New procedure uses a small incision to insert a tube into torn artery
By Robyn Shelton
Kurt Davis, with his damaged Yamaha motorcycle at a body shop recently, suffered a partially torn aorta in a June motorcycle accident. Davis, who lives in Brevard County, underwent an innovative surgery at Florida Hospital in Orlando that inserted a patch into the damaged aorta.
ORLANDO, Fla. – One moment, Kurt Davis was making a turn on his Yamaha motorcycle. The next, he was flying 25 feet through the air and slamming into the grass on a stranger’s front yard.
Witnesses told Davis that he rolled around and even tried to get up before lying still, barely conscious. Davis remembers the struggle to breathe, the pain from broken bones and the panicked feeling that he might die. He was right.
Deep inside his chest, the main artery in his body – the aorta – had been partially torn in the impact. An estimated 8,000 Americans suffer from these often-fatal injuries every year after blunt trauma.
But unlike most patients, Davis’ aorta was repaired with a new method that allowed him to avoid major surgery and the blood transfusions that often accompany it.
Working through a small incision in the groin area, Dr. Robert P. Winter fixed the damage by placing a fabric-covered tube inside the artery to create a new lining. Doctors have only recently begun to use the technique on torn aortas.
They expect it soon will replace the traditional surgery, which involves making a large incision in the chest, spreading the ribs to reach the aorta and sewing the damaged artery. The operation can take four hours and almost always requires blood transfusions.
It’s a lot for someone to endure, especially after already having been through a violent accident.
“The patient in these circumstances is usually dealing with multiple, other injuries: brain injuries, spinal-cord injuries, fractures,” Winter, a vascular surgeon with Florida Hospital, said. “But with this technique, we’re able to eliminate a life-threatening problem without subjecting the patient to additional trauma.”
For Davis, 21, the experimental surgery was not just the easier option for his fragile state. It was his only hope.
As a Jehovah’s Witness, Davis believes that blood transfusions are prohibited by the Bible. He said he had decided long before the accident that he would never accept blood, even if it meant he could die.
After being taken initially to a hospital in Melbourne, Fla., Davis was flown by helicopter to Orlando, where Winter had agreed to attempt the repair with the less-invasive method. The doctor had never fixed a torn aorta in this manner before. But the situation required it.
“Left untreated, this injury is going to be fatal,” Winter said. “We knew the risks going in, but if we did nothing, (Davis) was not going to be alive in a couple of hours.”
To do the procedure, the doctor makes a small incision in the groin area to tap into a major artery in the leg. Using X-rays to see inside the patient, the physician pushes a long, thin tube into the artery and navigates through the body to the damaged aorta.
The doctor then releases a small cylinder that expands to fit snugly at both ends of the torn area, creating a new, unbroken passageway for blood.
“It’s kind of like taking a garden hose with a leak and putting a new tube inside to stop the leak,” Winter explained. “We’re basically putting a tube inside the artery to reline the damaged portion.”
The same method has been used since the late 1990s to fix another condition in the aorta, aneurysms or weak spots.
When patching an aortic tear, doctors actually are using devices that were designed for these aneurysms. The company that makes the devices, W.L. Gore & Associates, estimates that only about 200 patients nationwide have been treated for a torn artery with the less-invasive method.
Dr. Grayson Wheatley and his colleagues at the Arizona Heart Institute in Phoenix are pioneers in using the new techniques. Wheatley estimates that about 20 patients with torn aortas have been treated with this method at his center since 1998, including a recent victim of a sky-diving accident.
He said the location of aortic tears – typically in a curved portion of the artery – makes the procedure technically difficult. Doctors need to follow the patients carefully to make sure the repairs hold up over time, Wheatley said. One concern is that these injuries often occur in younger patients who have decades of life ahead of them.
“You’re talking about putting an unproven device in someone who is 18, 20 years old and there’s no data yet to say what’s going to happen in the future,” said Wheatley, a member of the Society of Thoracic Surgeons.
Still, Wheatley said there are clear advantages to the new procedure. And in his experience, patients do very well afterward. He expects the less-invasive method to become the main treatment for aortic injuries in time.
“There’s no question that this is the treatment of the future,” Wheatley said. “When I see how well patients recover after (the new procedures), it’s clear this will play a very important role in the management of aortic diseases.”
For Kurt Davis, every passing week brings him closer to a full recovery. The motorcycle accident occurred in June when he lost control of his bike on a winding road and crashed into a low concrete wall.
In addition to his torn aorta, Davis suffered broken bones in his knee, wrist, finger and collarbone. His bones are healing, and he faces no limitations from the tiny tube that is holding his aorta together.
“I feel actually almost back to normal,” Davis said.