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Vascular surgeon first to perform new treatment
Joseph Ricotta, a surgeon and medical director of vascular services at Northside, gets ready to lead a Polish surgical team in the treatment of a patient with an aortic aneurysm. - photo by For the Forsyth County News

CUMMING — A local surgeon traveled to the other side of the world earlier this spring to help high-risk patients through a treatment he created.  

Joseph Ricotta, an internationally recognized vascular surgeon at Northside Hospital, went to Poland to perform that country’s first ever implant of a customized stent.

The procedure was performed on two patients with thoracoabdominal aortic aneurysms, or TAAA.

These aneurysms are a bulging or expanding area of a large section of the aorta, the body’s largest artery, which extends from the chest to the abdomen.

“It was a really interesting and fun experience to go there and be able to help them do their first one in the country,” Ricotta said. “That was a special thing for me.”

About 15,000 people die each year from a ruptured aneurysm, and 200,000 new cases are diagnosed annually.

The traditional method of treatment for TAAAs is open surgery. However, that approach often is not viable for many with TAAAs, and if it is, there are still many risks.

“Despite many advances in the evaluation and care of patients with [TAAAs], formidable challenges remain,” Ricotta said.  

“Patients who have these aneurysms, and who have underlying serious medical conditions or who present as an emergency, simply are not good candidates for the traditional open surgical approach.”

As a result, Ricotta has been working for several years to create a new treatment technique.  

He is the first surgeon in the United States to receive approval from the Federal Drug Administration to create and implant custom-modified endografts for high-risk patients with TAAAs.

Endografts, which have been used in treatment of aneurysms since the early 1990s, are fabric and metal stents that are inserted at the location of the bulging of the blood vessel.

They are inserted via the groin and moved into place, resulting in a smaller incision than in traditional open surgery.

A major problem with standard endografts is that they can take as long as 12 weeks to create, making them unavailable for patients who require emergency surgery.

According to Ricotta, it is not uncommon for a patient’s aneurysm to rupture while they wait for their device to be manufactured.

His surgeon-modified endograft, which can take as little as 30 minutes to fit to an individual’s specific anatomy, drastically reduces the waiting period for patients and allows for the treatment of aortic emergencies.

“We fix the aorta from the inside,” he said, noting that his technique is much less invasive and less dangerous than traditional methods.

“With traditional surgery, patients stay in the hospital a week to two weeks; with this technique, they stay in the hospital a couple of days.”

He said the mortality rate for traditional surgery is about 15 to 20 percent for elective cases and near 80 percent in emergency cases where the aneurysm has ruptured.

“Everything with our technique is about tenfold less — the morality rate is tenfold less, the complication rate is tenfold less, the hospital stay is tenfold less.”

Ricotta performed his first case of the customized endografts as part of a clinical trial at Northside Hospital-Forsyth in 2013.

As the medical director of vascular services at Northside Hospital’s Heart and Vascular Institute and chair of vascular surgery, Ricotta has gained vast knowledge and experience from institutions such as Johns Hopkins, the Mayo Clinic and Cleveland Clinic.

Physicians from all over the world come to Northside to observe and learn from him.

In October, two vascular surgeons from Poland did just that. After returning home, they identified two patients who qualified for Ricotta’s procedure and invited him to perform the surgeries himself.

One of those surgeons, Robert Proczka with the Medical University of Warsaw, said Ricotta’s treatment is important in Europe since availability of endografts is limited.

“Especially in acute cases, the vascular surgeon or interventionist has no possibility to get a … [customized] graft,” he said. “Thanks to Dr. Ricotta, his skills and experience, I would like to begin and develop the program of ‘surgeon-modified grafts’ in my practice.”

While some customized endografts are commercially produced in Europe, Ricotta said they cost “in the six figures. Whereas this technique that I use, it costs around $10,000 to $12,000.”

As for patients closer to home, currently Ricotta’s endografts are available only through clinical trials.

While the devices have full FDA approval, Ricotta said it is unlikely they will be widely produced.

“I had to go through a pretty rigorous process to get approval from the FDA to be able to customize these grafts,” he said. “Now whether it becomes a commercial rollout is quite a different story. And quite honestly, it probably won’t because it takes a certain skill set to know how to customize these grafts.”

But patients in Northside’s treatment area can take advantage of Ricotta’s technique since he leads practices in Cumming, Canton and Atlanta.

“I think it’s important to note that at Northside, we’re having people from all over the world come and try to learn how to do this technique,” he said.

And that flow of surgeons from around the world won’t be ceasing any time soon.

Ricotta said the Polish surgeons are planning a return trip to Northside in July or August to observe more of the procedures, and he will likely make a second there to continue to assist them.

In addition, Ricotta is planning a trip to Paris sometime in the next few months to help French surgeons learn about the technique.

He said he enjoyed his trip to Poland, and noted he wasn’t just a teacher.

“It was interesting to learn about the different health care system over there and how they do things a little bit differently from us,” he said. “I think they learned some things from me and I learned some things from them.”