovascular stent graft because of the location of the aneurysm.

Even though the graft used in the surgery is metal and cloth, it’s expensive. A large graft costs $12,000 to $15,000; a small graft runs $2,000 to $3,000. The manufactured graft is altered by the surgeons to create the branch grafts because they must be tailored for the patient’s particular condition.

The importance of this life-saving technology is immeasurable, said Baldwin.

“With the ability to do these, we can treat any aneurysm anywhere in the body,” he said.

Smith, a vascular surgeon, joined the UMMC Department of Surgery in July, allowing the department to offer aneurysm surgery. A 2002 graduate of the UMMC School of Medicine, she completed her surgery residency at the Emory University School of Medicine in 2009. As a research fellow in Emory’s Division of Vascular Surgery and Endovascular Therapy, she authored and coauthored papers on aortic aneurysms that were published in vascular surgery journals.

Baldwin, who joined UMMC in 2008, earned a medical degree from the University of Chicago Pritzker School of Medicine. He completed his general surgery residency training at the University of California (UC), San Francisco-East Bay. During residency, he returned to the University of Chicago, where he undertook a research fellowship. He also obtained specialty training at UC-San Francisco, where he finished fellowship training in vascular and endovascular surgery.

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