Vice President Has Procedure for Aneurysms in His Knees
By LAWRENCE K. ALTMAN
WASHINGTON, Sept. 24 - Vice President Dick Cheney successfully underwent [stent-graft] medical procedures to repair aneurysms in arteries behind both knees on Saturday, his office said....
Earlier, Stephen E. Schmidt, Mr. Cheney's chief spokesman, said doctors would operate only on the popliteal artery in the vice president's right knee. The change in plans was "an intraoperative decision," Mr. Schmidt said, meaning the doctors made the decision to also work on the left knee in the operating room.
Stent-grafts are being used increasingly for aneurysms in the leg, particularly for high-risk patients, doctors said in interviews. But the Food and Drug Administration has not approved any such devices for use in the popliteal arteries, although doctors often use them on an "off-label" basis. Many doctors consider such use experimental and say it requires the patient's permission.
One concern is that the devices implanted in a knee will be subjected to far more stress from bending and extension than when placed in other arteries. Few studies have been conducted to determine durability.
Dr. K. Craig Kent, chief of vascular surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, said that he knew all of the doctors who were involved in the procedure well and that they were medically conservative. Dr. Kent said he would not have done both knee aneurysm repairs on the same day, but assumed the team had "compelling reasons" to do so. ...
On Saturday, Dr. Kent and another vascular surgeon, Dr. Thomas R. Bernik, chief of endovascular surgery at St. Vincent's Manhattan Hospital said in separate interviews that the six-hour length of the procedures was about twice as long as usual. ...
Dr. Bernik, the St. Vincent's surgeon, said the decision to do both repairs on the same day was "surprising and a little bit irresponsible, I must say." That is partly because the extra procedure could increase the risk of complications now or in the future, he said.
"You really never want to tackle both sides at once," Dr. Bernik said, "because even though things may go smoothly on one side, you can still run into a problem while you are doing the other side, or shortly thereafter, and then you really could have a big problem on your hands." ...
Most doctors in the field "would say that is not the best way to go, but, who knows, maybe Cheney said, 'I want to get this over with, and I'll take the added risks,' " Dr. Bernik said.
Two doctors on Mr. Cheney's medical team said they would be willing to discuss his case with this physician-reporter if given permission to do so. But the White House declined to grant such permission.
The aneurysms are the latest problem with the heart and circulatory system of the vice president, who has suffered four heart attacks.
<http://www.nytimes.com/2005/09/25/politics/25cheney.html?pagewanted=print>
Carl