|
Trapped by fractured metal and shattered glass, Lois Freese feared the worst for her husband, Loren, who sat next to her, slumping lifelessly behind the wheel of her car.
The 1996 Ford Taurus had just been struck broadside by another vehicle.
"I thought he was gone," says Lois, who had minor injuries. "He was unconscious and everything. Then I saw little bubbles coming out of his mouth and I knew he was alive."
Freese was airlifted first to St. Luke's Hospital in Cedar Rapids, Iowa, and then to the UI Heart and Vascular Center at University of Iowa Hospitals and Clinics. His pelvis and ribs were cracked, his head and hand were lacerated, and he had sustained a life-threatening injury to his thoracic aorta, located behind the ribs.
Without surgery, the damaged area of the aorta would have formed an aneurysm or bulging area. As the aneurysm enlarged, the possibility of rupture would have been very high and Freese's chance of survival would have been minimal.
Jamal Hoballah, MD, a UI professor of vascular surgery, says the conventional approach to such injuries involves opening the chest to access the aortic injury: "The surgeon would have to replace that part of the aorta and sew a new prosthetic graft at the site."
However, the 79-year-old Freese had complicating factors that made conventional surgery a poor option: scar tissue from previous heart surgery and the need for blood thinner during surgery, which would have caused excessive bleeding. Furthermore, his overall medical condition, including the head injury, made him a poor candidate to tolerate this type of aortic replacement procedure.
"Our multidisciplinary team, which included cardiothoracic surgeons, carefully reviewed the options," Hoballah says. "We decided the best solution was to perform a minimally invasive thoracic endograft procedure (an endograft is a stent covered with fabric placed inside an artery to take pressure off an aneurysm or repair a damaged wall)."
During the procedure, the surgical team, which included vascular and cardiac surgeons, made a 3-inch incision in the groin, where they inserted a catheter containing the stent, which was threaded through the femoral artery into the thoracic aorta.
"It was our first thoracic endograft for a traumatic disruption of the aorta, and everything went very well," Hoballah says. "Mr. Freese was then cared for in the UI Burn Treatment Center (which specializes in treating patients with traumatic injuries)."
Freese's recovery in the weeks after surgery resulted in increasing physical strength and a gradual return of memory. He returned home on Jan. 15, 2007--one month after the accident--to complete a two-month period of rehabilitation at the Monticello Nursing and Rehabilitation Center.
"He's walking and thinking normally again," Lois says. "We're very pleased with all the people who took care of him. It's been quite a difficult time."
Asked if he's happy with the outcome, Freese says: "That's putting it mildly! I feel very blessed. It's taken a lot of miracles to get me to this point."
For more information about UI's services for patients with thoracic aneurysms, patients and family members may visit UI Heart and Vascular Center at www.uihealthcare.com/uiheartcare, or contact UI Health Access at 800-777-8442 or 319-384-8442
For consultation or referral, physicians should contact UI Consult.
--Michael Sondergard
Aortic aneurysm
A general term for any swelling of the aorta, usually caused by a weakness in the wall of the aorta at the site of bulge. While there might be discomfort, the greater risk involves rupture, which causes massive internal bleeding and, without prompt treatment, death. |
