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I'm only a geek though, an interview I did yesterday...full post at the blog with pictures. This is hopefully done so anyone can read and understand. I learned a lot too, and a bit of study for me ahead of time .
Today I was fortunate enough to spend a few minutes with Dr. Muhs from Yale University Medical Center and learned about endovascular surgery, in particular, we spoke about aneurysm detection,
treatments and overall about the technology today that is used to treat
patients with aneurysms. Some very well known celebrities have been
victims and lost their lives due to either an undiagnosed or non
treated condition, such as Albert Einstein and Lucille Ball he informed
me. The images within are from Cook Medical and may not be
representative of the actual catheters used.
A little bit about Dr. Muhs below and you can also follow the link to view his full profile as published on the Yale University website.
Assistant Professor of Vascular Surgery and Radiology Co–Director of Endovascular Surgery
Vascular and Endovascular Surgery
Muhs is an active investigator in the design and implementation of
clinical trials in the area of vascular disease. He is the principal
investigator on all of the endovascular trials conducted in the Section
of Vascular Surgery at Yale University School of Medicine.
Muhs could you tell us a bit about what you do at the Yale University
and perhaps a little about the Vascular Surgery Department and share
some information about your background in endovascular surgery?
In addition to my credentials in vascular surgery I also am a interventional radiologist
whereby minimally invasive procedures are mapped via images, to plan
the course of action and navigation to target the affected area, in
other words with software imaging the surgical procedure is fully
planned and charted out before beginning a procedure.
When an aneurysm
is detected, it is important to be evaluated and treated immediately,
as 50% of patients with a ruptured aneurysm will survive. An aortic aneurysm when ruptured and left without treatment can also result in sudden death, so timing is important.
have a greater risk than women and family heredity plays a key roll, in
other words if someone in the family has suffered from an aneurysm,
there’s a possibility that the odds of you having one will be greater.
90% of aneurysms are asymptomatic,
in other words there is no warning signs or pain associated. They also
tend to occur more frequently in aging individuals, those over 60 or
so, but individuals of a younger age can also suffer from one,
especially if they happen to run in the family.
When diagnosed with an aortic aneurysm,
there are two basic surgery options. The first is to have to have a
procedure with a long incision that goes almost down the full length of
your chest to operate. This has been the long time surgical procedure
that most are aware of. The second option, which we are discussing
here is the minimally invasive procedure of inserting a stent to
accomplish the same goal, and yet have either no incision or one that
is only one inch long.
There are pros and cons to both and both end up with the same outcome; however, with a endovascular aneurysm repair (EVAR)
many older individuals can also be treated who may not be potentially
able to survive the full open chest surgical procedure, and the
recovery time is much less to say the least.
Is recovery time less with the stent and repair?
first procedure is major and requires not less than a week or two in
the hospital for recovery, while with the endovascular aneurysm repair
patient stays over night and goes home the next day. There’s a big
difference right there. Basically for the first procedure to work, a
patient has to first be in pretty good health, otherwise the chances of
survival get lower. There is one trade off with having the EVAR
surgery and that is a lifetime commitment to regular check ups
to ensure the stent has not moved or slipped and is still functioning
as it should, so once a patient has had the device surgically placed,
they should return once a year for a check up and
some type of imaging performed, which could be ultra sound, CT scan or
an MRI. All images generated would provide the visual to review and
ensure the stent is still doing the job and has not shifted.
How long has this procedure been in use?
The FDA procedure was first introduced in the US in 1991;
however the first such EVAR procedure was done in Argentina in 1991,
and the patient continued to live for many years there after. I am
often asked about the longevity of how long the stents will last, and
as of this point I can’t predict or extend out to 20 years as we simply
do not have any clinical data that can give that information. We have
data on 10 years based on patient information. I have completed around
200 of these procedures. As is with many devices in place today and
with the technology still developing and in essence being relatively
new, we simply don’t know what the outcome will be in 20 years.
