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Physicians at Texas Health Denton Apply Minimally-Invasive Techniques to Repair Deadly Aneurysms
09/11/2012

DENTON, Texas — Ronald Largent, 70, was in Texas visiting an old friend when he began to experience intense lower back pain. It was the kind of pain he couldn’t ignore. After an ambulance was called, he was taken to a local hospital for evaluation. His personal physician in St. Louis had been monitoring his abdominal aortic aneurysm (AAA) for five years.

Raul Ortega, M.D., (left) used a minimally-invasive approach to help Ronald Largent.
Raul Ortega, M.D., (left) used a minimally-invasive approach to help Ronald Largent.
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“I had a feeling that my pain was being caused by the aneurysm,” said Largent. “And then, while I was lying on the exam table, I felt a “pop” in my back. I knew it wasn’t good.”

Recognizing that their patient needed a more specialized level of care than they could provide, and that their patient had only about 45-minutes before his burst aneurysm would take his life, Largent was transported by helicopter to Texas Health Presbyterian Hospital Denton. He was conscious during the entire flight.

“I was a paratrooper with the 101st Airborne. I served three years and got out in May. My buddies (who stayed in the military) were sent to Vietnam that June. I thought a lot about them while I was en route to the hospital,” said Largent.

He lost consciousness shortly after arriving at Texas Health Denton.

Abdominal aortic aneurysms (AAA), sometimes called triple A’s, are dangerous bulges in the aortic artery, the major pipeline that supplies blood to the lower half of the body. In an AAA, the walls of the artery are pushed out by blood pressure, making the artery bulge like a weak spot on a worn tire or like a balloon that’s had too much air pumped into it. When this happens, eventually the artery can rupture. Because of the large volume of blood that travels through the aorta, a rupture of the aneurysm can be deadly in a matter of minutes.

During the emergency transport, Raul Ortega, M.D., a vascular surgeon on the medical staff at Texas Health Denton, was notified of Largent’s impending arrival. Ortega, along with a highly trained vascular team, readied the operating room so that they could take immediate action.

“With cases like this one, time is of the essence. We must have our plan ready and we can’t hesitate, not even for a moment,” said Ortega. “The National Institutes of Health tell us that fewer than 40 percent of patients who experience a ruptured AAA survive. Of course, outcomes are much better when the condition is detected prior to rupture.”

Ortega used a minimally-invasive approach to help Largent. Using one small incision and a percutaneous (through the skin) procedure involving the insertion of a tiny wire into the leg artery and guiding it into the abdomen to the site of the aneurysm, allowed a stent graft to be deployed to give the artery new shape and strength. The aneurysm was then stabilized and there was no longer a threat of immediate rupture.

The traditional way to repair abdominal aortic aneurysms involves major surgery, with a long incision down the patient’s abdomen (belly). To access the aorta in one of these “open” surgeries, internal organs must be navigated and the patient’s intestines moved outside his body. By using a minimally invasive approach, patients usually heal faster; have better outcomes and experience less pain during recovery.

The endovascular procedure Ortega used, which is similar to the way stents are placed inside cardiac arteries to keep blood pumping to the heart muscle, was made even less invasive because of a new suturing technique. As surgeons remove the wire and sheaths that guide the stent insertion during the procedure, they tie the stitches outside the patient then slide the knot just below the skin surface, where the leg artery was accessed.

Largent has been home to St. Louis and then back to north Texas several times during the summer, but not necessarily for follow up appointments. A retired truck driver, he has a lot of living left to do.

“I’ve been doing a lot of walking and I’m almost back to 100 percent. Both my surgeon and the nursing staff at Texas Health Denton were excellent. These folks really know what they are doing,” said Largent.

About abdominal aortic aneurysms
Aneurysms can develop anywhere along the aorta, but most occur in the abdomen. Aneurysms that occur in the upper chest are called thoracic aortic aneurysms. Aortic aneurysms often grow slowly and usually without symptoms, making them difficult to detect. Some aneurysms will never rupture. Others expand at a faster rate, which increases the risk of rupture.

As an aortic aneurysm grows, symptoms may include:

  • A pulsating feeling near the navel
  • Tenderness or pain in the abdomen or chest
  • Back pain

Anyone age 60 and older who has risk factors for developing an aortic aneurysm should consider regular screening for the condition. Men ages 65 to 75 who have ever smoked should have a one-time screening for abdominal aortic aneurysm using abdominal ultrasound. Men age 60 and older with a family history of abdominal aortic aneurysm should also consider screening.

About Texas Health Presbyterian Hospital Denton
Texas Health Presbyterian Hospital Denton is a 255-bed acute-care, full-service hospital that has served North Texas and southern Oklahoma since 1987. The hospital’s services include: heart and vascular; a Level III neonatal intensive care unit; orthopedics and sports medicine; neck, spine and pain management; emergency medicine; an accredited sleep center; women’s services; and a weight loss surgery program that has been designated a Bariatric Surgery Center of Excellence. As one of the largest employers in Denton County, Texas Health Denton has more than 900 employees and more than 300 physicians on the medical staff practicing in more than 43 specialties. Texas Health Denton is an accredited chest pain center, and is certified by the Joint Commission as a Primary Stroke Center and designated by the State of Texas as a Primary Stroke Facility. Texas Health Denton is an affiliate of Texas Health Resources, one of the largest faith-based, nonprofit health care delivery systems in the United States.

For more information, call 1-877-THR-WELL, or visit TexasHealth.org/Denton.

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