A first-of-its-kind operation has been performed in the UK using a newly developed medical device, the Zenith® Helical Branch Iliac Endovascular Graft from Cook Medical. Mr Ferdinand Serracino-Inglott, one of Europe's most experienced vascular surgeons, carried out the complex medical procedure on an 81 year old man at the Manchester Royal Infirmary using the Helical Branch Endograft from the Aortic Intervention business unit of Cook Medical, the global sales and technology leader in endovascular therapy products. The patient, Mr Dennis Ryan, was suffering from an aortic aneurysm (a weakening of the wall of the aorta), a condition that kills around 7,000 people in the UK every year.

Unlike more common aneurysms, Mr Ryan's aneurysm extended from his abdominal aorta into his iliac artery, the main blood supply to the legs. This extension made the operation a more complicated procedure than if the aneurysm had only affected the aorta. To perform the operation, Mr Serracino-Inglott had to seal off both aneurysms, without restricting the blood supply to the patient's legs. If the blood flow is interrupted, he explained, the elderly patient could have experienced numerous disabling problems.

The minimally invasive operation took place on 12th September and lasted two hours, and the patient's general condition has been closely monitored since then. Mr Ryan made a good recovery, and within four weeks of the operation, was back to day to day life. Such a quick recovery would not have been possible with open surgical replacement of the diseased aorta, highlighting the potential patient benefits of the minimally invasive endovascular aneurysm repair (EVAR) procedure in complex cases.

Mr Serracino-Inglott explains: "Mr Ryan's case was slightly more complex than usual since the aneurysm not only effected the aorta but also the left common iliac artery. Using any other stent-graft would have resulted in us cutting off the blood supply to the buttocks and pelvis on this side. This could have given rise to buttock pain on walking, bowel problems and impotence.

"Cook Medical's Zenith® Helical Branch Iliac Endovascular Graft enabled me to repair Mr Ryan's common iliac aneurysm whilst still maintaining a good flow of blood to the internal iliac arteries (blood vessels to the pelvis and buttocks)." This was the first time that Cook's helical branched endograft has been used in the UK, and reflects the great strides being made in product innovation by medical device manufacturers such as Cook Medical.

Phil Nowell, global leader of the Aortic Intervention business unit of Cook Medical, explains: "We developed this product specifically to enable surgeons to treat complicated conditions such as Mr Ryan's using EVAR. By continuing to focus on product innovation we hope that more and more patients can experience the reduced trauma and improved mortality rates offered by EVAR rather than having to undergo the far more invasive and potentially debilitating open surgical alternative."

What is an aneurysm?

An aneurysm is a bulge in the arterial wall caused by blood pressure pushing against a weakened area. Aortic aneurysms occur either in the chest (a thoracic aortic aneurysm - TAA) or in the abdomen (an abdominal aortic aneurysm - AAA). When the aneurysm reaches a certain size (typically larger than 5.5cm in diameter) it is considered at risk of rupturing. A burst aneurysm results in severe internal blood loss and is usually fatal. In some AAA cases, the aneurysm can extend down into the iliac arteries, which supply blood to the legs. This is a more complex condition to repair, requiring the more advanced endograft designed by Cook Medical.

How is an aneurysm repaired?

To repair an aneurysm, a stent-graft is guided into the body using a catheter-based delivery system. Once inserted into the aorta, the stent-graft - a tubular fabric device supported by self-expanding metal stent bodies - is released inside the diseased section of the aorta where it expands and seals off the aneurysm from within, relieving blood pressure against the weakened walls of the aorta, the body's main blood vessel, to reduce the risk of premature rupture.

About the operation and device

The operation performed is known as EVAR. This stands for EndoVascular Aneurysm Repair, a relatively new procedure rapidly gaining wide acceptance in the medical community in the UK and around the globe. Traditional open surgery, which involves a general anaesthetic and making a large incision the length of the abdomen to clamp off the aorta and replace the damaged section with a surgical graft, can lead to serious complications and extended recovery times. Instead, the patient was treated using minimally invasive endovascular therapy, with the medical team inserting catheters via two small incisions in the groin to access the femoral arteries. The delivery system carrying the stent-graft is precisely positioned over the guidewires, where the device was deployed to treat the aneurysm. This kind of minimally invasive repair frequently results in less patient discomfort and complications, a shorter hospital stay and faster recovery than undergoing the more traumatic open surgery.

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About Cook Medical

Cook Medical was one of the first companies to help popularise interventional medicine, pioneering many of the devices now commonly used worldwide to perform minimally invasive medical procedures. Today, the company integrates minimally invasive medical device design, biopharma, gene and cell therapy and biotech to enhance patient safety and improve clinical outcomes in the fields of aortic intervention; interventional cardiology; critical care medicine; gastroenterology; radiology, peripheral vascular, bone access and oncology; surgery and soft tissue repair; urology; and assisted reproductive technology, gynecology and high-risk obstetrics. Founded in 1963 and operated as a family-held private corporation, Cook is a past winner of the prestigious Medical Device Manufacturer of the Year Award from Medical Device & Diagnostic Industry magazine.

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