Cover Stories
Christie surgeon appears on national TV
Photo by: Christine Walsh
A Christie Clinic vascular surgeon recently had a national platform on which to raise awareness of innovations in treatment options for abdominal aortic aneurysms.
Dr. Jennifer Ash was featured on the Lifetime TV series “Access Health,” which aired on Feb. 13 and 20. The episode was titled “Abdominal Aortic Aneurysms – Understanding Your Options.”
“It (an abdominal aortic aneurysm) is a widening out of the abdominal aorta that bulges over time and puts the patient at risk for a rupture,” Ash said. “If left unchecked, it could explode or rupture, which is obviously often fatal.”
Abdominal aortic aneurysms (AAA) are often termed the “silent killer” because there are no warning signs until they rupture, an event that can lead to death 90 percent of the time. “Until it ruptures, there are no symptoms,” Ash said. “You have no idea.”
After it ruptures, patients can pass out from blood loss, and there is intense pain. When it gets to that point, Ash said, time is of the essence when it comes to treatment.
“Screening is recommended for all men over 65 who have smoked at least 100 cigarettes in their lifetime and for women over 75 in that same situation,” Ash said. “The other factor is if there is a strong family history.”
Diagnosis is typically done with an abdominal sonogram. Follow-up is typically done on an annual basis, with repeat sonograms to make sure the aneurysm isn’t growing and if so, that it is not at a rapid rate, which would be a reason to repair it.
The more conventional surgical repair, which has been done for decades, requires a long abdominal incision. “In the old days, you made a big incision in the belly,” Ash said. “That’s a major surgery, as you can imagine.”
The newer standard in care is abdominal endovascular aneurysm repair (EVAR), a more minimally invasive method in which a stent is inserted to reline the blood vessel. Ash compares it to a cardiac catheter. With the new procedure, 70 to 80 percent of the time, no incision is needed and time in the hospital is vastly reduced.
“Endovascular repair is essentially a means by which you can access the aorta,” Ash explained. “We use a stent, but instead of a big, metal stent we use a coated stent. It’s essentially repairing the aorta from the inside out.”
Although 21 percent of AAAs in the United States occur in women, only 6 percent to 10 percent of patients enrolled in endovascular AAA investigational device studies are female “because their vessels are too small to handle it,” Ash said. Women have traditionally had limited eligibility because 30 to 40 percent don’t meet the necessary criteria and worse outcomes after EVAR.
Women tend to have much higher rates of complication with the “large, stiff, clunky delivery systems,” Ash said. “The complications with that are much higher.”
Women die more frequently after an aneurysm. And women were often delaying treating diagnosed abdominal aortic aneurysms because of fear of the procedure, Ash explained. “So it’s kind of a domino effect,” she said.
Ash was the national chairperson of the LUCY Study: Evaluation of Females Who Are Underrepresented Candidates for Abdominal Aortic Aneurysm Repair (LUCY), serving with five other female surgeons. They helped to develop the procedure for the first prospective trial to assess outcomes of minimally invasive AAA repair in women versus men.
The name LUCY was chosen in honor of actress Lucille Ball, who died of a ruptured abdominal aorta.
The initial results of the LUCY study suggest that women treated with a delivery device called the Ovation Abdominal Stent Graft System have similar procedural outcomes, no death, no conversion, low 30-day major adverse event rates and low rates of endoleaks at 30 days compared with the men in the study. “Of all the devices on the market, it’s the smallest and most flexible,” Ash said. Previous delivery devices were “not particularly well suited to the female anatomy,” Ash said. “One of the challenges with the female anatomy is they typically have small, kind of delicate blood vessels.”
The Ovation graft’s smaller profile and increased flexibility than others on the market, making it better for not only smaller blood vessels but tortuous, or winding, ones. In the past many women were not offered repair because it was believed the risks were too high.
“It was a very difficult study to get off the ground,” Ash said. “A lot of institutions and surgeons felt it wasn’t necessary.”
An analysis comparing the outer diameters of several EVAR delivery systems and the maximum diameter of the iliac access vessels of LUCY patients shows that Ovation would expand eligibility for women with AAAs by at least 28 percent.
Ash has traveled to Europe and Australia to present the study results. “It ended up being a landmark study,” Ash said. “Nobody had ever done it before. It gained a lot of traction.”
The makers of “Access Health” wanted to do a show about aneurysms. In their research, they discovered the LUCY trial and asked Ash to appear on the program to discuss it.
Ash has three things that she would like for people to take away from her appearance on “Access Health.”
The first would be more recognition of the prevalence and the severity of the problems facing women with AAAs and encouraging those with risk factors to be proactive and get screened.
The second would be to alleviate fears that previous led diagnosed patients to avoid treatment. “In 2019, it is not what it was 20 years ago,” she said.
Lastly, she wanted to increase awareness that more women can be candidates for this therapy. “Contrary to popular belief, the days are over of having patients being turned down because men are assumed to have higher risk,” Ash said.
Ash said that the problems that the study addresses seem to be universal. “I think it is the case everywhere around the country,” she said. “What I’ve found is it’s the case around the world. Ultimately we were all referring to the same clinical trials.”
There are new technologies coming out constantly, according to Ash. “There’s so much crazy, fun stuff in research and development,” she said. “That’s the fun thing about this specialty. There’s so many ways you can treat from the inside out, with balloons or stents or stent grafts. Every month there’s something new we can test to have better experiences, no matter where the artery.”