EVAR: Endovascular Aneurysm Repair
Dr. Papia and Dr. Dueck have been instrumental in pioneering – and advancing — a minimally invasive alternative for treating potentially fatal aortic aneurysms.
Treating aortic aneurysms — blood-filled, balloon-like dilations of the aorta caused by degeneration of the aortic wall — used to require large incisions.
Sunnybrook now offers a state-of-the-art, minimally invasive procedure called endovascular aneurysm repair (EVAR).
“We fix the aneurysms through two small incisions in the groin in the main arteries of the leg,” Dr. Papia explains. “We put up a series of wires and catheters, pre-ordered devices – off-the-shelf devices but custom designed, based on a unique software we have in our clinic.”
Purchased by a generous donor, the software makes matching the size of the medical equipment to patients very accurate, Dr. Papia says.
“Just an example, we did six EVARs last week — none of them stayed past the weekend. They all went home within two days,” Dr. Papia says. “Traditionally with a big, open operation, they have a one- to two-day ICU stay, a one-week hospital stay and a six-week recovery with a much higher complication rate. So this is just an unbelievable piece of technology.”
With hundreds of EVARs successfully completed, Dr. Papia and Dr. Dueck are now setting their sights on advanced EVARs.
“These involve the vessels of the kidneys and the gastrointestinal organs. When aneurysms are involved there, the open procedure becomes much more high risk than the closed procedure,” Dr. Papia said.
Using highly specialized custom grafts and planning out the procedure on the computer, the surgeons are able to take on cases turned down from other heart centres. Until recently, the procedure was funded entirely by donors. Thanks to the work done at Sunnybrook, it is now funded by the Ministry of Health.
Many minimally invasive procedures — for example, EVAR — are born when a Sunnybrook scientist or medical company invents a device that allows for a new way of doing a procedure. Then, staff becomes trained on the new procedure, and the surgeons, imaging scientists and researchers all then work together to perfect its delivery. Sunnybrook Foundation raises money to fund it so enough procedures can be performed to show the Ministry of Health it works, and works well.
So, Dr. Strauss says, Schulich’s experts have to know what’s going on in terms of the latest technology.
“We have to be at the table when the new technology comes out, and make sure we have access to it,” he says.
What does the future hold?
While most minimally invasive valve procedures are presently reserved for high-risk patients, Dr. Radhakrishnan thinks that will change in the near future.
“In five to 10 years, we’ll see these minimally invasive techniques used on a larger subset of patients for their cardiac disorders,” Dr. Radhakrishnan says. “Certainly the skill sets of the operators and the technology will evolve and improve. And, equally important, the detailed non-invasive imaging needed to allow for further advances in these therapies will also improve.”
Advances in imaging play a huge role, Dr. Strauss says.
“We have Dr. Graham Wright, who is the director of research for the Schulich Heart Program and he is an imaging scientist,” Dr. Strauss says. “He understands how imaging contributes to the planning and the carrying out of the procedure. He’s been very involved in trying to develop new imaging techniques, especially with MRI, to help us move forward.”
Inventing and perfecting minimally invasive procedures is a natural fit for Sunnybrook, he says.
“I wish we just had more hours in the day,” Dr. Strauss says. “That way, we could develop all the stuff that we could because we have everything here to make ourselves an incredible place of innovation.”
But for patients like Steve Segal and Ron Armstrong, Sunnybrook is already a place of innovation.
“They gave me a new lease on life,” Ron says. “The older we get, the more risky open surgeries are. But the team at Sunnybrook explained it all to me and I wasn’t nervous at all. Now, I walk a couple miles a day. I golf. I’m really thankful.”