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At the Hospitals
n Colon Cancer: A Disease of the emerging as a promising treatment, as well. cardiovascular medicine. In 2013, Sanger Heart
But still, Stage IV colon cancer has no cure. & Vascular Institute was the first in the world
Elderly, Until Recently to implant a branched stent graft specifically
Salem recently treated a woman in her 20s designed for branch vessel repair of thoracic
A study led by the American Cancer Society with Stage IV colon cancer who asked about aortic aneurysms. This endovascular treatment
last year confirmed what oncologists have seen the impact of her disease on having children. for aortic aneurysms has provided an important
firsthand: Rates of colorectal cancer, which He had the difficult conversation with her that alternative to open-chest operations.
include colon and rectal cancer, are rising chemotherapy and pregnancy aren’t compatible
among people in their 20s, 30s and 40s. but that without chemotherapy, her life n Invention Revolutionizes Recovery
expectancy would decrease significantly.
The risk factors for colorectal cancer — After Surgery
including obesity, diabetes, smoking and Education and awareness, then, are vital to
drinking — are more prevalent in older early discovery of colon cancer. Salem says Jeko Madjarov, MD, of Atrium Health’s
populations than younger ones, yet the rates younger people who notice unusual health issues, Sanger Heart & Vascular Institute, knew open
are decreasing in the older and increasing in should visit a doctor for an exam. If they’ve had chest surgery was a life-saving procedure for
the younger. Last year’s ACS study revealed a relative with colorectal cancer, they should ask many patients, but he also saw just how tough it
20-somethings have experienced the most their doctor when to be screened. could be on the body. For patients who already
dramatic increases, with rates of colorectal have weak muscles from certain conditions, it
cancer rising nearly 4 percent each year n Sanger Heart & Vascular Institute can be even harder. Supporting a patient’s bone
between 1987 and 2013. structure after open heart surgery was critical
Performs First-in-World Stent — not only to their recovery, but to lessen the
“It’s a very alarming phenomenon,” says damage from any future trauma or impact.
Mohamad Salem, MD, an oncologist with Implantation
Atrium Health’s Levine Cancer Institute. Dr. Madjarov came up with a solution. Instead
“Most of the younger patients with colorectal Atrium Health’s Sanger Heart & Vascular of the traditional titanium and wire that holds the
cancer we see in our clinic don’t have these risk Institute’s clinical team has enrolled and treated breastbone together horizontally after surgery, he
factors. Most of them eat healthy, are in good the first patient in the investigational device developed a device that could close and hold the
shape and have no family history. Most likely, exemption study for a venous self-expanding sternum together with additional support. The
there’s something else going on causing this.” stent system. sternal closure device was developed entirely in-
house at Atrium Health over the course of six
A Call for Colorectal Cancer Awareness Erin Murphy, MD, FACS, director of Sanger years, and in February 2016 it was approved by
Heart & Vascular Institute’s venous and the FDA. The device is the only one of its kind
Because colorectal cancer is associated lymphatic program, and Gregory Stanley, MD, that uses a high-quality polymer.
with older populations, most young people FACS, vascular surgery fellowship director,
aren’t screened for it, nor do they have much performed the venous procedure on the first Soon after, Madjarov performed the first-
knowledge about the disease. This means that patient in the world in December 2017 at Atrium ever chest implantation of his device. His
when a younger person is diagnosed, the cancer Health’s Carolinas Medical Center. The patient, patient, Thomas, needed the enhanced support
has often progressed to a later stage. It also means who has nonthrombotic iliac vein lesion (NIVL), of the new device due to a condition called
awareness of the symptoms of colorectal cancer is doing well post-treatment. The implantation is myasthenia gravis, that left him with very weak
becomes critical. Symptoms include rectal part of a multicenter international trial, with Dr. skeletal muscles. After a successful procedure,
bleeding, changes in bowel habits, consistent Murphy as the lead principal investigator for the Madjarov was hopeful the patient would benefit
nausea and unintended weight loss. Dr. Salem ABRE IDE trial in the United States. — but he couldn’t have guessed that his new
emphasizes that having any of these symptoms device was about to be put to the ultimate test.
shouldn’t cause alarm — many conditions can “Deep venous obstruction impacts more than
cause them — but it should push people to get 27 million people worldwide and can result in The very day Thomas was cleared to
examined to find out the cause. limited mobility and poor quality of life,” says resume normal activities, including driving,
Murphy. “By investigating a new form of iliac he was involved in a car accident. His air bag
Earlier Diagnoses, More Effective Treatments vein stenting, we are committed to exploring the deployed in the crash. In usual circumstances,
latest treatment options for patients.” this impact likely would damage the chest and
Levine Cancer Institute actively participates in possibly break the structure supporting the
research of innovative treatments for colorectal The multicenter study, which analyzes breastbone. But, while Thomas suffered rib and
cancer, including the TAPUR study, a national treatment of symptomatic iliofemoral back injuries, his chest closure was rock solid.
clinical trial that matches tumor types with the venous outflow obstruction in patients with For Madjarov — and the patient — the closure
best medicines to fight them. Immunotherapy is venous occlusive disease, will enroll up to device was validated as a true life-saver.
35 sites internationally.
“I’m inspired by the way this device has
“Iliac vein stenting for venous obstruction helped save multiple patients’ lives to date,”
has now become a first-line treatment option says Madjarov. “This option now is available
for many patients, vastly improving symptoms nationally and has been used in more than
related to the diseased vein and quality of life,” 2,000 cases.”
says Dr. Stanley.
Sanger Heart & Vascular Institute is
uniquely positioned as a leader in the future of
12 | June 2018 • Mecklenburg Medicine
