A Ruptured Aneurysm in the Right Patient
Early last summer, Henrietta Bartecki felt the worst pain she’d ever known—a terrible piercing on the right side of her abdomen. “I wouldn’t wish it on a dog,” she says. The 84-year-old widow ended up at Hopkins, the hospital closest to her tiny row house. By the time she reached the emergency department, “Man, I was screamin’ and hollerin’,” she says.
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| Surgeon Bruce Perler used a new technique to save Henrietta Bartecki. |
Bartecki had suffered a ruptured abdominal aortic aneurysm, a condition so lethal that the massive internal bleeding kills half of victims before they even make it to the hospital. Only when the leaking blood happens to form a clot that seals the hole—thereby giving surgeons enough time to intervene—do patients make it through.
When Bruce Perler, director of vascular surgery, set eyes on Bartecki in the emergency department, he estimated her chances of surviving an open operation were less than 30 percent. Her age and underlying health problems—hypertension and heart disease—already put her behind the eight ball. Her body had also sustained a tremendous shock, and traditional surgery, releasing the clot to sew in a graft and repair the aneurysm, would cause her to lose more blood. “It’s about as difficult a surgical procedure as we do,” Perler says.Then it hit Perler that this woman might be a candidate for a new technology in which a graft is advanced up to the aneurysm through a small incision in the groin, then mesh-like stents are expanded to hold the graft in place. The technique had never been performed emergently here to fix a ruptured aneurysm. In the whole world, in fact, there had been only a few hundred such cases.
“You have to have the right patient with the right anatomy,” Perler explains, so Bartecki needed to remain stable long enough for him to get a CT scan, measure the size of her aneurysm, and make sure he had the right graft. “Turns out, we had one stent graft in house that was just the right size.”
Even after the minimally invasive surgery, Bartecki spent two weeks in the Hospital recovering, which convinced Perler that she probably would not have survived a traditional operation. Today, though, she’s back home, going out for walks and playing bingo with her “lady friends.”
“Oh, no, I don’t stay home!”
