UMass Memorial Center for Complex Aortic Disease

          
  Background   Recent Cases   Improved Patient Satisfaction
  Recent Publications   Simplified Referral System   Fenestrated & Branched
  Endografts
  Innovative Care   Appointments in 24 Hours   Future Directions


Dear Colleagues,

It’s my pleasure to provide you with an update on behalf of the multidisciplinary UMass Memorial Center for Complex Aortic Disease. With access to a growing number of endovascular devices through our participation in industry trials, as well as through our physician-sponsored Investigational Device Exemption (IDE) trial, we are now able to offer most high-risk patients with complex aortic aneurysms a minimally invasive repair option.

With our current portfolio of 17 clinical trials, we have now performed over 200 fenestrated and branched endovascular repairs for complex aortic aneurysms involving the abdominal aorta, thoracic aorta, thoracoabdominal aorta and aortic arch.

We are encouraged by the early and midterm results that we have achieved in the Complex Aortic Repair with Physician Modified Endografts and Custom Made Devices trial (CARPE-CMD, IDE: #G130210, clinicaltrials.gov: #NCT02050113). The CARPE-CMD trial is a safety and feasibility study evaluating custom-made commercial endovascular devices (with up to five branches or fenestrations), as well as physician-modified endovascular devices (with up to five branches or fenestrations).

First and foremost, ensuring outstanding patient outcomes continues to be our guiding principle. Despite having treated a wide-range of complicated patients (all deemed high-risk for open repair) with fenestrated and branched endografts, we have seen great results:
• Our technical success continues to be over 90 percent
• Our 30-day mortality for the last 125 patients treated is less than 2 percent
• Our one-year survival with complete aneurysm exclusion is above 90 percent.

To date, we have not observed any aortic aneurysm ruptures during follow-up. In our published series of the first 100 patients treated (Schanzer et al, Journal of Vascular Surgery, March 2017), as the complexity of the repairs has increased, there has not been any increase in the rate of morbidity or mortality.

A critical component of ensuring excellent outcomes has been the creation of a structured multidisciplinary aorta team that takes care of each patient at every step of the process: from the preoperative evaluation through the inpatient hospital stay and through each follow-up visit. This programmatic approach to patient care has allowed us to identify and respond to problems early in their course. Our experiences have allowed us to derive process measures that ensure the best outcomes for our patients. For patients referred from a distance, we work with the referring provider to ensure follow-up at their site or at ours, depending on provider preference.

If you would like to learn more about the UMass Memorial Center for Complex Aortic Disease, don’t hesitate to call me.

Warmest Regards,

Andres Schanzer, MD
Chief of Vascular and Endovascular Surgery
UMass Memorial Medical Center


Background 

As part of the Heart and Vascular Center, the UMass Memorial Center for Complex Aortic Disease (CCAD) provides comprehensive care for patients with complex aortic aneurysms involving the abdominal, thoracic, and thoracoabdominal aorta. Under the leadership of our division chief, Dr Andres Schanzer, and with the strong support of Dr Louis Messina, our Division of Vascular and Endovascular Surgery has developed a multidisciplinary approach to achieve outstanding patient outcomes. The idea for this program began back in 2008, with our Division's mission to become an internationally recognized center of excellence for the endovascular treatment of complex aortic pathology, from the aortic valve to the external iliac artery. We are now able to offer high risk patients with complex aortic disease a minimally invasive repair option. We recently celebrated a milestone, having performed over 100 complex endovascular aortic repairs!

We are proud to be one of a few select centers in the country that is conducting a special type of clinical trial that studies endovascular aortic repair with devices that are tailored to a patient’s specific anatomy (both physician modified endografts and custom made commercial devices). This form of personalized medicine has enabled our group to obtain excellent outcomes in many patients who were previously told they had no available treatment options. 

In our last 125 repairs,
our 30 day mortality is less than 2 percent


Our Recent Publications

Dossabhoy SS, Simons JP, Diamond KR, Flahive JM, Aiello FA, Arous EJ, Messina LM, Schanzer A.Reinterventions after fenestrated or branched endovascular aortic aneurysm repair. J Vasc Surg. 2018 Mar 6. pii: S0741-5214(18)30143-5. doi: 10.1016/j.jvs.2017.12.036. [Epub ahead of print] PMID: 29523438

Schanzer, A, Simons, J, Flahive, J, Durgin, J, Aiello, F, Doucet, D, Steppacher, R, Messina, L. Outcomes of Fenestrated and Branched Endovascular Repair of Complex Abdominal and Thoracoabdominal Aortic Aneurysms. Journal of Vascular Surgery. 2017 Mar 1. pii: S0741-5214(17)30101-5.