Has there been any problems or noted issues?
the 200 stents in place, only 2 have had to be removed, and again the
overall patient health and the possibility of complications from other
health issues could also have some impact on those that are removed.
Tell me a bit about the stent technology, are they ready for surgery off the shelf?
are several manufacturers of catheters and I use several, many from
Cook Medical. I had the opportunity to work in the Netherlands before
coming to Yale and in Europe the EVAR technology is a bit more advanced over what has been FDA approved in the US,
thus I was able to work with stents that had not yet been approved
here, with newer technology in clinical trials. At Yale University we
are also engaged in clinical trials with stents as well as several
other major health institutes such as the Mayo Clinic and Cleveland
Basic endovascular repair is becoming more common place
as treatment procedures with technology advance. As an example, with
one of the devices used frequently on surgical procedures in the US, is
on the 4th generation of the product. At Yale, we are working with the 5th and 6th generation of the stent. By contrast in Europe, they are already working with the 7th and 8th generation
of the EVAR stent product, so as you can see my time spent in the
Netherlands allowed me to work with products and technology that have
not been approved and cleared for use by the FDA but had been fully
approved and are in use in Europe. I was able to bring some of this
knowledge and expertise with me when I came to Yale.
How expensive are the stents and do hospitals have them available at all times?
Yes they are a bit costly and each device is around $13,000.00.
When I first came to the facility, we were having to order the stents
from the manufacturers and in the case of an aortic aneurysm time is of
the essence and the facility would ship one out “express” to the
hospital, but as more and more patients are being treated this was
becoming non-efficient, so now we work with the various manufacturers
and store the stents at the hospital and we are not charged until one
is used. There is also the possibility that the stent could be dropped
on the floor, which has not happened yet, but a replacement would be
readily available just in case. That has made a huge difference.
Do you keep the devices under lockdown due to the value?
We use an RFID tracking system for all,
so this way we have full control and knowledge at all times as to their
locations and how many we have at the hospital. EVAR stents come in
many sizes as do people, so a number of sizes need to be available to
meet the needs of the patient requiring surgery.
Does insurance cover the procedure?
Yes insurance companies are covering the EVAR procedure.
The cost, when it is compared to the extended stay at the hospital and
the expenses that are incurred for recovery of a full procedure versus
having the stent inserted pretty much equal about the same amount of
money, with the only difference being the patient coming in once a year
for a check up and image, and that over the years adds a little more to
the total bill, but again that can be done with an ultrasound to check
and make sure the catheter is still in place and doing it’s job. Most patients who undergo the EVAR procedure do not experience any ICU time.
visits and screenings are important as you may remember the case in the
news recently with John Ritter having an undiagnosed tear, so I am a
big promoter of patients being screened. As mentioned before most
aneurysms are found when patients are being consulted and treated for
other health conditions as there really are no symptoms for most individuals. Medicare is also now paying for one screening for men who have every smoked at any time in their lifetime.
How long does it take you to prepare for surgery for this procedure?
It takes me about 15 minutes as I use the software imaging program to map and target exactly
where the stent needs to be placed. By using the software I can rotate
and move the image in any direction and this also helps in determining
the size and brand of the device to be used for this patient. I have
been doing the procedure for a while now and someone who is not as
experienced or new might need an hour or so do accomplish the same with
the software. The procedure itself takes about an hour and a half to complete.
At present there are 5 of us at Yale who perform the EVAR procedure.
I read so much today about telemedicine, can this procedure be done remotely?
As of today, no, as there are no robotics involved here and that is pretty much how surgery is done from a remote location.
How do most patients react to the opportunity to have a procedure that is minimally invasive and allows a shorter recovery time?
Patients are basically the focal point driving the surgical technology as we see it today. Shorter recovery times coupled with procedures that involve either one small or no incision are very much in demand and I look for the same to continue for years to come.
Thank you very much for your time and in turn it was a good educational process for me as well!
End of Interview
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