The new device allows doctors to treat aortic arch disease and proximal descending thoracic disease without surgery. Image provided
Arthur Kemp was suffering. He’d had two strokes, and an aortic aneurysm threatened to wreak further havoc. It needed to be treated. During a visit to the MUSC Health Heart and Vascular Center to talk about that, he learned something that surprised him – in a good way.
“I was scared at first because I thought I had to have an operation. But I thank God that I didn’t. And when he told me that, I’m like, ‘Whew!’”
“He” was Mathew Wooster, M.D., a vascular surgeon who’d worked with colleagues to come up with a new device that they could use in cases like Kemp’s, no open surgery needed. Instead, the doctor and his team could use the minimally invasive procedure he patented.
It’s formally called endovascular total aortic arch graft and method of placement. The other doctors on the patent are Sanford Zeigler, M.D., Adam Tanious, M.D., and Ryan Gedney, M.D.
“It came about from a patient need, quite frankly,” Wooster said. “We see a very large number of patients who have aortic arch disease or proximal descending thoracic disease. And there aren’t any true devices that are currently designed for it. Historically, it’s been an area that has only had the option of having open surgical repair.”
The disease involves the aorta, the largest artery in the body. Sometimes, part of its wall weakens due to a medical condition, genetics or trauma. Then, blood pressure can cause a bulge, or aneurysm, in that part of the wall. If the aneurysm gets too big, it can burst or tear the arterial wall. That’s what Wooster’s invention is designed to prevent. It uses what they call a graft, which is a tube, to shore up the weak part of the aorta. The design of the new system is what sets it apart.
“Essentially, our standard devices that existed for this are a straight sort of a tube. It’s a cylinder made of plastic and metal that goes inside, and it’s sort of like a spring that opens up inside of the body and holds itself against the aortic wall,” Wooster said.
“The next step to that is what we call fenestrated devices. They’re things that have a single hole cut out in the side. And you line that hole up with the branches that go to the aortic arch.
“And then our design is sort of a modification of that, where we actually put it distal to the branches so it’s not actually covering anything.” Distal means far from the branches of the the aorta.
“And it has three arms coming out of it. And then we eventually connect those arms up to the brain and up to your arms. So that it seals things off without ever having to obstruct the blood flow to those vessels.”
Wooster, an associate professor of Vascular Surgery at the Medical University of South Carolina, said it adds to patients’ options. Some of those options are being tested at MUSC Health.
“We’re part of clinical trials where we do bypasses from one side of the neck to the other and then have a single hole going into the great vessels. And those early trials are good, but they do still require surgery. They require a bypass from one side to the other. Okay. And they still have that 4% to 10% stroke rate associated with them.”
Wooster said his design is a way to avoid doing a bypass, which reduces that stroke risk. “And it allows us to, what we call ‘fail forward.’ We know aneurysms are degenerative disease. We know there’s a chance they’re going to need another operation in the future. And our design makes it very easy for us to do that if they were to need another operation ever in the future.”
Wooster said they worked with the Zucker Institute for Innovation and Commercialization to patent it. The institute is a nonprofit that examines and manages inventions such as Wooster’s that were created at the Medical University of South Carolina. “This would just be some off-label thing that we do and we keep offering to patients, and it wouldn’t get out there to other doctors as a design if it weren’t for the Zucker Institute.”
Kemp is glad that design was available when he needed it. “I feel much better.”
He had some advice for other patients with aortic issues. “Don’t be scared. Yeah. Because I was very scared. And I just gave it to God. I said, ‘God, you gotta help me with this.’”
Wooster continues to see Kemp for checkups. “He’s doing great. He’s at home. He’s still going to be in close surveillance because he’s still at high risk for problems in the future. But at least for now, his aneurysm is not growing anymore. And he is home and functional and really just back to his baseline before this all started. It’s amazing. Those are the wins that we live for.”
Written by Helen Adams