Gut Check: Leading the Way with Minimally Invasive Abdominal Aortic Aneurysm Surgery

Charles Fieglein, 66, leads an active life, repairing power lines and motorcycling along Tristate roads on his days off. When TriHealth doctors found a growing bulge in Fieglein’s abdominal aorta in 2015, Fieglein’s lifestyle and his life were put in jeopardy. The abdominal aortic aneurysm, left untreated, could eventually burst and cause potentially fatal bleeding.

TriHealth Heart & Vascular Institute vascular surgeon Matthew Recht, MD monitored Fieglein’s aneurysm for several months and then recommended surgery only when the aneurysm’s size posed a significant risk of rupturing.

Fieglein had never had surgery, but he praises the minimally invasive aneurysm repair performed by Dr. Recht and his partner Patrick Muck, MD: “I can’t believe how easy it was. There was no pain afterwards, and I felt a lot better. The pain in my stomach was gone.”

Looking back a year after his surgery, Fieglein relates that the aneurysm first made its appearance during his emergency room visit more than two years ago. He was at home on his couch when abdominal pains brought him to his knees and sent him to TriHealth’s Good Samaritan Hospital Emergency Department. A CT scan revealed the aneurysm as well as some spots on his lungs. The aneurysm wasn’t large enough to warrant repair yet.

The lung spots disappeared, but over the next year, Dr. Recht kept an eye on the slowly growing aneurysm. When the size of the aneurysm reached 5.3 cm (about two inches across), Dr. Recht recommended that Fieglein have a minimally invasive procedure called percutaneous endovascular abdominal aortic aneurysm repair (PEVAR) to relieve pressure on the weakened area.

Dr. Recht explains in simpler terms the surgical technique that he and his partners introduced to Cincinnati in 2011: A patient receives light sedation and a local anesthetic. Then, small (less than 1 cm) incisions are made in each groin. Surgeons insert hollow tubes called sheaths into those openings. About the diameter of a pencil or a Sharpie (depending on the size of the stent needed), the sheaths are threaded through the femoral arteries in the groins and into the abdominal aorta.

One of the sheaths carries a stent graft that surgeons can place inside the aorta. As Dr. Recht explains, “The stent graft is an artificial tube that allows the aneurysm to be excluded from the circulation. The stent graft is anchored in a normal portion of the artery above and below the aneurysm. This decreases the pressure in the aneurysm and prevents it from rupturing.”

“With PEVAR, we have fewer groin complications, fewer infections, less pain and quicker return to work and activities than open surgeries with large abdominal incisions,” Dr. Recht says.

Fieglein can attest to that. “After surgery, I had no pain and no problems. I stayed in the hospital overnight and just had to take it easy for about 10 days. Dr. Recht did a really great job. The nurses and doctors were so nice. They took great care of me.

“A couple of months later, Dr. Recht said I could work out, lift weights or do anything I wanted.”

He’s working and back to riding his motorcycle with friends. At his first annual checkup, his aneurysm had shrunk by more than 2 cm.

In 2013, TriHealth physicians were first to perform a variation of PEVAR for people with an aneurysm near the kidney arteries. These patients receive custom-made fenestrated grafts (grafts with precisely placed openings) to allow blood flow into the kidney arteries.

Performing up to 100 PEVAR procedures each year, Dr. Recht and fellow surgeons are testing new, more flexible grafts. They also train other physicians from around the country on PEVAR techniques.

“The potential for minimally invasive aneurysm repair continues to grow,” says Dr. Recht. “It’s gratifying to help increasing numbers of people with a procedure that keeps getting better and better.”