Wilford Hall Medical Center chosen for national study

  • Published
  • By 2nd Lt. David Herndon
  • 59th Medical Wing Public Affairs
The vascular surgery service at Wilford Hall Medical Center has been chosen to participate in a national trial looking at the effectiveness of stent graft treatment of abdominal aortic aneurysms versus standard open repair. The trial has been named PIVOTAL, which stands for the Positive Impact of Endo Vascular Options for Treating Aneurysms Early.

"We feel privileged to have been asked to participate. Nationally there are only about 60 active centers, only four in Texas," Lt. Col. (Dr.) Todd Rasmussen, chief of vascular surgery services said. "Wilford Hall will be the only center in San Antonio and the surrounding area enrolling patients. We look forward to offering this unique opportunity to all military beneficiaries."

Abdominal aortic aneurysms affect about 1.5 million patients in the United States. A disease of aging, they result from degeneration and expansion of the abdominal aorta before it branches into the leg arteries. The natural history of aneurysms is one of expansion, rupture or leaking which results in about 15,000 deaths per year.

Since the 1950s traditional treatment has been open repair of the aneurysm when it reaches a significant size, where the risk of rupture and death increases. This older operation requires general anesthesia, an abdominal incision, several days in the intensive care unit and an expected stay of five to 10 days in the hospital. Recovery time at home is generally four to six weeks.

In 1997 the Food and Drug Administration approved a procedure for the treatment of abdominal aortic aneurysms which involves placement of a covered stent inside the aorta, sealing the aneurysm and allowing it to decrease in size and heal. The effectiveness and popularity of this endovascular technique has resulted in more than 50 percent of minimal aortic aneurysms treated in this manner.

The stent procedure can be performed through small incisions and often does not require general anesthesia. In addition, this procedure usually requires only one evening in a monitored setting and only a few days in the hospital. According to Colonel Rasmussen there is considerably less discomfort and the recovery time at home is much quicker than after an open operation.

The PIVOTAL study conducted at Wilford Hall will evaluate patients diagnosed with small aneurysms to see if there is an advantage to treating the aneurysms at an earlier or smaller stage. The study will last for approximately five years and will follow both groups of patients closely during this time.

In addition to the potential advantage of early stent treatment, enrollees will benefit from very close surveillance of their aneurysm as well as close monitoring of their cardiovascular risk factors and evaluation of other potential sites of vascular disease.

"This all means a lot for Wilford Hall because we are the only military medical center spearheading this type of study," Colonel Rasmussen said.

The operation was first conducted at Wilford Hall when Robert Gonzales became the first patient in San Antonio to have this therapy for a traumatic aortic aneurysm in the chest. Surgeons from the Wilford Hall group teamed with University Hospital surgeons in August 2005 to conduct the repair.

"This exciting, new and minimally invasive technology also allows surgeons to treat blocked arteries in the legs, which may limit walking, and in the carotid arteries which may lead to stroke," Colonel Rasmussen said.

All interested in being a part of this study should contact the Wilford Hall Vascular and Endovascular Surgery Clinic at (210) 292-5924. (Courtesy of Air Force Print News)