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Complex Abdominal Aortic Aneurysm: Joe's Story

Patient Stories |
Categories: Heart Vascular Highlights
Joe Bower Patient Story

Unstoppable is the word that comes to mind when you meet Joe, a 74-year-old Pipersville man with a zest for life, a love of family and a passion for his excavating business that keeps him in perpetual motion.

A Life-saving Diagnosis

Eight years ago, Joe Bauer's visit to Doylestown Health's Emergency Department for indigestion-like pain revealed that he had a huge abdominal aortic aneurysm, and it was at risk of rupturing.

An aneurysm is a weakening in the wall of an artery that causes it to "bubble" out. Depending on location, size and severity, aortic aneurysm management varies from careful monitoring, known as "watchful waiting," to surgical repair. Because the aorta is the main artery that carries blood from the heart through the center of the chest and abdomen, a rupture causes lifethreatening internal bleeding.

"Dr. Renee Sangrigoli saved my life when she discovered that aneurysm!" exclaims Joe, who was found to also have a severe blockage in another artery.

Minimally Invasive Solutions

Joe's treatment involved two endovascular aneurysm repairs which were minimally-invasive as repair occurs inside blood vessels. This offers quicker recovery, a shorter hospital stay and reduced risk of complications compared to open surgery.

Monitoring Joe's Condition

"Heart and vascular specialists follow endovascular repair patients with regular office visits and imaging studies to ensure the repairs are holding," says Doylestown Health vascular surgeon Atul Rao, MD. "I met Joe a few years after his initial repair. There was no evidence of a leak into his aneurysm sack, but his graft had shifted a bit south, so I kept a very close eye on him with follow-up surveillance imaging studies."

The Aneurysm Returns

"In September 2018, Joe's scan showed new aneurysmal growth at the upper border of his graft, right at the origin of his right kidney artery," says Dr. Rao. "Joe was a complex aortic patient, as he had a prior abdominal repair and now had both a potential migrating graft and recurrent aneurysmal disease in a prior normal area of aorta that was further compromising the integrity of his stent graft."

Advanced Treatment Options

Concerned that Joe's aneurysm could rupture, Dr. Rao discussed treatment options with his patient.

"We weigh the risks and benefits for each patient individually. One option was to continue to monitor Joe's condition; however, the aneurysm had already demonstrated significant growth," says Dr. Rao. "The second option, endovascular stent-based repair, might have required unique approaches. This option could be effective, but not necessarily the most durable."

"In option three, an open surgical repair, we would remove the stent graft and replace the entire segment of the aorta with a new surgically-placed graft. Joe was a relatively good surgical candidate and opted for the open repair."

Complex Aortic Aneurysm Repair

"A major surgical undertaking, open repair involved clamping the aorta above the kidney arteries, removing the existing stent graft and implanting a new graft shaped like a pair of pants. The top was sewn into the aorta and each of the "pant legs" were sewn into the two iliac arteries, which branch from the aorta and run to the legs," explains Dr. Rao.

"Joe's case illustrates that although we've seen considerable advances in complex, minimally invasive procedures, sometimes an open surgical repair can be a more appropriate fix," notes Dr. Rao.

"I woke up without pain. I was able to get out of bed and walk all the way down the hall and back on the first day," says Joe.

Safeguarding Joe's Heart Rhythm

In addition to his aneurysm, damage from a previous heart attack put Joe at high risk of recurrent, life-threatening arrhythmias (irregular heartbeat). To safeguard Joe's health, electrophysiologist Robert Sangrigoli, MD, implanted a combination cardiac defibrillator/pacemaker in Joe's chest before his hospital discharge. The device monitors Joe's heart for arrhythmias and restores normal rhythm when needed.

Back in Business

Joe and his wife, Barbara, enjoyed a trip to Florida in February, and he's back to his unstoppable self. "I'm working, walking on the treadmill and enjoying my hot tub," says Joe. "I feel fantastic!"

Doylestown Health's Aortic Center

Doylestown Health's Aortic Center delivers a personalized approach to care with advanced expertise, innovative treatment options and state-of-the-art facilities.

Our fellowship-trained cardiothoracic and vascular surgeons offer extensive experience in minimally-invasive endovascular procedures, as well as technically challenging open and hybrid surgical repairs. The Endovascular Hybrid Operating Room combines state-of-the-art imaging technologies with a fully-integrated and sterile surgical suite, allowing for treatment of the most complex cases.

The new 100,000 square-foot Cardiovascular and Critical Care Pavilion is scheduled for completion in late 2019. This patient-centered, technologically advanced facility will be the new home of Doylestown Health's nationally recognized Center for Heart and Vascular Care and the new Clark Center for Critical Care Medicine.

Find a Vascular Surgeon

About Doylestown Health's Heart & Vascular Services

Expert cardiologists and cardiac surgeons assist patients and physicians with managing risk factors for heart disease, offer advanced treatment options and provide outstanding emergency cardiac care. Doylestown Hospital’s accredited Chest Pain Center is fully prepared to treat cardiac emergencies around the clock, focusing on rapid diagnosis and effective treatment. The multidisciplinary team at the Richard A. Reif Heart Institute is dedicated to providing the highest level of quality care and patient safety.

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