The robotic arm that can save you from a fatal aneurysm

By David Hurst
UPDATED: 02:55 GMT, 7 February 2012


Around 7,000 Britons die every year from an aneurysm — when a major artery in the body ruptures.

Retired lorry driver Barry Merchant, 67, from Aylesbury, Buckinghamshire, was the first person to undergo a new type of preventive surgery.

THE PATIENT

'The aneurysm kept growing, and I knew it
could burst at any moment,' said Barry Merchant

Two years ago, I was having a routine heart check for my angina when doctors spotted an aneurysm.


They explained an aneurysm is a swelling in a blood vessel, and I had the most common type: an abdominal aortic aneurysm, in the body’s main artery, the aorta.


The wall of the aorta had weakened and ballooned, meaning it could burst, causing severe internal bleeding which could kill me.


The doctors said usually they would operate and put in a little metal tube called a stent where the aneurysm is, to stop the pressure on the swollen walls and allow the blood to flow safely.


But my aneurysm was close to branches of the aorta which supply blood to the kidneys, liver, spleen and stomach.

To operate here would be just too risky, so all they could do for now was keep an eye on me.

I saw the doctors every six months to get it checked.

Unfortunately, the aneurysm kept growing, and I knew it could burst at any moment. It was like living with a time bomb inside me.

Within a few months of being diagnosed, just walking made me really breathless because my blood was not flowing round my body properly.

I got lots of hot sweats. I’m divorced, so was on my own a lot, which made it harder.

I also slipped on some ice and banged my hips, but the doctors couldn’t operate on that while I had the aneurysm, as it was too risky — so for the past two years I’ve been in a wheelchair.


By the end of last year, the swelling was 7.5 cm long.

My surgeon, Professor Nick Cheshire, who I’d been seeing at St Mary’s Hospital in London, said they had to do something. He told me about a new procedure where they’d use a robot arm to put in the stent, going in through an artery in my groin.

It was more accurate than a surgeon, so it wouldn’t damage surrounding organs.

I’d have a specially fitted stent with holes so that the blood could keep flowing through the branches of the aorta.

Apparently it can be very difficult to fit a stent like this by hand, so using the robotic arm was perfect.

When they said I’d be the first person in the world to have this operation, I was amazed they’d picked me.

So in January this year, I had the surgery under general anaesthetic. It took about four-and-a-half hours.

I was a bit bruised afterwards from the incisions on my groin, and I was kept in for 13 days for observation as it was such a new procedure.

But just a couple of days after the operation, I started to feel brand new.

I’m hardly ever breathless now. It’s a huge weight off my shoulders to know I don’t have the aneurysm any more.

So long as I carry on watching what I eat — less fatty stuff and alcohol, and lots of vegetables and fruit — I should be OK and no more prone to getting another aneurysm than anyone else my age.

I’ve got a new lease of life. In April, I’m going to see about getting my hips operated on.

I’ve told my grandchildren — I’ve got six — to watch out, because soon I’ll finally be able to catch up with them.

THE SURGEON

Professor Nick Cheshire is consultant vascular surgeon and head of circulation and renal sciences at Imperial College Healthcare, London. He says:

Aneurysms can occur in any artery, but they most frequently strike in the aorta, which is the body’s main artery, running from the heart to the abdomen.

Most aortic aneurysms are in the part of the aorta that passes through the abdomen and are called abdominal aortic aneurysms (AAAs).

As part of the ageing process, the wall of the aorta can lose its normal strength and elasticity, causing it to bulge.

The main concern is that the aneurysm might burst — like a balloon being over-inflated. Patients will suffer internal bleeding leading to collapse and death.

The death rate from rupture is over 80 per cent: half of patients die before even getting to hospital.

They’re most common in men, people with high blood pressure, and those over the age of 65. Four in 100 men and two in 100 women over the age of 65 will have an abdominal aortic aneurysm.

Most people with an aneurysm are not aware they have one, as in seven out of ten cases there are no symptoms. If symptoms do occur, it is when the ballooning is so large it causes mild abdominal or back pains.

However, the NHS is now rolling out a screening programme in which all men over 65 will be invited for a simple scan to test for AAAs.

Traditionally, aneurysms have been treated with open surgery where surgeons make an incision in the stomach and cut out the swollen piece of aorta, replacing it with an artificial artery made of polyester.

This is a major operation and carries risks such as excessive blood loss and infection. One in 20 patients die during or because of this operation.

In a newer, much safer technique called endovascular repair, we pass a polyester fabric graft wrapped around a metal stent up through one of the arteries in the groin into the area of the aneurysm.

The graft material bonds with the arterial wall and the blood flows through the stent instead of the weakened aneurysm. The advantage here is that there is just a 3cm incision in the groin.

However, for 10-15 per cent of people with abdominal aortic aneurysms, surgery of any kind is considered too risky as their aneurysm is too close to the branches of the aorta.

The branches of the aorta are the renal arteries to the kidneys either side, the coeliac artery to the liver, spleen and stomach, and the superior mesenteric artery to the bowel.

Operating on this area can damage surrounding blood vessels and the interruption of blood supply to vital organs.

The mortality of this surgery is two to three times that of repair of a standard abdominal aortic aneurysm.

Therefore, with these patients, we usually observe the aneurysm until the risk of rupture is greater than the risk of operation.

However, last year scientists in California developed a 3mm diameter, flexible robotic tube which can feed the stent into the patient’s body with far greater precision than the human hand.

The surgeon operates the arm using a console about five metres from the patient. It has a monitor with X-ray images showing an internal picture of the patient’s blood vessels.

The arm can be manouevred in every direction so we can access hard-to-reach parts with much less risk of damage to the blood vessels in the branches from the aorta.

Mr Merchant had a specialised, custom-made stent known as a fenestrated endograft fitted. This has multiple holes which correlate to the branches of the aorta.

We then attached three smaller side branch stents going through the holes into the kidney arteries and the artery supplying his bowel, all covered by the fabric graft.

The robot could also be used for treatment of carotid artery narrowing in the neck to prevent stroke, and to open up narrowed blood vessels in the legs that cause gangrene.

The robot arm operation is available on the NHS at St Mary’s Hospital in London, as well as privately at St Mary’s Lindo Wing.

We’re putting in place a teaching programme for vascular surgical teams to come to St Mary’s and observe us using the system, so I hope it will soon start to roll out across the country.

The system costs around £1.2 million.

For further details, tel. 020 7886 1610 or visit www.imperial.nhs.uk/stmarys/ourservices/vascularsurgery


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