Putting three A’s together can signify lots of things.
But when Dr. Luis Leon talks to you about Triple A, he’s probably not referring to the massive roadside-assistance club or America’s former credit rating or the type of baseball played by the Tucson Padres.
Vascular surgeons and all too many of their patients know Triple A as shorthand for an abdominal aortic aneurysm. It’s a ballooning of the body’s largest vessel, a condition with an unknown cause that becomes more serious as the aneurysm grows. If the bulge bursts, the result is often excruciating and sometimes fatal.
Abdominal aortic aneurysms, in fact, are the third-leading cause of sudden death in men age 60 and older. Triple A’s are five to 10 times more common in men than in women. Those with a history of smoking are at greater risk than those who don’t.
One way of fixing this vital stretch of infrastructure is open surgical placement of a stent graft to shore up the weakened artery. Depending on the shape and position of the aneurysm, along with other factors, this might be the best way to go.
But the other option, endovascular repair, is where everything is headed. It’s a much less invasive procedure that requires just a 2-inch incision in one groin, and a puncture in the other.
Patients can usually go home the next day, says Leon, while the recovery time for open surgical repair requires an average of seven nights in the hospital, followed by another six weeks at home.
“Risk to the patient, blood loss, length of stay in the hospital, complications and mortality has been dramatically reduced with endovascular techniques,” he says.
Endovascular surgery, which represents 85 percent of Leon’s practice, involves the introduction of a catheter through the skin and into major blood vessels.
According to the Society for Vascular Surgery, the world’s first endovascular aortic repair was performed in 1987 in the former Soviet Union. The technique was introduced in Argentina in 1991 and in the United States that same year.
“The downside to doing endovascular Triple A repair is that the stent graft has a tendency to move downward,” says Leon. For that reason, patients must have long-term follow-up examinations and further endovascular surgery might be required at some point.
“The good thing about doing it the old way is that you don’t have to do it again,” said Leon. No long-term follow-up is required.
Last month, Leon became the first surgeon in Tucson to use a new stent from Endologix, one of four makers of such products. Since then, he has performed two more surgeries using the stent, which he says has an improved design that makes navigation easier and helps prevent migration.
“The estimated blood loss for the three patients was about 50 to 60 cc’s each,” he added. “With open surgical repair, blood loss averages 400 cc’s. All three were discharged the next day.”
Leon, a native of Peru, earned his medical degree in 1996 at Cayetano Heredia Peruvian University. He received surgical training at Harbor-UCLA Medical Center and San Joaquin General Hospital in California, from 1997 to 2003. He also completed a Vascular and Endovascular Fellowship at Loyola University Medical Center in 2005.
He comes from a family of physicians. His father and his brother are both surgeons, and his mother is a nurse. They live and work in Lima.
Leon, a fitness nut who finds time for regular ultra-runs, joined Agave Surgical Associates in 2009. Before that, he was the chief of vascular surgery at the Veterans Affairs hospital in Tucson.
His enthusiasm about the endovascular world and all its possibilities is contagious.
“Surgeons at TMC are moving rapidly into an entirely percutaneous environment,” says Leon, clearly excited to be among those leading the way.
M. Scot Skinner, an Arizona native, is an award-winning reporter with more than 25 years of experience in daily journalism. After a long career at the Arizona Daily Star, he is now working for Tucson Medical Center as a freelance writer. He can be reached at firstname.lastname@example.org.