September 25, 2005

Cheney Heads Home After Surgery for Aneurysms
WASHINGTON, Sept. 25 - Vice President ***** Cheney went home from a
hospital here this morning, a day after doctors performed procedures
to repair aneurysms in arteries behind both knees.

Mr. Cheney, 64, slid his hands along a railing as he walked slowly
out of George Washington University Hospital with his wife, Lynne, at
his side. Mr. Cheney stopped, turned around, and shook hands with a
number of the doctors who performed the procedures. Then Mr. Cheney
looked down at the sidewalk as he continued walking slowly and
steadily but unaided to a limousine. He smiled and waved to the staff
and onlookers before the limousine returned him to his residence.

Mr. Cheney planned to rest today and work from home on Monday, his
chief spokesman, Stephen E. Schmidt, said.

On Saturday, a team of five doctors performed a minimally invasive
procedure to implant flexible stent-grafts in the popliteal arteries
behind each knee. Mr. Cheney was given local anesthesia during the
procedures that lasted six hours. That is about twice as long as
usual, according to experts in the technique who were not connected
with Mr. Cheney's case.
Dr. R. Eugene Zierler, a vascular surgeon at the University of
Washington in Seattle, said that patients would be advised to take it
easy for about a week after undergoing a stent-graft procedure for a
popliteal aneurysm.
During that time doctors would generally restrict walking for such
patients to places like the bath room and dining room, and tell them
not to do vigorous exercise, he said. Then such patients would be
encouraged to resume full activity.

Doctors also said they would advised patients not to fly in
commercial airplanes for about two to three weeks.

Also, in monitoring a patient's progress, the doctors would
periodically use ultrasound tests to detect potential complications
like potentially dangerous clots that could form in the stent-grafts.

Some vascular surgeons like Dr. Zierler who were not connected with
Mr. Cheney's case and who perform the stent graft technique raised
questions about is use for the vice president.

One concern is that the Food and Drug Administration has not approved
any device for use in repairs of popliteal aneurysms, although
doctors use often them on an "off label" basis. Many doctors consider
such use experimental and say it requires a patient's permission.

Another 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.
Mr. Schmidt, Mr. Cheney's spokesman, said late Saturday night: "The
vice president did a great deal of research and consultation on the
treatment options. He is very comfortable with his decision and doing
very well." Mr. Schmidt said that, before they started, the doctors
had expected to perform the procedure only on the popliteal artery in
Mr. Cheney's right knee. But during the procedure, he said, the
doctors decided to repair both knees.
Stent-grafts are being used increasingly for aneurysms in the leg,
particularly for high-risk patients like Mr. Cheney who has a long
history of significant heart disease.

Although the stent-graft procedure avoids use of general anesthesia,
"there still is stress associated with the procedure under local
anesthesia and there are potential complications," said Dr. K. Craig
Kent, chief of vascular surgery at Weill Cornell and Columbia
University medical schools. "For patients with the usual risks, the
traditional surgical operation is the better way to go," Dr. Kent
said in an interview.
Dr. Kent said he would have performed the knee repairs on separate
occasions. But, he added, "it takes a certain amount of bravado to
put stents in popliteal aneurysms in both legs in the vice president,
and I have to give them credit."
Dr. Kent also said he knew the doctors on Mr. Cheney's medical team
very well, and "the last thing any one of those doctors would want is
a bad outcome, so in using the stent-graft procedure and doing it on
both sides on the same day they must have known they were doing the
right thing."