Winter 2006

Stent Graft Repair of Thoracoabdominal Aneurysms

Many years after pioneering the use of branched stent grafts to fix thoracoabdominal aneurysms, UCSF physicians are now taking the lead in a clinical trial that may firmly establish the efficacy of the devices.

"Using stent grafts to fix thoracoabdominal aneurysms offers a big advantage over the current surgical approach, which is associated with a high morbidity and mortality, even in the best hands," says UCSF vascular surgeon, Timothy Chuter, M.D.

"Five years ago, we started doing these with homemade devices, and our patients did very well," says Chuter. Since last autumn, though, Chuter and his colleagues have been working with stents especially made for this purpose by Cook in Australia. "With the standardized equipment, we are able to work with more patients," he says.

This method of thoracoabdominal aneurysm repair is just the latest in a series of innovations. Chuter was the first to use bifurcated stent grafts for abdominal aortic aneurysms and arch aortic aneurysms, the first to use modular multi-branched stent grafts for common iliac aneurysms, and the first to perform endovascular repair of inflammatory aneurysms and aortobronchial fistulae. He continues to be an innovator. "By the time a therapy becomes standard practice, we have already moved on," Chuter says.

This form of translational research allows Chuter and his colleagues to apply catheter-based techniques in a wide range of aortic diseases. "Access to new technology and experience in challenging cases have allowed us to help many patients who have been told elsewhere that they have a dreadful problem that can't be treated," Chuter says.

The group is not only actively involved in developing stent technology, but is also concerned with improving devices to make them function reliably for a longer time. "Some of the early models were not durable, so we conducted research to identify the long-term failure modes and address underlying problems," Chuter says. "The result is that we can do repairs that we know are going to be stable."

"Basic research in the past has focused on the biology of the disease, but the clinical efforts we are undertaking now are part of our applied technology research. The Heart and Vascular Center provides us with an arena in which we can bring to bear technology that hasn't been available in this way before."

To contact Dr. Timothy Chuter, call (415) 353-4366.

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