Simons, J, Shue, B, Flahive, J, Aiello, F, Steppacher, R, Eaton, E, Messina, L, Schanzer, A. Trends in use of the only FDA-approved commercially available fenestrated EVAR device in the United States. Journal of Vascular Surgery. 2017 Feb 19. pii: S0741-5214(16)31663-9.

Schanzer, A, Baril D, Robinson, W, Simons, J, Aiello, F, Messina, L. Developing a Complex Endovascular Fenestrated and Branched Aortic Program. Journal of Vascular Surgery.2015: March; 61(3): 826-31.

Dr Schanzer and his group presented their outcomes on the first 100 patients treated at UMass CCAD this September at the 43rd Annual Meeting of the New England Society for Vascular Surgery. More information about this trial can be found on www.ClinicalTrials.gov (Complex Aortic Repair with Physician Modified Endografts and Custom Made Devices trial, CARPE-CMD, IDE# G130210).


Innovative Care Only Offered at UMass Memorial Medical Center

We are the only center in the Northeast to offer fenestrated and branched endovascular repair of abdominal and thoracoabdominal aneurysms through a physician sponsored investigational device exemption trial using both company
manufactured custom made devices and physician modified devices. Our one-year survival is greater than 90 percent, and no treated patients have experienced late aortic aneurysm rupture.

Using the most advanced, three-dimensional reconstruction
software, a custom-made endograft is planned and designed
for your patient’s specific anatomy.


Examples of Some of Our Recent Cases


Simplified Referral System for Expedited Patient Access

A single call to 844-89-AORTA (844-892-6782) is all that is necessary.

  • Connected directly to a nurse practitioner or complex aorta surgeon
  • Answered 24/7
  • Appointment within 24 hours
  • Email complexaorta@umassmemorial.org

Appointments in 24 Hours

When you call, you will receive a response that day, if not immediately.

A secure web link can be generated at that time thereby enabling you to send any relevant CTA images to us for review.

Your patient will be seen within 24 hours. They will meet with our complex aorta team, including a vascular surgeon, cardiologist and our cardiovascular anesthesia team. At the initial consultation, a seamless system is in place for your patient to obtain the following services to minimize travel back and forth to the hospital: 

  • Cardiology risk optimization visit with a cardiologist from our complex aorta team
  • Cardiac stress testing
  • Pulmonary function testing
  • CT imaging
  • Any additional testing that may be needed
  • On the day of surgery, the referring surgeon is always invited to join us during the repair of their patient’s complex aortic aneurysm.

Improved Patient Satisfaction through Nurse Practitioner Liaison

We understand how much anxiety a patient experiences when faced with a complex aortic aneurysm. Each patient referred is assigned a nurse practitioner/patient liaison to ensure a smooth navigation from initial referral to surgery and through their postoperative visits.


About Fenestrated and Branched Endografts

For complex aneurysms (those aneurysms which include portions of the aorta with branch arteries that supply organs such as the kidneys and intestines), a special type of repair is required to preserve flow to these branch arteries: a fenestrated endograft, with special holes placed in the endograft at the precise location in which these branches arise. The fenestrated endograft is designed specifically to fit each patient’s particular anatomy; this is possible through the use of sophisticated imaging software that allows Dr Schanzer and his team to manipulate the CT images obtained of the patient’s aorta and branch arteries.

terarecon

The fenestrated endograft, designed specifically for the particular patient, is then positioned inside the aorta from within the blood vessels in the groin; this allows for the aorta to be “re-lined”, with the holes positioned precisely to allow blood to continue to flow into the branch arteries, while blood flow no longer fills the aneurysm sac.

Some of the intraoperative techniques that facilitate this approach include the use of a state-of-the-art hybrid operating room. A CT scan is performed right in the OR; these images are merged with the preoperative CT scan images using “fusion” technology. This technology enhances the safety of the procedure by allowing Dr Schanzer and his team to minimize the amount of radiation and contrast dye that is used in the procedure.

Hybrid OR


Future Directions

The Program's primary guiding principal remains ensuring outstanding patient outcomes, which is achieved through rigorous evaluation of each patient’s postoperative course through structured research in the context of these clinical trials.  The other critical priority of Dr Schanzer and his team remains enhancing the patient experience, which is realized through our team approach and dedicated nurse practitioner-patient liason.

Specialized complex aorta team approach from initial referral through
post-operative course,
providing outstanding patient outcomes

The UMass Memorial Center for Complex Aortic Disease is committed to transformative innovation in care for patients with complex aortic disease. Many of these patients would not be candidates for traditional repair strategies, or would be subject to significant morbidity, prolonged hospital courses, or even perioperative death with traditional repairs; instead, Dr Schanzer has been gratified by sending many of them home on postoperative day #2, with only small incisions. We look forward to continuing to recruit patients who may benefit from this approach, and in doing so, help to guide the care of future patients through evidenced-based medicine.

 
A comprehensive multidisciplinary specialized aorta team providing the highest standards of care.