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Accidental Fall Leads to Life-Saving Discovery of Bulging Blood Vessel

Abington Vascular Surgeon Repairs Life-threatening Aortic Aneurysm Using Minimally Invasive Procedure

Rick PizzoDuring their nightly leash walk last autumn, Rick Pizzo’s dog, Rex, lunged after a rabbit, flipping Rick to the ground. Rick landed on his back in excruciating pain, while Rex whimpered at his side, licking his face. The Lansdale resident said it was one of the luckiest nights of his life.

After the incident, Rick put off going to the doctor. Having experienced the same symptoms after an accident decades ago, he was convinced he had bruised his ribs and healing would come with time. A week later, Rick, 53, was still experiencing severe pain. He had trouble sleeping and his breathing was labored. Rick finally gave in to his wife, Caroline. She urged him to visit his doctor, who ordered X-rays and rest. Rick knew that even if the ribs were broken, they would have to heal on their own. He took it easy; put his rigorous, daily exercise routine on hold; and resumed work as a flooring salesman.

Fortunately, the results of the x-ray showed no sign of fracture; the ribs were bruised and Rick would need rest. There was more to the x-rays, however, which revealed a large mass in Rick’s chest that was not connected in anyway to his recent fall-related symptoms. “I was completely blindsided by the news,” said Rick.

The doctor ordered a CT scan, which showed Rick had a thoracic aortic aneurysm (TAA) – a bulging of a weakened area of the upper part of the aorta, which is the body’s main artery. “It was pure luck they found the aneurysm,” said Rick. “if I hadn’t fallen that night, I never would have known about it. God and Rex were looking out for me. I learned I had been walking around – probably for years – with a bulging blood vessel in my chest. And it had grown to the point where it could burst at any time, most likely killing me.”

“As was the case for Rick, frequently, these types of aneurysms are discovered incidentally, while we are testing for something else,” said Danielle Pineda, MD, a vascular surgeon at Abington – Jefferson Health. Rick’s aneurysm measured 9 centimeters – nearly twice the size for which doctors recommend surgical repair. The risk for rupture or leakage is high once the aneurysm reaches 5 centimeters. Thoracic aortic aneurysms affect nearly 15,000 people in the united states each year. Generally, there are no signs or symptoms until the blood vessel bursts or tears, causing massive internal bleeding. “If a TAA ruptures, the mortality rate is greater than 50 percent.”

TAA

Large aneurysm arising
from the thoracic aorta

Rick had consulted Dr. Pineda at his physician’s recommendation and learned he was fortunate to be a candidate for a procedure known as thoracic endovascular aortic repair (TEVAR), which results in less physical stress and postoperative pain, and has a significantly shorter recovery period than traditional open-chest surgery.

Not everyone qualifies for TEVAR. Surgeons consider a number of factors when considering an open-chest or endovascular procedure, including the patient’s age, height and overall health; and the location, size and growth rate of the aneurysm.

Stent Graft

Stent graft in aorta
has caused occlusion
of the aneurysm

With his risk for rupture being high, Rick decided to proceed with an aortic stent graft operation as soon as possible. Just five days later, he was undergoing surgery in the skilled hands of Dr. Pineda and the surgical team in Abington’s sophisticated hybrid operating room.

To perform the procedure, Dr. Pineda made a tiny incision in Rick’s groin and used live X-ray technology to guide a catheter (a thin, hollow tube) through an artery to the site of the aneurysm in Rick’s chest. Through the catheter, she threaded a stent graft – a tube comprised of fabric reinforced by metal mesh – and attached it to the healthy parts of the artery above and below the aneurysm. Once the stent graft was in place and sealed, blood flowed through it, removing pressure from the surrounding aneurysm. Rick spent only one night in the hospital following his endovascular procedure, and returned to work a week later. He will follow up with Dr. Pineda routinely and undergo scheduled CT scans to monitor the graft.

Dr. Pineda explained everything very clearly and I was so confident in her and the entire team at Abington Hospital, I went into surgery with no fear,” said Rick. “Every person I came in contact with – nurses, doctors, housekeepers, food service folks – made an effort to make a personal connection with me. My care was top-notch.”

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