Community member benefits from new minimally-invasive treatment for enlarged aortas

Posted on 3/28/2018

Vascular surgeons at Palmetto Health-USC Medical Group performing latest in fenestrated endograft

Howard Gaymon was nearly out of time. It was a routine checkup that sent the 65-year-old retired truck driver from Sumter in for an ultrasound and then immediately to Palmetto Health Richland’s emergency room. Tests revealed that Gaymon had an abdominal aortic aneurysm (AAA), an enlargement of the aorta, the largest artery in the body, which can be fatal if untreated. Vascular surgeons at Palmetto Health USC-Medical Group assured Gaymon that he had treatment options for this unusually located AAA.

Palmetto Health-USC Vascular Surgery is the only practice in the Midlands performing fenestrated endografts and complex aortic repair for AAA and more extensive aneurysms involving other parts of the thoracic and abdominal aorta. The procedure offers a significantly less invasive treatment option for people with abdominal aortic aneurysms while providing shorter hospital stays, significantly smaller incisions and faster recovery times.

“It’s great to be able to provide this locally,” said Firas F. Mussa, MD, who came to the practice from New York City in August to join Daniel Clair, MD, as one of two vascular surgeons performing fenestrated and complex aortic repair in the area. The team of Clair and Mussa is world-renowned for the care of patients with aortic and vascular disease.

Traditional endovascular aneurysm repair uses a stent (placed just below the kidney) to prevent blood from flowing into the aneurysm. But when an aneurysm is too close to the arteries that go to the kidneys, open surgery is often required to repair the weakened artery wall. Such surgeries typically last four to five hours and require about a 10-inch incision, general anesthesia, a five to seven-day hospital stay and two weeks rehabilitation before the patient can return home.

With a fenestrated endograft, surgeons go through the skin with a less than one-centimeter hole and guide the custom-made stent through the blood vessel to the aneurysm. There, “fenestration” holes on the stent are positioned to allow blood to flow to the vital vessels but away from the aneurysm. Once the graft is secured, it provides a “healthy sealing zone” that allows the aneurysm to seal above the kidneys.

Mussa explained the fenestrated endograft generally takes from 90 minutes to two hours and can be performed while the patient is under local anesthesia. Patients undergoing this procedure typically spend one to two days in the hospital, go straight home and resume daily activities in a much shorter time period.

Mussa stressed that while both procedures provide good repair, the traditional route takes a much higher physical toll on patients. “They are at least a month behind in their recovery,” he said.
It was that message that he shared during his initial meetings with Gaymon, who opted for the fenestrated endograft.

“They told me that it was serious and that I needed to get it done and that was it,” Gaymon said, adding the prospects of avoiding major surgery was appealing. “They didn’t have to do all the cutting on me.”
Mussa said it was important that Gaymon – as with all patients – be fully informed of the options.

Mussa said, “Well-trained and experienced vascular surgeons are unbiased in rendering the most appropriate treatment approach that they think best serves any particular patient, based on anatomy, risks-benefits balance and delivering durable results. You want the patient to be fully engaged and informed.”

Gaymon underwent the procedure Jan. 21 and said he was amazed when he left the hospital in less than two days. “I was a little surprised,” he said. “I was looking to stay a little longer than that.” Having undergone a previous surgery for a hernia years ago, Gaymon said he now has a stronger appreciation of the contrast between traditional surgery and less invasive procedures.

In the meantime, he also has given up smoking. “I have been smoking for a long time,” Gaymon said. “Dr. Mussa told me I had to quit.”

Mussa, who is board certified by the American Board of Surgery in Vascular Surgery, explained that abdominal aortic aneurysms normally are discovered in one of three ways:

  • During a routine imaging test for an unrelated matter
  • When it ruptures
  • When a patient is known to have an aneurysm and enrolled in a screening program (over 65 years of age, smokers and/or family history of AAA)

Mussa added, “The beauty of it is you provide a new and unique service to patients in the Midlands that they previously had to travel out of state to have. The personal satisfaction is when you know that you are making a difference.”

For more information about Palmetto Health-USC Medical Group, including Palmetto Health-USC Vascular Surgery, visit


RSS 2.0